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.
Mechanism Narrative:
1. Goals: Reduce sexual HIV transmission and impact of HIV/AIDS including stigma and discrimination in the general population of two selected regions of Ethiopia .
Objectives: 1) Increase correct and consistent adoption of HIV risk reducing behaviors, 2)Increase number of people with the motivation to access HIV services, 3)Reduce stigma and discrimination, 4) Increase capacity of local government/NGOs to implement effective HIV services/outreach activities.
2. Geographic Coverage: Afar and Somali regional states.
3. Target population: General population and MARP groups residing in urban and peri-urban settlement areas. Specific target population will be identified in consultation with the regional health bureau/HAPCO, CDC and local partners.
4. Contribution to the health system
The project (COSM) contribution focuses on the service provision related activities through promoting the prevention of sexual HIV transmission and the demand for HIV/AIDS services. Among the eight components of the Ethiopian government HSDP, the project will contribute on four of them: human resource development, IEC, health service delivery and quality of care, M&E.
5. Cross-cutting programs and key issues
The following cross-cutting issues will be addressed:
Human resource for health: Train health care providers on the importance of integrating HIV/AIDS prevention and treatment services.
Gender: monitor and ensure gender equality throughout the HIV/AIDS prevention campaigns and service uptake. In collaboration with UNFPA, which supply's female condom for free, female condom will be available. Addressing male norms and behaviors is another approach the project will adapt in mitigating the impact of HIV/AIDS.
6. Implementation strategy
COSM technical approach is built on evidence based and innovative approaches; building on existing/proven interventions; capacity building; effective partnerships.
COSM scale-up its reach in a cost effective way by working with multiple local organization and PEPFAR partners operational in the impact regions. Small grant scheme is designed to grant to local NGOs/CBOs and execute community outreach/social mobilization activities. To address PEPFAR/local partners' challenges towards increasing the uptake for HIV/AIDS services, the project demand creation campaign will be made in a coordinated manner. For instance, the project's road show/MVU will be made in consultation with regional health bureaus and partners providing mobile HCT (OSSA/Abt/RHB). Promotion of correct and consistent condom use will be implemented in partnership with the "USAID Targeted HIV Prevention Program;" STI/ART/PMTCT with USG universities and other actors.
COSM implementation strategy focuses on social/community mobilization and capacity building initiatives. Leveraging the skills of local project partners, it will conduct intensive community outreach and social mobilization and communication activities. Effective from second year, these activities will be supported by complementary mass media which will promote comprehensive HIV prevention, care and treatment, and combat common myths and misconceptions which fuel stigma and discrimination. At the local level, community empowerment and engagement will be the primary focus to ensure long-term sustainability achieved through local ownership and transfer of best practices and implementation tools.
7. M&E Plan
COSM uses community based MIS. Monitoring data will be collected regularly and fed into PSI's database system, which provide monthly/quarterly summarized information by region and zone.
This activity comprises of two seperate entities: (A) The Community Outreach and Social Mobilization (COSM) for Prevention of Sexual HIV Transmission and Integrating Sexual Prevention in Care and Treatment Project primarily focuses on other sexual prevention; however, a significant level of effort will be given to AB initiatives. The AB initiatives focus on promoting abstinence, fidelity, reducing multiple concurrent partners, and social norms that affect these behaviors. Afar and Somali Regions cover major parts of Ethiopia's borders with Djibouti and Somalia. Contraband trade routes are pervasive in these corridors, attracting men with money, young smugglers and laborers, and a range of displaced individuals. These regions attract MARPs that challenge local norms and aggravate the spread of HIV. COSM's AB initiatives strive to avert this by launching innovative community outreach and social mobilization activities. COP2010 AB activities focus on achieving the following outputs:
Increase target communities' ability and motivation to reduce risk of HIV through use of appropriate community-based and interpersonal HIV prevention techniques. Increase individuals' ability and motivation for adopting behaviors that reduce risk of HIV transmission.
The AB campaign will target in-school adolescents and sexually active men and women (aged 15-49) who have the potential to be attracted by and to the MARP groups. COSM will address the HIV prevention needs of junior and secondary high schools, preparatory and college students, youth associations, and anti AIDS clubs. Women's associations and workplaces are targeted to reach sexually active adult women and men. (B) This is an activity carried out in previous years by Population Services Incorporated that will be re-announced with COP10. The aim is to deliver AB messages and to increase demand for quality HIV and sexually transmitted infections (STI) prevention services in Ethiopia through social marketing of STI treatment services that are linked to HIV counseling and testing. Funding for this effort is shared with the HVOP program area.
In FY08, PSI distributed 60,000 STI (urethral discharge) treatment kits to patients through private health facilities in STI/HIV hotspots in Addis Ababa. PSI further trained 137 health workers in private facilities on STI syndromic management and distributed over 5,000 posters and point-of-sale materials. In FY09, kits for the treatment of urethral discharge and genital ulcers were developed and distributed in private facilities in STI/HIV hotspots, targeting MARPs. These kits contained STI drugs, educational materials that included AB messaging, partner-notification cards, condoms, HIV testing information, and vouchers to access free HIV tests. Kit distribution is accompanied by promotion activities to generate demand for quality HIV/STI services.
Because of the stigma associated with STI, most STI patients still visit lower-level and private facilities. Private facilities have poor STI reporting and recording systems, and few training opportunities are available to providers in private facilities. Therefore, in FY10, emphasis will be given to strengthening private facilities. In addition, the project will procure STI drugs for MARPs for inclusion in the kits. HIV patients in ART or on palliative care will also receive STI treatment and messaging from this project.
In COP 2010, the partner will carry out the following major activities in collaboration with the Federal Ministry of Health (MOH) and regional health bureaus (RHB): 1) Distribute of STI treatment kits through private and public facilities, ART clinics, and high risk corridor centers. 2) Link STI services to HIV counseling and testing. 3) Train private-sector providers on syndromic management of STIs. 4) Promote quality STI services and pre-packaged treatment kits. 5) Strengthen and improve STI recording and reporting 6) Strengthen STI partner notification and management
COSM targets populations residing in urban and peri-urban settlements of these two regions' major hotspots and high risk corridors. COSM, in partnership with regional government and local partners, organizes community outreach, social mobilization/marketing campaigns, and produces AB communication messages and materials. Gender equity will be monitored throughout the implementation process. To ensure quality of the project campaign, the project's social and community mobilization activities will be closely monitored through regular supportive supervision visits and collection of monitoring reports.
This activity comprises of two seperate entities: (A) PSI will continue to implement Community Outreach and Social Mobilization for Prevention of Sexual HIV Transmission and Integrating Sexual Prevention in Care and Treatment Interventions (COSMs). COSM's technical approach is built on four pillars: evidence based and innovative approaches; building on existing and proven interventions; capacity building; and effective partnerships.
COSM focuses on seven intermediate results; 1) Increasing adoption of safer sexual behaviors; 2) Enhancing communities' use of HIV/AIDS services; 3) Increasing involvement of health care providers; 4) Reducing stigma and discrimination; 5) Increasing correct and consistent condom use among MARPs; 6) Increasing awareness and demand for early treatment of STIs; 7) Enhancing ART adherence and PLHIV's knowledge on PwP.
In COP 2010, activities will focus on achieving the following outputs:
1. Increase target communities' ability and motivation to reduce risk of HIV infection and transmission through use of appropriate and consistent community-based and interpersonal HIV prevention techniques.
2. Increase the ability and motivation of health care providers to promote HIV/AIDS services.
3. Increase individuals' ability and motivation for using comprehensive HIV/AIDS knowledge to adopt behaviors that reduce risk of HIV transmission.
4. Increase individuals' ability and motivation for using HIV/AIDS services.
5. Increase the capacity of local organizations and individuals to implement COSM activities.
COSM focuses on high-risk corridors. The primary target populations are MARPs, which include CSWs, sexually active youth, mobile population and migrant workers, persons in multiple concurrent partnerships, transactional sex workers, and PLHIV in Afar and Somali regional states. PSI, in partnership with regional governments and local partner NGOs/CBOs, organizes different community outreach and social mobilization/marketing campaigns, and produces communication messages and materials. PSI utilizes IPC, community media, and mass media approaches. Social and community mobilization activities will be closely monitored through regular supportive supervision visits and collection of regular monitoring reports. (B) The aim of this new activity is to increase demand for quality HIV and STI prevention services through social marketing of STI treatment services that are linked to HIV counseling and testing. The intervention includes intense STI service promotion and demand creation activities.
A recent study by CDC and the Ethiopia Public Health Association in selected urban and rural areas identified a number of barriers that limit utilization of STI services. Some of these barriers include space constraints, shortage of diagnostic equipment, failure to follow syndromic management guidelines, lack of BCC/IEC materials, poor recordkeeping, and a lack of confidentiality. Providers lack training, counseling and education skills, and can be judgmental. In urban areas, STI sufferers buy drugs to treat their disease without consulting health care, indicating that they view government facilities as their last resort, because of a fear of stigma, judgment, lack of confidentiality, and long waiting times.
In COP 2010, the awarded partner will carry out the following major activities in collaboration with the Federal Ministry of Health and the Regional Health Bureaus:
Distributing 200,000 STI treatment kits through private and public facilities, ART clinics and high-risk corridor settings. The kit will be used for the treatment of urethral discharge, genital ulcer, and recurrent genital ulcer disease. The kit is an essential tool for providers, as it prescribes the correct medication and dosage as well as condoms and STI-related IEC materials.
Linking STI services to HIV counseling and testing.
Training providers in syndromic management.
Increasing awareness and demand for STI services.
Improving STI recording and reporting.
Strengthening STI partner services.
Expanding coverage areas to other major towns in Ethiopia.
