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.
Years of mechanism: 2008 2009
improving Diagnosis of TB in HIV Positive Persons & Introducing Liquid Culture Diagnosis
ACTIVITY UNCHANGED FROM FY2008 (no Update needed)
Tuberculosis (TB) is the most common cause of death among HIV-infected persons, but diagnosis of TB in
these persons is difficult. In addition, the global burden of drug-resistant TB in HIV-infected persons is
increasing and can only be addressed through accurate diagnosis of drug-resistant TB. Improving the
diagnosis of TB in HIV-positive persons was one of Ethiopia's emphasis areas in FY07. Using plus-up
funding from 2007, the Ethiopian Health and Nutrition Research Institute (EHNRI) sought to increase TB
culture capacity in five regional laboratories through renovations of existing facilities, procurement of
appropriate supplies, training of regional staff, and ensuring quality assurance and control. In FY08, EHNRI
will build on that work by implementing liquid TB culture, which is the most rapid and sensitive method for
TB diagnosis, and drug-susceptibility testing at these five regional laboratories. This will maximize the
sensitivity and speed of TB diagnosis and the identification of drug-resistant TB.
EHNRI will work with the Federal Ministry of Health (MOH), regional health bureaus (RHB), and PEPFAR
partners to realize these activities. Activities will include:
1) Site assessments
2) Renovation of existing laboratory facilities for appropriate biosafety precautions
3) Procurement of equipment and reagents
4) Training of regional staff
5) Implementation of liquid-culture diagnosis
6) Transport of specimens from health facilities to regional laboratories
7) Internal and external quality assurance
8) Provision of technical assistance
9) Appropriate monitoring and evaluation
In addition, the national reference laboratory needs support for its work with a network of regional
laboratories to enhance TB culture-capacity. To do this, an additional three staff members will need to be
hired by EHNRI, and their staff should be re-trained in liquid-culture techniques. A study tour that would
bring EHNRI staff to a laboratory with such activities is under consideration.
New/Continuing Activity: Continuing Activity
Continuing Activity: 16652
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
16652 12314.08 HHS/Centers for Ethiopian Health 7490 673.08 Expansion of $1,634,280
Disease Control & and Nutrition HIV/AIDS/STI/T
Prevention Research Institute B Surveillance
and Laboratory
Activities in the
FDRE
12314 12314.07 HHS/Centers for Ethiopian Health 5493 673.07 $1,330,000
Disease Control & and Nutrition
Prevention Research Institute
Emphasis Areas
Construction/Renovation
Health-related Wraparound Programs
* TB
Military Populations
Human Capacity Development
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.12:
Specimen Management and Referral Services
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
Ethiopia has four-tier public health laboratory system and has started implementation of Maputo consensus
meeting recommendations. EHNRI will lead the coordinated effort of sample transfer in the tier system with
emphasis on integration and capacity development for logistic system and smooth coordination and
collaboration between the testing and referring sites
COP 08 NARRATIVE:
Ethiopia has four a tier public health laboratory system and has started implementing the Maputo
consensus meeting recommendations. Even though it is weak, the laboratories across the tier have been
linked with the specimen referral system. Most health facilities are in the process of being equipped with
basic equipments. Hence referral-testing services are extremely important. In order to offer laboratory-
monitoring services (CD4, and other basic tests) for PLWHA, including children and pregnant women, a
sample referral system was established. Clinical samples are transported from outlying clinics to referral
laboratories where equipment and human resources are available. To enroll patients and monitor the
efficacy of ART, basic and advanced laboratory tests are required: CD4, biochemical and hematology
profiles at specified period of time as per the guidelines for ARV use in Ethiopia. However, most of the
health centers and some peripheral hospitals involved in ART implementation do not have the capacity to
support laboratory services.
The sample referral system in the interim period was supported by University partners. This activity later
has been supported by Ethiopian Health and Nutrition Research Institute (EHNRI). EHNRI with the support
of partners has developed Standard Operating Procedures (SOPs) and guidelines for the specimen
transport and referral testing services nationwide. EHNRI with the Regional Health Bureau/Regional
Reference laboratories has been leading the effort of referral services for peripheral hospitals and health
centers. In addtion, EHNRI provided techncial assistance in quantification and purchasing of laboratory
supplies, including diagnosis and monitoring reagents and distributed them to laboratories for diagnostic
and monitoring tests requested through referral at the facility-based levels. Nonetheless, specimen
management and referrals are still weak and require a reliable courier system as well as strengthened
coordination and communication across the referring labs or sites and testing laboratories.
In FY09, EHNRI will lead the nationwide coordinated effort of specimen referral for CD4, chemistry,
hematology, viral load, and DNA PCR-based early infant diagnosis. EHNRI, with the regional laboratories,
will work to strengthen logistic system for improving TB diagnosis; to support EQA for hospital and health
center laboratories and to ensure ownership and sustainability of the program. EHNRI will procure safety
materials, cold boxes, thermometers and related supplies to address safety and quality for sample referral
testing. As a continuation of COP08 activity, specific training on specimen management, transport, and
storage, recording and reporting will be provided. The specimen management, transport, and referral
system will be followed using the strict guidelines and Standard Operating Procedures (SOP) developed by
EHNRI. Additional SOP and guides will be distributed to the laboratories that are newly initiating the referral
testing services. The National HIV Laboratory will continue providing referral diagnostic services for
HIV/TB/STI drug resistance and EQA including HIV DNA PCR for infant diagnosis, CD4, hematology, and
chemistry tests.
The logistic support for referral testing will be supported through courier system. Within this system non-
laboratory personnel will be trained on sample storage, transportation and safety during sample
transportation. This includes transport of specimens and results to and from health centers to the next level
hospital or regional laboratories and/or to National HIV Reference laboratory. PEPFAR provide technical
support to EHNRI and regional laboratories for effective coordination and implementation of the referral
testing services.
The lab tests done at the hospital laboratories are returned within two days. It is anticipated that the turn-
around time from health center to test sites and back to the clinic will be 2-3 additional days. For better
management of sample transfer and to deliver appropriate results timely, patient tracking numbers and
tracking sheets will be used during receipt and delivery. Samples are collected in test-specific containers
that already contain necessary preparation reagents. After the samples are collected, the laboratory request
form are included in the collection container, sample placed in a cooler, and transported. All the regular
samples are transported in cool gel packs. In order to maintain integrity of samples, the local samples are
delivered within a day using cargo or courier mode.
The facilities that send the sample will work very closely and communicate regularly with the facilities testing
the samples. Commonly agreed upon sample and result delivery schedule will be developed and
coordinated regularly. More than 320 health centers and 25 peripheral hospitals will be linked to the nearby
referral hospitals or regional laboratories for ART monitoring. More than 200 health centers and hospitals
will provide early infant diagnosis through sample referrals to 7 testing sites including the national reference
laboratory.
Continuing Activity: 16653
16653 10612.08 HHS/Centers for Ethiopian Health 7490 673.08 Expansion of $1,900,000
10612 10612.07 HHS/Centers for Ethiopian Health 5493 673.07 $1,565,550
Table 3.3.16:
Expansion of Laboratory Information System
ACTIVITY UNCHANGED FROM FY2008
Information, in the form of test results and clinical investigation, is the primary product of the clinical
laboratory. To meet the needs of the laboratory's consumers, it is essential that this information is accurate,
available, and timely. Laboratory Information System (LIS) supports workflow and information flow in all
steps of the laboratory testing process, including patient registration, test ordering, sample collection,
testing, and reporting. LIS enables laboratories to manage their data, to maintain quality, and to improve
efficiency. In developing countries, almost all laboratories meet these needs with a manual information
system, but the scale-up of ART and monitoring programs forces these laboratories to implement a
computer-based LIS to handle the ever-increasing volume of data that they receive and report out. There
are a number of challenges as, piloting and implementing of LIS continues, some of which include the lack
of network availability at different facilities and difficulty in finding facilities that can support the system.
Laboratory Information System (LIS) support has been piloted and the system is functioning at national and
Regional reference laboratories and selected hospital laboratories. Prior to this several trainings were
provided to laboratory technologists and IT managers who use and support the software, respectively.
Strengthening and expansion of activities started in FY08 and will be continued in FY09 at EHNRI and 8
other facilities. Electronic-based LIS will be strengthened to support operations and quality-assurance
activities at the Ethiopian Health and Nutrition Research Institute (EHNRI), regional laboratories, and
PEPFAR-supported ART hospital laboratories. LIS will enable sites to have efficient data and report
exchanges. To achieve this, the following activities will occur (1) procure additional LIS software site and
accessories for 8 sites; (2) procure barcode printers, barcode readers, and barcode printer paper; (3)
provide refresher training to laboratory technicians and receptionists in LIS; (4) procure computers and
accessories; (5) support peer-to-peer network for regional and hospital laboratories including broadband
internet, networking and cabling; (6); support operational cost (7) provide technical and logistic costs; and
(8) local human capacity development.
The planned activities will also include strengthening the paper based LIS in all facilities especially in those
sites where electronic LIS is not established. EHNRI will coordinate and closely work with regional
laboratories, CDC and Association of Public Health Laboratories (APHL).
Continuing Activity: 17828
17828 17828.08 HHS/Centers for Ethiopian Health 7490 673.08 Expansion of $350,000
Equipment Maintenance and Technical Support for Laboratory Services
In FY09, EHNRI will implement the Maputo Declaration on strengthening of laboratory systems with
emphasis on equipment standardization and service contracts for equipments at various levels of the tiered
system. EHNRI will consolidate equipment preventative and curative maintenance mechanism of bundling
with manufacturers. EHNRI will develop a sustainable national system of preventative and curative
maintenance across the tiered laboratory network.
The Ethiopian Health and Nutrition Research Institute (EHNRI) is the technical arm of the Ministry of Health
(MOH) responsible for providing guidance to laboratory services. EHNRI is the lead institution in
coordinating laboratory programs in Ethiopia with a strategic national plan to support integrated disease
laboratory services. Preventive and curative equipment maintenance constitutes a key component of the
national laboratory strategic plan.
EHNRI provided technical assistance to strengthen laboratory quality service at all levels of the laboratory
network: technical assistance including preventive and curative maintenance services of equipment,
inventory laboratory management and on-site practical trainings, follow up and supportive supervision were
provided to all ART hospital laboratories. Equipment preventative maintenance and curative maintenance
play a critical role in ensuring quality laboratory testing and uninterrupted service delivery as ART services
are rolled out.
In FY08, preventive and curative maintenance service was provided for major laboratory equipment at all
expanded 131 hospitals, 240 health centers and ten regional laboratories. Preventive maintenance and
calibration of major equipments including centrifuges, FACS counts, hematology and chemistry analyzers
were provided quarterly at all sites where the equipments were installed. Broken machines repaired and
spare parts changed to prevent/minimize service interruption. Technical assistance included maintenance
and troubleshooting of laboratory equipments (fridges, freezers, microscopes, incubators, autoclaves,
chemistry analyzers, hematology analyzers and FACS count machines) at all ART hospitals and health
centers. PEPFAR also provided technical assistance in developing standard operating procedures for use
during instrument operation, developing preventative maintenance and maintenance logs, training of
laboratory personnel and monitoring them on how to perform preventative maintenance. There are
challenges in the establishment and implementation of a sustainable preventive and curative maintenance
system across the country. Some of these challenges include training, availability of spare parts and
protracted negotiations with vendors on establishing maintenance contracts. The establishment of
maintenance contract is imperative for major and sensitive equipment including thermocycler, centrifuges,
ELISA washer, ELISA reader, centrifuges, chemistry and hematology analyzers, FACS count, FACS
calibur, freezers, refrigerators, incubators, biosafety cabinet, microscopes, biosafety cabinets. EHNRI has
encountered difficulties setting up curative maintenance contracts with major manufacturers of equipments
resulting to a protracted process. EHNRI is pursuing a maintenance mechanism (through SCMS) termed
"Bundling" with one of the manufacturers of an instrument routinely used in Ethiopia. Bundling is the
agreement whereby prices of reagents are negotiated with a manufacturer of equipment to include the
required maintenance of that equipment. Bundling has the added benefit in that it compels the vendor to
maintain equipment in order to consume reagents supplied by vendor.
EHNRI is also committed to the implementation of the "Maputo Declaration on Strengthening of Laboratory
Systems" which emphasizes list of supplies and tests needed at each level of an integrated laboratory
network, standardization of laboratory equipment at each level of the tiered laboratory and considerations to
guide maintenance and service contracts for equipment at various levels of the laboratory network.
During FY09, all the above mentioned activities will continue and be expanded to additional new sites with
emphasis on developing a sustainable national system on preventive and curative maintenance. This will
entail an equipment maintenance policy that addresses national reference, as well as regional, district and
health centers laboratories. Such a policy will inform equipment maintenance which actually begins with the
selection and acquisition of suitable testing platforms as well as equipment inventory. Support will be
provided for purchase of critical spare parts for national and regional laboratories and establishment of the
Equipment Maintenance Center at EHNRI. The technical support will continue and expand to new sites
initiating ART services including health center laboratories. Technical assistance including curative and
preventive maintenance of equipment, functional and structural organization of laboratory, on the job
training in test procedures, specimen management, data recording, and reporting, inventory laboratory
management, on-site practical trainings and follow up and supportive supervision will be provided in
collaboration with other partners. Technical support includes inventory and laboratory management for
maintenance of clinical laboratory services and ensures laboratory standards are implemented at all ART
hospital, health center and VCT laboratories. Review of existing laboratory operating procedures, recording
and reporting at facility levels will be performed. Training of required number of engineers for preventive and
curative maintenance of equipment at the national reference as well as regional, district and health centers
laboratories will be emphasized. Engineers will be trained such that they will be able to identify equipment
fault for appropriate action to be taken as well as perform calibration of common laboratory equipment such
as thermometers, timers, pipettes. Also ensuring proper mechanisms for reporting of damaged equipment
to regional and reference laboratories with proper documentation is in place. Ensuring equipment
maintenance contracts are in place with manufacturers or their local representatives with periodic evaluation
of the service they provide. Support of the above activities will enable a sustainable preventative and
curative maintenance system that addresses an integrated laboratory service for equipment maintenance,
builds local capacity and ensure accurate, reliable and reproducible results are provided to client.
Continuing Activity: 16655
16655 10607.08 HHS/Centers for Ethiopian Health 7490 673.08 Expansion of $1,500,000
10607 10607.07 HHS/Centers for Ethiopian Health 5493 673.07 $1,021,300
Laboratory Quality Assurance Program
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS: (insert a maximum of 5000 character
narrative here):
EHNRI will make the QA program comprehensive and include TB and Malaria smear microcopy, DNA-PCR
based early infant diagnosis and viral load assays for advanced clinical monitoring. In addition to the
National External Quality Assessment Schemes (NEQAS), EHNRI will support and strengthen Regional
Quality Assessment Schemes (REQAS). EHNRI will also ensure the implementation of Maputo declaration.
The Ethiopian Health and Nutrition Research Institute (EHNRI) is the technical arm of the Ethiopian Ministry
of Health (MOH) responsible for providing guidance to laboratory services. It is the lead institution in
coordinating laboratory programs in Ethiopia, and has a national plan to support HIV laboratory services. It
also serves as the National Reference Laboratory for the country.
In 2008, EHNRI provided national leadership in strategic planning, laboratory policies, guidelines, standard
operating procedures (SOPs), training, integrated services and testing. The activities are focused on quality
assurance programs, training, referral diagnosis, establishing tiered laboratory services, and referral
linkages. EHNRI supported improvement of laboratory services for the National HIV surveillance program,
development of standard training curricula, training of laboratory personnel in HIV testing and treatment
monitoring, and evaluating of diagnostic technologies. The DNA PCR-based early infant diagnosis of HIV is
expanded to six regional reference laboratories. Regional reference testing services were initiated. EHNRI
worked closely with CDC Ethiopia to maximize support, especially to implement the national quality
assurance program, including training-of-trainers (TOT) program. EHNRI also implemented laboratory
quality assurance process, including the expansion of National External Quality Assurance Scheme
program. However, several challenges still exist in ensuring a sustainable laboratory quality assurance
program including expansion of an integrated EQA programs to more testing sites, implementation of the
WHO checklist or guidelines on accreditation for the different tiered laboratory levels and standardization of
tests and testing platforms across the laboratory network.
The FY09 activity plan will focus mainly on the continuation and expansion of FY08 programmatic areas:
quality assurance programs, training, diagnosis, and strengthening of tiered laboratory services. EHNRI will
continue supporting the strengthening of laboratory standards and will work closely with the regional
laboratories as sub-partners. EHNRI will ensure the implementation of quality-assured tiered laboratory
services from health center to district hospitals, from district to zonal/regional hospitals, and then to
reference laboratories. Regional laboratories will support routine quality assurance and control plan for
voluntary counseling and testing (VCT), diagnosis of opportunistic infections (OI), and laboratory monitoring
of ART at hospitals and health centers.
In FY09, the External Quality Assurance Program established in 52 regional and hospital sites will be
strengthened and the program will be expanded to 131 health networks. In addition to the current tests
(hematology, chemistry, CD4, HIV serology, and molecular diagnostics, DNA-PCR based early infant
diagnosis and viral load), TB and malaria smear microscopy, STI and OI diagnosis will be included in order
to make EQA program comprehensive. EHNRI in collaboration with the regional laboratories will support
strengthening of the Regional External Quality Assessment Schemes (REQAS) including preparation of
proficiency testing (PT) panels for rapid HIV testing. The dried tube spot (DTS) method will be implemented
in all facilities that are enrolled in HIV serology EQA program.
Quality control materials (proficiency panel) will be distributed to the sites thrice annually. External quality
assessment, including site visit reports and proficiency panel test results will be regularly communicated to
sites. EHNRI will develop guidance and will put a sustainable system in place for logistic management of
EQA including but not limited to panel distribution, collection of results and dissemination.
EHNRI, in partnership with CDC and PEPFAR implementing partners, will continue its training activities,
place higher emphasis on TOT of laboratory personnel in: HIV rapid diagnosis; monitoring of ARV therapy;
maintenance of laboratory equipment; laboratory quality management systems; tuberculosis (TB) and OI
diagnosis; and HIV surveillance. EHNRI will ensure that standardized training modules are used for regional
and site-level training programs supported by Regional Reference laboratories and implementing partners
As part of improving quality of services, EHNRI will strengthen the laboratory monitoring and evaluation
activities. A monitoring and evaluation system will be implemented for the effectiveness of EQA, referral
testing and in-service training and continuous quality improvement process in general. EHNRI, in
collaboration with CDC, will strengthen the laboratory monitoring and evaluation activities including, revising
and standardizing recording and reporting forms, registers/logbooks and reporting forms and ensuring
implementation at all sites.
With technical assistance from PEFPAR Ethiopia, EHNRI will support and ensure that National Reference
laboratory is accredited and will prepare regional and hospital laboratories for accreditation. EHNRI will
ensure the implementation of the Maputo declaration: standardization of testing platforms; standardization
of testing across the tier; and integration of laboratory services. EHNRI will closely work and coordinate
activities with regional laboratories, CDC, and implementing partners to strengthen the laboratory system as
per the national laboratory plan and to improve the standards of clinical laboratories. Additionally, EHNRI
will work with partners to implement the WHO checklist/guidelines for accreditation of regional, district and
health center laboratories.
EHNRI will continue supporting eight regional laboratories (Addis Ababa, Adama, Nekmet, Bahir-Dar,
Dessie, Awassa, Mekele and Harar) and the regional hospital laboratories that serve as reference
laboratories in emerging regional states to strengthen the overall quality of laboratory services. EHNRI will
disburse up to 50% of the total budget to laboratories for regional implementation of EQA program regional
training, site supervision and monitoring services and regional capacity development including program
management support. Regional laboratories will continue reporting their activities to EHNRI quarterly.
Activity Narrative: EHNRI will monitor and evaluate the performance of the sub-partners and will ensure regional capacity
developed for long term sustainability
Continuing Activity: 16654
16654 5610.08 HHS/Centers for Ethiopian Health 7490 673.08 Expansion of $2,100,000
10459 5610.07 HHS/Centers for Ethiopian Health 5493 673.07 $1,500,000
5610 5610.06 HHS/Centers for Ethiopian Health 3771 673.06 $800,000
Supporting the National HIV/AIDS/STI Surveillance System
The Ethiopian Health and Nutrition Research Institute (EHNRI) will continue to serve as the national lead
responsible for all HIV and related surveillance, and will continue to coordinate and finance the regional
Health Bureau's to help them support the related activities. In COP08, EHNRI produced and disseminated
the 7TH AIDS in Ethiopia report that was prepared mainly based on the results of the 2007 round of ANC
based HIV surveillance that involved the participation of ANC providing centers located in 108 of the health
facilities in the country. Support was also provided to all the preparatory works for the 2009 round of ANC
based HIV surveillance including for the selection of additional sites, capacity assessment of existing sites
and the conduct of national and regional review and planning meetings. Guidelines were developed,
finalized, and piloted for TB/HIV and HIV surveillance among blood donors and among commercial sex
workers. Sites for the conduct of TB/HIV and HIV surveillance among blood donors were selected by the
close collaboration between and among EHNRI regional health bureaus and the Ethiopian Red Cross
Society.
Data collection for the 2009 round ANC-based, sentinel- HIV surveillance activities will be supported in all
108 existing sites. Additional rural sites will be identified to increase the representativeness of the data and
assist in producing more valid local HIV estimates and improve the data quality. Over 1000 health workers
drawn from all sentinel sites for the ANC based HIV surveillance will be trained through regional trainers
that will be trained as trainers of trainee (TOT) at the national level. Support will also be continued to other
surveillance activities including: data collection, sample transport, provision of test kits, and other
supplies/equipments to be used by sites. Support will also be provided for supervisory visits and national
and regional review workshops. Dissemination of the ANC based HIV surveillance findings will also be
supported by PEPFAR.
]Support for non ANC-based HIV surveillance systems including TB/HIV surveillance and HIV surveillance
among blood donors will be continued. Activities related to review of the manuals; provision of relevant
trainings, data collection, processing and dissemination will be supported.
Preliminary findings of a study that was conducted to look at the prevalence of HIV and STIs and associated
risk behaviors among Most at Risk Population (MARPs) in Amhara region (official results to be released by
Amhara Health Bureau and HAPCO soon) has shown that some locally relevant MARPs may be driving the
HIV epidemic in the region. The importance of such surveillance programs/studies is now becoming
increasingly important. This is so because the low level generalized HIV epidemic in Ethiopia is more likely
to be driven by factors among locally relevant MARPs. The information currently available on MARPS is
very limited. As the trends of infection and behaviors in these population groups need to be more reliably
and consistently estimated, PEPFAR Ethiopia will continue its support for the design and implementation of
surveillance systems that consistently generate, analyze, and disseminate information that can be used for
making programmatic and policy decisions. In FY09, surveillance systems that monitor levels of HIV
infection and risk behaviors among commercial sex workers will be strengthened and implemented.
Moreover, surveillance systems that monitor levels of HIV infection and risk behaviors among mobile
population and uniformed services will be developed and piloted.
EHNRI will also undertake an HIV surveillance activity (BED assay) to estimate the extent of new HIV
infections in the country. Appropriate protocols related to this will be developed and stored blood samples
collected in previous ANC based HIV surveillance rounds as well as those collected in the 2009 round will
be used for the testing. The results of this assay will help to corroborate the data from other HIV
surveillance sources and to identify trends in new HIV infections.
PEPFAR Ethiopia will also support EHNRI to build the capacity of regions for undertaking surveillance
activities and enable them to better understand HIV surveillance data for decision making. Hence training of
regional and central staff in electronic data processing using EPI info, GIS and other analysis softwares will
be provided. Key surveillance staff will also participate in experience sharing workshops and trainings
abroad and in country to address the challenges and share best practices and lessons learned. (Eight staff
for abroad and 15-20 in country experience sharing events).
COP08 NARRATIVE
The Federal Ministry of Health (MOH) began work on strengthening and supporting the National
HIV/AIDS/STI (sexually transmitted infections) Surveillance system in 2002. Activities have been ongoing;
however, implementation of activities was slowed in the second half of FY06 and first quarter of FY07 due
to organizational changes at the Ministry, at which time the responsibility for implementing and coordinating
HIV/AIDS/STI/TB (tuberculosis) surveillance was given to the Ethiopian Health and Nutrition Institute
(EHNRI). Since then, PEPFAR Ethiopia has been heavily involved in supporting EHNRI in the facilitation
and implementation of most surveillance activities; however, recently EHNRI reorganized itself and has
been better able to handle these activities.
Funds from FY07 have been used for building the capacities of the EHNRI and regional health bureaus
(RHB) to enable them to extend their support to zonal health departments (ZHD), district health desks, and
health facilities that are directly involved and benefiting from HIV/AIDS, TB/ HIV and STI surveillance
programs. Moreover, in FY07, EHNRI, with PEPFAR Ethiopia funding, extended support to RHB to allow
them to support 19 additional health facilities as sites for antenatal clinic (ANC)-based HIV surveillance.
EHNRI will train site staff in the collection, compilation, and reporting of HIV case surveillance data.
IN FY07, communication between and among all the surveillance partners was also enhanced. The
capacity of RHB to provide supportive supervision to all the health facilities involved in surveillance activities
was strengthened. EHNRI, in collaboration with CDC and other relevant partners, also provided support to
RHB to conduct their annual surveillance planning and review meetings with their respective surveillance-
site staff.
RHB, ZHD, district health desks, and health facilities were all supported through EHNRI in their preparations
Activity Narrative: for the planning and execution of the 2007 National HIV/AIDS/STI surveillance activities. EHNRI provided
them with technical guidance in the selection of staff for trainings, selection and preparation of sites, data
and sample collection, sample transportation, supportive supervision, and data management.
In FY08, preparatory work for the 2009 round of ANC-based, sentinel-site HIV surveillance activities will
commence. These activities include: assessment of sites; training of site-level ANC clinic and laboratory
staff; procurement of test kits and other supplies to be used by sites; and conduct of national and regional
review workshops.
PEPFAR will also support EHNRI in the initiation of several new types of surveillance, including HIV case,
STI, and TB/HIV surveillance. These programs will be implemented based on the guidelines developed by
EHNRI and PEPFAR over the past several years. EHNRI will work this year toward building its own capacity
and the capacity of regional laboratories, RHB, and health facilities involved in established and new
surveillance programs.
PEPFAR will also support EHNRI to build a national drug-resistance surveillance system. This will help
PEPFAR partners and the Government of Ethiopia to ensure the generation, analysis, and use of
information that can help develop and maintain effective strategies for ARV use. This activity will help to
produce the evidence to guide national the HIV/AIDS treatment plan and other measures to sustain the
effectiveness of ART among newly infected patients.
Finally, PEPFAR will also support EHNRI to design and implement an HIV/AIDS/STI surveillance system
using selected sites that provide HIV/AIDS/STI services to the most-at-risk populations (MARPs), especially
to commercial sex workers. This will help PEPFAR and the country to generate information that can be
used to guide HIV/AIDS/STI/ programs for MARPs, given the nature of the low-level, generalized HIV
epidemic in the country.
Continuing Activity: 18050
18050 18050.08 HHS/Centers for Ethiopian Health 7490 673.08 Expansion of $1,200,000
Estimated amount of funding that is planned for Human Capacity Development $150,000
Table 3.3.17:
