PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
Added 10/21/08
This is approved country specific PHE activity. Reprogramming is taking place to reflect change of Prime
Partner and Agency. Prime Partner is changed from To Be Determined to the Ethiopian Public Health
Association (EPHA) and agecy is changed fro State Department/OGAC to HHS/CDC.There will be no
change in emphasis, coverage area or target population.
The narrative of this activity remains the same. The only change will be that it was initially proposed as a
potential multi country protocol, but now, it is approved and will be undertaken as a country specific Public
Health Evaluation (PHE).
-------------------
PARTNER: Johns Hopkins University Bloomberg School of Public Health
Title
Identifying Groups with Poor Access to ART - potential Multi Country Protocol
Time and Money Summary:
Expected timeframe: 1 year, Total projected budget: $ 100,000
Local Co-Investigators: In Ethiopia, this study would be carried out by Johns Hopkins University (JHU)
Technical Support For The Ethiopia HIV/AIDS ART Initiative (TSEHAI) as a supplement to the JHU/TSEHAI
Advanced Clinical Monitoring (ACM) of ART in Ethiopia project, which is governed by a Memorandum of
Understanding with 10 Ethiopian institutions.
Primary evaluation question:
What patient factors affect whether patients initially enroll in the national ART program at an early or late
clinical stage of disease?
Project Description:
This case-control study is designed to identify target groups with comparatively poor access to enrollment in
a country's national ART program. It takes advantage of the insight that hospitalizations for conditions
amenable to primary care can be used as indicators of poor access to primary care. The relationship of
access to demographic characteristics, risk behaviors, attitudes to HIV and pathways to care will be
assessed.
Programmatic importance:
Both WHO and the Institute of Medicine report evaluating PEPFAR have expressed great concern about
possible inequities in access to care for women, rural populations, the poor, and other vulnerable groups.
WHO said in April 2007 that in monitoring progress toward universal access to HIV/AIDS prevention,
treatment and care, "Higher priority must be given to promoting, monitoring and evaluating equity in access
to services. …special studies will be needed in order to help to understand uptake patterns, factors which
inhibit or facilitate access to services for men and women, and potential differences in clinical outcomes."
After these factors are identified, interventions targeting them can be developed.
Population of interest:
This study uses case-control methodology to compare the characteristics of three groups: (1) Cases:
Patients with "late" access to care, who are admitted to hospital wards with HIV disease without ever having
received outpatient HIV care. (2) Control group A: patients who enroll in ART "timely," become eligible due
to a CD4<200 without ever having developed WHO stage III or IV clinical disease, and (3) Control group B:
patients with "intermediate" access, who enroll in ART after developing WHO stage III or IV conditions but
without ever having been hospitalized for HIV disease. Cases will be sampled from hospital ward logs.
Controls will be identified from ART clinic registers. They will be matched by facility and month of case
admission matched to month of control ART enrollment. 900 participants per country will be selected: 180
cases, 360 from control group A and 360 from control group B.
Methods:
The exposures shown in the table below will be abstracted from hospital and clinic records. Not all
exposures may be available for analysis in all countries or sites; they are available in Ethiopian nationally
standard ART clinic forms, and staff at ACM sites ensures that these data elements are captured. A subset
may be available in hospital charts. Conditional and ordinal logistic regression techniques will be used to
assess the association between each exposure and different levels of access to ART. To assess the direct
effect of demographic factors on access, it is necessary to control for the fact that different demographic
groups (e.g. men and women) may have been infected with HIV at different periods of the HIV epidemic in a
given country. Therefore multivariate regressions will be conducted including and excluding proxy variables
for length of infection: CD4 count and time since first positive HIV test.
Exposures:
Demographic: Gender, age, urban/rural residence, income/poverty status, level of education, religion,
employment, marital status, household composition
Behavior: Sex risk behavior, drug use behavior
Attitudes: Disclosure of HIV status, perceived stigma, depression, attitudes toward ART
Pathways to care: referral source, HIV support group member
Sample size calculation:
Activity Narrative: The sample size was based on the number of cases required to detect a 15% point difference between
cases and controls with rural residence (Power= 0.9, alpha=0.05, 1 case: 2 controls). Based on these
calculations, the total number of cases required was rounded up to 180. They would be matched at a ratio
of 1 case: 2 timely access controls: 2 intermediate access controls; therefore the number in each control
group was set at 360 and the total number of participants in Ethiopia at 900. The cases would be divided
evenly among participating facilities that serve both rural and urban patients. If the ACM sites are used for
this study in Ethiopia, there are 5 such sites; 36 cases, 72 timely access controls and 72 intermediate
access controls would be enrolled per site.
Dissemination plan:
The study will be cleared by CDC and the ACM steering committee for publication in professional journals.
Budget justification:
Ethiopian personnel - $ 24,400
Statistical support - $ 12,000
International travel - $ 7,000
Domestic travel - $ 2,250
Computers - $4,000
Supplies/Communications - $5,000
Total - $54,650
Total including indirect costs - $67,470
New/Continuing Activity: Continuing Activity
Continuing Activity: 18792
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
18792 18792.08 HHS/Centers for Johns Hopkins 7485 3787.08 Support for $100,000
Disease Control & University program
Prevention Bloomberg School implementation
of Public Health
through US-
based
universities in
the FDRE
Table 3.3.11:
