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: 2010 2011
This mechanism was a TBD in FY2009, but was awarded to Family Health International (FHI) as a new activity to address HIV prevention in most-at-risk populations (MARPs) in Amhara Region.
FHI has supported HIV/AIDS and reproductive health programs in Ethiopia since 1992. It works to increase the capacity of the Government of Ethiopia, local NGOs and CBOs, and selected private sector partners to implement an expanded and comprehensive response to AIDS. This includes building capacity to scale up quality HIV prevention, care, treatment and support interventions across an expanded and comprehensive response continuum. FHI has a country office in Addis Ababa and branch offices in the regions of Amhara and SNNPR. Its purpose is to contribute to a broader goal of improving the quality of life of Ethiopians in the face of HIV/AIDS and extreme poverty, in part by improving the coping capacity of communities (community groups, individuals and families affected by AIDS).
This implementation mechanism is a follow-on response to the CDC-supported MARPS study conducted in partnership with the Amhara Regional HIV/AIDS Prevention and Control Office (AHAPCO) by the Ethiopian Public Health Association (EPHA) in 2008. AHAPCO wanted this study, the first of its kind in Ethiopia, because while Amhara Region accounted for only 20% of national population in 2009, it accounted for an estimated 40,000 (31%) of the 131,000 new HIV infections nationwide, 107,000 (32%) of the 336,000 PLWHAA in need of ART, and an even more disproportionate share of OVC, having 340,000 (40%) of the 856,000 AIDS orphans nationwide. Why Amhara's HIV burden is disproportionately higher than other regions remain unclear. Being largely rural and agrarian in nature, bridging populations exist between rural and urban "hotspots" where commercial sex work (CSW) is common. These dynamics are thought to play a central role in transmission. HIV prevalence (n=400 in each subgroup) in the Amhara MARPS study was 37% among CSWs, 15% amongst casual day laborers in towns, and 15% amongst mobile merchants who move from marketplace to marketplace to trade agricultural and other goods. CSWs likely serve as the "core-transmitters" to these mobile, yet relatively affluent groups, who travel back and forth between the countryside and towns. Disturbingly, HIV prevalence among 400 secondary students (median age 19 years) from non-randomly selected schools within suspected urban "hot spots" was 12% overall, including 16% in males and 8% in females. The hypothesis is that secondary education being largely unavailable in rural areas is resulting in large numbers of students migrating to towns where they lack support systems and engage in high-risk behavior. All of these groups are considered MARPs in Amhara Region.
Since starting in mid-2009, FHI has moved quickly to conduct an initial desk review, mapping of the target groups and service availability, and a regional dissemination meeting in collaboration with AAHAPCO. Numerous gaps geographically and in combination prevention interventions were identified. FHI is now implementing evidence-based, replicable "Demonstration Models" for effective delivery of a comprehensive package of HIV prevention services to MARPs in identified hotspot areas. These include strategic behavior change communication (SBCC) approaches to reduce risky behaviors, increasing access to condoms and user-friendly STI/HIV/AIDS services, and linkages to other services. The package of services is being based on draft guidelines for MARPs currently under development by the National HIV Prevention Advisory Group. Early access to ART for those with a CD4<350 will also be emphasized. Male circumcision is already routinely practiced in Amhara but it needs to be confirmed if practices have changed.
In COP 2010 targeted inter-personal communication activities with individual and peer outreach and peer group discussion will continue with the support of communication material. This will be supported with 'YeWein Zelela' strategy to address sexual mixing between groups. As a continuation of 2009, core trainers will roll out peer leadership training to select Peer Leaders who didn't receive training and will conduct supportive supervision of outreach workers to monitor the ongoing activities.
SBCC activities will be complemented with a tailored service delivery and referral strategy package, which includes MARPs-accessible HIV/AIDS/STI service. Refresher training will be provided to service providers and monitoring of service will be conducted to enhance the access to MARPs friendly service. Commodities like STI drugs will be procured only to address short-term shortages of drugs and condoms which will be made available freely at selected service outlets.
The project will organize quarterly project supervision and annual project review to see project progress, present analysis of project and quality improvement. The partnership with AHAPCO is strong which will facilitate ownership and sustainability. A quality assurance and improvement process involving close monitoring and site supervision takes rapid feedback into account to identify solutions to address gaps, and propose small cycles of improvement. Discussions are ongoing with AHAPCO, other PEPFAR partners, and CDCEthiopia to expand coverage to reach more MARPs groups and areas with targeted interventions to have a significant population-level impact on HIV prevention in the region.
Under this project in FY 2009 FHI conducted desk review of existing documents, mapping of the target group, partners and service delivery stations. FHI has also started the implementation of evidence-based, replicable "Demonstration Models" for effective delivery of a comprehensive package of HIV/AIDS/STI prevention services to MARPS in selected hotspot areas in Amhara region.
In COP 2010, inter-personal communication activities with individual and peer outreach and peer group discussions will continue with the support of communication material including targeted radio programs using local FM radios. This will be supported with the 'YeWein Zelela' strategy to address sexual mixing between groups.
To advance activities from FY 2009, core trainers will continue to roll out peer leadership training to select peer leaders and will conduct supportive supervision of outreach workers to monitor the ongoing activities. FHI will provide refresher training to service providers and monitor services to enhance the availability of MARPS-friendly services.
SBCC activities will be complemented with a tailored behavior change communication strategy focusing on reducing sexual partners and being faithful, building negotiation skills, and creating an enabling environment for implementation, service delivery and referrals to MARPS friendly HIV/AIDS/STI services.
The project will organize quarterly project supervision and annual project reviews to assess progress, and to present analysis of project and quality improvement. This will be done in consultation with the regional MARPs Taskforce. The quality assurance and improvement process will focus on monitoring and supervisory feedback, identifying solutions to address gaps, and proposing incremental steps for improvement.
In COP 2009, FHI conducted desk reviews of existing documents and mapped target groups, partners and service delivery stations. FHI has also started the implementation of evidence-based, replicable demonstration models for effective delivery of a comprehensive package of HIV/AIDS/STI prevention services to MARPS in selected hotspots in Amhara region.
In COP 2010, interpersonal communication efforts with individual and peer outreach, as well as peer group discussion, will continue with the support of communication materials. These communication materials will use a combination of targeted radio programs using local FM radios. This will be supported with the 'YeWein Zelela' strategy to address sexual mixing between groups.
In continuing activities from COP 2009, core trainers will continue to provide training to peer leaders and will conduct supportive supervision of outreach workers to monitor ongoing activities. Refresher training will be provided to service providers and monitoring will be conducted to ensure the availability of MARPS-friendly services.
SBCC activities will be complemented with tailored behavior change communication for MARPs focusing on condom promotion and distribution, STIs detection and treatment referrals, HTC and service delivery, and a referral strategy package. The package of services will be basing the minimum package of services for MARPs that is suggested by the National HIV Prevention Advisory Group.
The project will organize quarterly project supervision and annual reviews to assess progress and to present analysis of the project and quality improvement efforts. This will be done in consultation with the regional MARPs taskforce. Quality assurance and improvement process was developed and is being implemented. FHI will continue to discuss monitoring and supervision feedback, identify solutions to address gaps, and propose incremental steps for improvement.
