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
Adherence Support for HIV Positives
The current proposal aims to develop, implement, and evaluate an ARV adherence-support program for HIV
-infected military members and spouses who attend military clinics in Ethiopia. The university of
Connecticut's Center for Health, Intervention, and Prevention (CHIP) will work collaboratively with
representatives from the National Defense Forces of Ethiopia (NDFE), the University of California, San
Diego (UCSD), and the US Department of Defense HIV/AIDS Prevention Program (DHAPP) to develop an
ARV adherence-support program that is acceptable to staff and patients. This program is feasible to
implement in the clinical care setting, can be delivered with fidelity, and is effective at increasing the ARV
adherence of HIV - positive soldiers and spouses. This theory-based, ARV adherence-support program will
be adapted and tailored to the socioeconomic, cultural, and healthcare context of Ethiopia and the Ethiopian
military, and will be implemented in multiple military healthcare sites.
There is no doubt that maintaining optimal ARV adherence is challenging for people living with HIV/AIDS
(PLWH), but it is likely even more challenging for PLWH in the NDFE. They face ARV adherence barriers
that are unique to military life, such as combat and other deployment situations that make it particularly
difficult to access, store, and take medications as prescribed. In addition, because soldiers live and work in
such close quarters, they may be more likely to skip doses of their medications because of fears that they
will be observed taking their medications and thus reveal their HIV status and be exposed to HIV - related
stigma. These additional barriers increase the probability that members of the NDFE will be unable to
achieve and maintain optimal levels of ARV adherence necessary for reaping the health benefits of
treatment. Military PLWH who are unable to maintain high rates of adherence over time may not only
exhaust their options for treatment through the development of ARV resistance, but may also pose a larger
public health threat if they fail to consistently practice safer sex behaviors and transmit their drug-resistant
strain of HIV to others. With over 3,500 troops and family members in Ethiopia receiving ARV treatment
(DHAPP Country Report, 2006), it is therefore critical that programs be developed that provide PLWH in the
NDFE with the tools that they need to properly adhere to their ARV medications.
GOALS and OBJECTIVES
(1) Conduct a needs assessment to identify the dynamics of non-adherent behavior among HIV-positive
soldiers and spouses, and to determine what is feasible and practical to do in military healthcare settings.
We will conduct a minimum of five focus groups (two female PLWH, two male PLWH, and one staff focus
group) at each military hospital site in Ethiopia that participates in this project. The specific goals of the
needs assessment work are to: (a) explore the dynamics of non-adherence among Ethiopian military
PLWH; (b) identify culturally appropriate strategies that Ethiopian military PLWH can use to increase their
adherence to ART; (c) determine whether the adherence-support program should be delivered in a group or
one-on-one format; (d) determine which individuals (e.g., doctors, nurses, counselors, pharmacists, and/or
peer educators) are most appropriate for implementing the adherence-support program and what their
specific training needs are; and (e) assess how to most effectively and efficiently integrate the adherence-
support program into the daily clinic routine. There will be 6-10 participants in each focus group.
(2) Based on the findings from the needs assessment, develop a tailored ARV adherence-support program
that addresses the specific adherence needs of HIV-positive military and spouses in Ethiopia. Once the
focus groups are completed, the findings will be compiled and analyzed, and an adherence-support
program developed. Our Ethiopian Collaborators (representatives of the NDFE and DHAPP) will play a
central role in the framing, conduct, and analysis of the needs assessment and its integration into the final
adherence-support program. The needs assessment and multidisciplinary collaboration will allow us to
tailor the adherence-support program. The needs assessment and multidisciplinary collaboration will allow
us to tailor the adherence-support program to the clinic site and the particular needs of its integration into
the final adherence-support program. The needs assessment and multidisciplinary collaboration will allow
us to tailor the adherence-support program. The needs assessment and multidisciplinary collaboration will
allow us to tailor the adherence-support program to the clinic site and the particular needs of its HIV-positive
patients.
(3) Train Ethiopian military interveners in the ARV adherence-support program. The content of the
adherence-support program and the training protocol will be based upon: (1) the findings from the needs
assessment; (2) the US team's extensive experience developing adherence-support programs in Uganda
and the US and training interveners to deliver them; and (3) extensive input and feedback from the
multidisciplinary Ethiopian team. Interveners (e.g., doctors, nurses, psychologists, counselors, pharmacists,
and/or peer educators) will be jointly trained by the US team and at least one medical provider (preferably
someone from the NDFE) with expertise in ARV medications and adherence issues. One of the interveners
will eventually be selected and trained as a master trainer in the program protocol. This individual will
continue to provide training once the US-led portion of the project is completed.
(4) Implement the ARV adherence-support program at multiple military healthcare sites within Ethiopia. At
all sites, trained interveners will implement the adherence-support program on an ongoing basis when
patients come in for their routine clinical care visits. Depending on the format of the adherence-support
program (which will be determined as a function of the needs assessment and in collaboration with the
Ethiopian-DHAPP team), patients will either participate in group adherence-support sessions or in one-on-
one discussions with an intervener. If the adherence-support program is offered in a group format, different
adherence-related topics will be presented each month (e.g., how ARV medications work in the body,
strategies for remembering to take one's medications, managing side effects, learning from a missed dose,
effective communication with one's healthcare provider, disclosing one's HIV status, dealing with HIV-
related stigma, and managing one's stress levels). Each group session will include an interactive
component to encourage active participation in the group.
If instead, the format of the program is one-on-one, patients will meet individually with an intervener at each
routine clinical care visit. Each session will consist of a patient-centered discussion in which the intervener
works collaboratively with the patient to identify and understand the dynamics of the patient's ARV non-
adherence and to develop strategies to help him/her consistently adhere to his/her ARV medication
regimen. Specifically, these discussions will: identify patients' informational, motivational, and behavioral
skills barriers to taking their ARV medications as prescribed; provide critical ARV adherence information,
Activity Narrative: motivation, and behavioral skills to overcome the barriers; and set specific adherence-related goals for
PLWH to accomplish between clinical care visits as a means of enhancing their adherence. Subsequent
discussions between HIV-positive patients and their interveners will focus on: monitoring progress toward
their goals; providing additional information, motivation, and behavioral skills training as needed; and
negotiating a new goal, when appropriate.
(5) Evaluate the effectiveness of the adherence-support program by comparing the pre-program ARV
adherence to the post-program adherence of 150 to 200 PLWH. An in-country project assistant will recruit
a randomly selected sample of 75-100 HIV-positive NDFE military personnel on ARVs, and 75-100 HIV-
positive military members' spouses on ARVs to complete the program-evaluation measures. The project
assistant will administer measures of ARV adherence to these patient participants prior to the first
adherence support session (at baseline) and then again at four-month and eight-month intervals following
the patients' first adherence support sessions. The project assistant will also review each enrolled patient's
medical chart to obtain any available CD4 and pill count data. Baseline levels of self-reported adherence
behavior, pill counts, and CD4 counts will be compared to follow-up levels taken at four and eight months,
respectively. This will allow us to evaluate the effectiveness of the program at improving ARV adherence
behavior using three different indicators. We will also evaluate whether the adherence-support program is
differentially effective with soldiers and soldiers' spouses.
New/Continuing Activity: Continuing Activity
Continuing Activity: 18704
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
18704 18704.08 Department of University of 8141 8141.08 DOD-UCONN- $225,000
Defense Connecticut PWP
Emphasis Areas
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 3.3.09:
