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
Technical Assistance to (TB) TB/HIV Prevention and Control in Ethiopia
ACTIVITY UNCHANGED FROM FY2008
Ethiopia ranks as seventh among the 22 highest burden tuberculosis (TB) countries in the world according
to the 2007 World Health Organization (WHO) Global TB Report. It is a leading cause of morbidity and
mortality, and since the disease strikes people during their economically productive years, it represents an
important development challenge. Pulmonary TB (PTB) is the third leading cause of hospital admission and
second leading cause of death. The estimated incidence of all forms of TB and smear-positive PTB (PTB+)
was 341 and 152 per 100,000 populations, respectively. The case detection rate of PTB+ cases was 33%,
less than half the global target of 70%. The burden of HIV/AIDS is also significant. Ethiopia's national adult
single-point HIV prevalence for 2007 was estimated at 2.1%, with a 7.7% urban rate and a 0.9% rural rate.
Adult (15-49 years) deaths due to AIDS accounts for about a quarter of all young adult deaths in the
country.
HIV prevalence studies among a representative group of TB patients have not been carried out. The HIV
prevalence among TB patients is considerably higher than in the general population, and varies by area.
According to data from hospitals and health facilities implementing TB/HIV collaborative activities, including
provider-initiated counselling and testing (PICT) of TB patients, 41-70% of TB patients are HIV-positive in
these sites.
The presence of extremely drug-resistant TB (XDR TB) and multidrug-resistant TB (MDR TB) raises the
concern of a future drug-resistant TB epidemic with restricted treatment options that will jeopardize the
major gains made in TB control and progress on reducing TB death among persons living with HIV/AIDS
(PLWH). WHO, in 2007, estimated that 420,000 new MDR TB cases occur each year as a result of
underinvestment in basic TB control, mismanagement of anti-TB drugs, transmission of drug-resistant
strains, problems in drug supplies, limited laboratory capacity, and the health workforce crisis.
The XDR TB and MDR TB situation in Ethiopia, and the extent to which they are related to HIV, is not well-
understood. With an estimated 5,102 MDR cases, Ethiopia ranks 12th in the world in terms of estimated
burden of MDR TB. In 2007, WHO estimated that among TB cases, 1.7% are MDR, and among previously
treated cases, 8% are MDR. The proportion of XDR is not known. Patients who fail to respond to first-line
treatment, or patients who relapse, are put on a re-treatment regimen. Although there is now country-wide
notification, there are a large number of patients who fail re-treatment. At St. Peters hospital in Addis Ababa
in 2007, of 130 MDR patients who failed re-treatment, 50% are resistant to four drugs and 35% to three. As
second-line treatment for these patients is not available in Ethiopia, they are consequently sent home,
risking infecting others. Only the few who can afford to buy drugs from abroad can be put on second-line
treatment. WHO estimates that Ethiopia will need to treat 343 MDR and 34 XDR TB patients in 2007, and
669 MDR patients and 61 XDR TB patients in 2008.
Ethiopia established a TB/HIV Advisory Committee (THAC) in 2002. THAC is comprised of key
stakeholders from the TB and HIV/AIDS programs, major multi- and bilateral donor organizations, research
institutions, academic institutions, and professional associations. THAC provides technical and policy
guidance to the Federal Ministry of Health (MOH) and other partners, and it established a TB/HIV technical
working group in 2007. The group chair alternates on an annual basis between the director of the National
TB and Leprosy Control Program (NTLCP) and the director of the HIV/AIDS Prevention and Control Office
(HAPCO).
Ethiopia's TB/HIV program has benefited recently from increased resources for TB/HIV collaborative
activities, with support from the USG, WHO, German Leprosy and TB Relief Association (GLRA), and Italian
Cooperation. In addition, in 2006 Ethiopia was awarded a Global Fund for AIDS, TB and Malaria (Global
Fund) Round 6 grant for TB. The TB/HIV collaborative activities have now expanded to almost 300 health
facilities in the country, including 98 USG-supported ART hospitals and nearly 200 USG-supported health
centers.
In FY07, the USG allocated $4,650,000 in "plus-up" funding for TB/HIV collaborative activities in Ethiopia,
but gaps still remain, especially in the presence of XDR and MDR TB. In July 2007, PEPFAR Ethiopia
asked a team from the USG TB Control Assistance Program (TBCAP) to undertake an assessment of
Ethiopia's collaborative activities. The review included review of the FY07 plus-up work plan, the Global
Fund's Round 6 proposal, and the 2007-2008 XDR and MDR TB Global Response Plan. The assessment
led to recommendations for the USG to focus on the following three key program components in FY08:
Component One: Strengthen TB/HIV management and leadership capacity:
1) Provide high-level technical and financial support to strengthen the national TB/HIV technical working
group, including supporting the finalization of the group's expected outputs, such as policy and guideline
development
2) Strengthen TB/HIV leadership, through long- and short-term technical assistance (TA), to 2-3 regional
health bureaus (RHB) with low rates of TB case-finding and treatment outcome, to improve TB/HIV
coordination, collaboration and supervision. The regions with the highest population and greatest need will
receive priority: Oromiya, Amhara, Southern Nations, Nationalities and Peoples regions (SNNPR), and
Addis Ababa. The four regions hold 85% of Ethiopia's total population.
3) Strengthen advocacy and communication on TB/HIV and XDR and MDR TB among policy makers and
healthcare management at different levels
4) Strengthen analytical and presentation skills among the TB staff for managerial and advocacy purposes
5) Increase the capacity of HIV/AIDS staff to undertake TB control at various levels of the health system, at
the national level and in 2-3 regions
Component Two: Strengthen XDR and MDR TB management, particularly of TB/HIV co- infected patients,
in line with the Global Response Plan 2007-2008. The USG will provide technical and financial support to
ensure effective and efficient implementation of the recommendations made by the MDR Task Force
Activity Narrative: established under the FY07 TBCAP work plan to assist Ethiopia in reaching the targets set by the Global
Plan to Stop TB, and the Global MDR TB and XDR TB Response Plan 2007-2008. The USG support will
build on the results of activities already planned in FY07 and will focus on:
1) Strengthening the management of MDR TB by training National TB Program (NTP) staff at national
regional levels through study tours, workshops, and conferences
2) Assisting the NTP with developing, disseminating, and beginning implementation of the MDR guidelines
on scaling up program management on XDR and MDR TB, particularly in co-infected patients. This would
include expanding MDR TB treatment sites and helping Ethiopia to obtain "Green Light Committee"
approval from the WHO/Geneva/Stop TB Program for approval and renovation of facilities at those sites.
3) Developing and beginning implementation of a national infection-control strategy, including training at all
levels
4) Strengthening the lab referral network between TB/HIV and XDR and MDR TB services
Component Three: Strengthen the monitoring and evaluation (M&E) system of TB/HIV and XDR and MDR
TB. The USG will provide technical assistance to strengthen the existing M&E system for TB/HIV and XDR
and MDR TB, as follows:
1) Provide technical assistance to TB/HIV, XDR and MDR TB M&E systems to strengthen analytical skills in
M&E and data collection and use among NTP staff at different levels, and to strengthen presentation skills
among the TB staff on data management
2) Assist the NTP to monitor the extent and effectiveness of cotrimoxazole preventive therapy in TB/HIV co-
infected patients
3) Build on the efforts of the Government of Ethiopia and other partners' efforts at the national level. Work
with all relevant stakeholders and implementing partners to train regional and district TB/HIV management
staff on data management, including analysis and use.
4) Where appropriate, procure computers for selected sites to strengthen site-level capacity to analyze and
use TB/HIV data.
The end result of this activity will be to decrease the burden of TB among people living with HIV/AIDS
(PLWH) and the general population through strengthening the TB/HIV collaborative initiative in Ethiopia.
The targeted population is PLWH and persons living with TB/HIV, TB suspects, and patients, the NTP staff
and healthcare workers at the lower levels. In addition, the general population will be an indirect beneficiary,
because the burden of infectious TB will be reduced.
Activities will be implemented in a collaborative and coordinated manner with other partners working on
control of TB and TB/HIV. The activity will leverage a wraparound of an estimated $500,000 in FY08 non-
PEPFAR USG TB funding for TB control and management, and will link closely with work by other PEPFAR
partners working on TB/HIV, including the Ethiopian Health and Nutrition Research Institute (ID 11157 and
12314), Abt Associates Private Sector Program (ID 10375), WHO (ID 12316), the four PEPFAR-supported
US universities working in HIV/TB (ID 10456, 10429, 10463, 10469), Management Sciences for Health/Care
and Support Program (ID 10400), HAPCO (FY07 reprogrammed PEPFAR funds), and other donors,
including the Global Fund, GLRA, Italian Cooperation, and the Dutch Government.
New/Continuing Activity: Continuing Activity
Continuing Activity: 18568
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
18568 18568.08 U.S. Agency for Royal Netherlands 8135 8135.08 TBCAP $1,162,500
International TB Foundation
Development
Emphasis Areas
Construction/Renovation
Health-related Wraparound Programs
* Child Survival Activities
* TB
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $1,162,500
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.12: