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.
Subdivisions of Program Areas, these track general higher level sub-classifications of expenditure.
Subdivisions of Major categories, these are the most detailed expenditure data.
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
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
Cervical cancer continues to be a major public health problem for women in Guyana, as it is in many
developing countries and throughout most of Latin America and Caribbean (LAC) region. Cervical cancer is
the leading cause of cancer deaths in women of the LAC region, and Guyana suffers one of the highest
cervical cancer burdens in the world. The age-standardized rate (ASR) in 2002 for cervical cancer incidence
in Guyana is 47.3 cases per 100,000 women, and a mortality rate of 22.2 per 100,000 women (Global
Epidemiology Group), both of which are 50% higher than the LAC region. Yet, when precancerous lesions
are detected and treated, cervical cancer is almost completely preventable. In countries that have
developed and implemented high quality organized cervical cancer prevention programs with high
participation rates, the incidence of cervical cancer has decreased by a remarkable 70-90%. In comparison,
Guyana lacks an organized cervical cancer prevention program. Cervical cancer prevention services in
Guyana are characterized by low coverage rates, poorly targeted services, lack of coordination and linkage
of screening and treatment components, and inadequate tracking of patients for follow-up.
A "Single Visit Approach" (SVA) that is proposed for introduction in Guyana, is a recognized alternative for
low resource setting to the cytology-based model of cervical cancer prevention services. In the cytology
based program a test is taken, read at a laboratory, results become available a few weeks later, the client is
referred to a central site for confirmatory tests and therapy - a process that takes a long while, and is a
significant burden on women. By contrast, the SVA approach links testing with the offer of treatment or
other management options, at the same visit. This linkage is not only clinically important; it is cost-effective,
as reported in two recent studies (New England Journal of Medicine, November 17; Journal of the National
Cancer Institute; 94:1-15). Both studies report that once-in-a lifetime VIA testing, followed by offer of
immediate cryotherapy treatment for eligible lesions, was the most cost-effective, defined as fewest dollars
spent per life-year saved or cancers avoided.
The situation of HIV/AIDS in Guyana, and its influence on the development of cervical cancer, poses very
significant risks for women's health, as well as the well-being of their families and communities. HIV-infected
women are at a much higher risk of developing precancerous lesions of the cervix, and have more rapid
progression to cancer than women who are not HIV-infected. In addition, women receiving appropriate ARV
therapy are living longer, increasing the risk of precancerous lesions of the cervix to progress to cancer. As
a result, HIV-infected women should receive cervical cancer prevention services as part of their routine HIV
care and treatment (Gynecologic Oncology: 103: 1017-1022). Currently, this is not happening in Guyana.
An excellent opportunity exists to integrate cervical cancer prevention and HIV services because Guyana
receives support from the President's Emergency Plan for AIDS Relief (PEPFAR) program, and Omni Med
has previously conducted some cervical cancer prevention training and education at the HIV Center of
Excellence (GUM Clinic).
The Government of Guyana (GoG), through its Ministry of Health (MoH), has prioritized cervical cancer
prevention as a programmatic issue to be addressed using a single-visit approach (SVA) with visual
inspection with acetic acid (VIA) and cryotherapy. Omni Med's collaborative efforts over the past three years
within Guyana has led to the development of a national policy for cervical cancer prevention based on the
VIA and SVA model, and the desire of the MoH to have Omni Med partner with them to provide technical
assistance for the program. The GoG has committed its own resources to pay the in-country costs of
initiating a national cervical cancer prevention program, including funds for training, local travel, supplies,
and equipment. In addition, the local Rotary Club has committed resources to pay for equipment, supplies,
and to help conduct education and mobilization campaigns. However, in order to initiate the program, funds
are needed to support the costs of the international expertise needed to guide the MoH through the initial
three-year start up phase in order to establish local capacity to provide and maintain services. Working in
partnership with the GoG, JHPIEGO and Omni Med are collaborating to provide the needed technical
assistance for this program: development of national policy and service delivery guidelines, conducting
stakeholder meetings to ensure broad-based support, training trainers and providers, adapting learning
materials, installing information and monitoring systems, and supervising initial training and service
Importantly, through this program, the GoG intends to lay the groundwork for introducing HPV testing and
the HPV vaccine. The single visit approach combined with appropriate use of HPV testing and the HPV
vaccine is an effective national strategy for detection; control; treatment, care and management; and
prevention of an important public health problem that accounts for significant disease and death among
Guyanese women. This will be achieved by using the screening program as a platform to reach young
women with the vaccine when it becomes available and affordable. Although this combined initiative may be
many years before becoming a reality in Guyana, an initial effort to establish the screening program (the
platform for launching HPV vaccine services) is a requisite first step to provide prevention services to
Program Goal and Objectives:
?Establish strategy, policy, and guidelines for cervical cancer prevention services for the general population
and for HIV-infected women in particular.
?Provide cervical cancer prevention services with appropriate follow-up to at least 2000 HIV+ women.
?Establish cervical cancer prevention services with appropriate follow-up as part of routine care for HIV-
infected women at the HIV Center of Excellence (GUM Clinic), with at least 50 percent of these women
receiving cervical cancer prevention services in the first program year.
?Establish cervical cancer prevention services with appropriate follow-up as part of the PMTCT program,
with at least 30 percent of these women receiving cervical cancer prevention services in the first program
?Develop two screening centers in the public sector (Georgetown and either New Amsterdam or Suddie) to
provide regular cervical cancer screening with linkage to appropriate treatment, utilizing a single-visit or
Activity Narrative: ?Increase from one to three the number of the ten Regions served by mobile cervical cancer prevention
clinics staffed primarily by Guyanese health care personnel. The remaining Regions would be covered in