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: 2007 2008 2009
SUMMARY: The activities included in this project relate to establish TB laboratory testing facility at the
National Public Health Laboratory (NPHL) for TB culture and drug resistance to Mycobacterium
Tuberculosis, hiring staff, training plus maintain its infrastructure.
BACKGROUND: The NPHL was established in 2006. Laboratory space was allocated for its TB laboratory.
However, this laboratory is still empty and is only functioning as a TB slides QA/QC rereading operation.
Diagnosis of TB by sputum smear microscopy is useful as a screening test, but it has some limitation as it
can only detect 70% of TB cases. TB suspected cases with clinical symptoms but TB smear negative
should be further investigated and diagnosed by culture and/or radiology. There were numerous reports on
multiple drug resistance to Mycobacterium Tuberculosis globally including Dominican Republic, Haiti's
neighboring country that caused deaths. Co-infection of TB and HIV is common occurring. Multiple drug
resistance to TB is a public health threat. Currently, the Ministry of Health, (NPHL) does not have capacity
to conduct TB culture or performing MTB drug resistance and/or drug susceptibility testing. There is an
urgent need to set up such facility at the NPHL to provide TB laboratory services to TB/HIV patients.
Activity 1: The NPHL will continue to use methods for culture identification and drug sensitivity and/or
resistance Mycobacterium Tuberculosis. Supply Chain Management (PFSCM) will continue procure TB
culture laboratory equipment, specific equipment and lab supplies to establish TB culture and drug
resistance testing for the NPHL. The NPHL will subcontract local company to improve improving its TB
laboratory infrastructure in order to meet laboratory safety standard requirements, and to install lab
equipment so that the TB culture laboratory will be maintained. The NPHL will continue to work with French
speaking TB lab consultants hired by the American Society of Microbiology (ASM) in order to start up and
implement the project. In COP 09, the NPHL has a goal to conductTB cultures and detection of MDRTB and
XDRTB drug resistance for clinical decision-making and drug resistance surveillance.
Activity 2: The NPHL will provide to 80 lab personnel at PEPFAR supported laboratories (ARV, and
palliative care labs) a refresher training course to conduct TB smear diagnosis. In addition, the NPHL will
train 40 lab personnel at TB clinics to conduct HIV rapid testing. This number of lab personnel is already
included and described in the NPHL narrative in the Lab Infrastructure program area.
Activity 3: The NPHL will continue to establish and expand an integrated quality assurance program of TB
smear diagnosis and HIV testing at 180 TB clinics nationwide. The QA/QC activities will include regular
supervisory visits, EQA TB smear diagnosis panel test development and proficiency testing, TB slides
rereading, and trouble shooting.
New/Continuing Activity: Continuing Activity
Continuing Activity: 17205
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
17205 12374.08 HHS/Centers for Ministre de la 7689 6218.08 National $800,000
Disease Control & Sante Publique et Laboratory
Prevention Population, Haiti
12374 12374.07 HHS/Centers for Ministre de la 6218 6218.07 National Lab $300,000
Disease Control & Sante Publique et Mechanism
Table 3.3.12:
SUMMARY:
The activities described reflect ongoing efforts to build laboratory infrastructure in Haiti through
strengthening the capacity of the National Public Health Laboratory (NPHL) and its network. Funding will be
used to continue and expand the national laboratory quality assurance and quality control program (QA/QC)
in HIV and syphilis rapid testing as well as ARV and palliative care lab services. In addition, NPHL will
reinforce bacteriology and parasitology laboratory expertise for HIV/AIDS related opportunistic infections,
and strengthen its biomedical engineering service unit to install and repair laboratory equipment. All planned
activities will be carried out by NPHL employees, in collaboration with Haitian Group for the Study of
Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), USG, and other PEPFAR-supported
implementing partners.
BACKGROUND: Accurate test results are very critical for public health. With help from the USG team, Haiti
has established a functional regulatory body (NPHL) to coordinate and evaluate laboratory performance in
the country. Proposed activities for COP09 are ongoing from previous funding years in addition to 2 new
activities (see Activity 11), all consistent with NPHL and MSPP mission.
ACTIVITIES AND EXPECTED RESULTS:
Activity 1: Quality Assurance
NPHL will reinforce its QA/QC program for HIV and syphilis rapid testing and AFB smear microscopy. A
combination of QC activities will be conducted: 1) use of a standardized logbook for recording information at
VCT centers along with a standardized tool for M&E; 2) regular supervisory sites visits to 150 VCT sites to
track and monitor laboratory testing data on HIV and syphilis; 3) refresher courses on QA of HIV and
syphilis rapid testing; and 4) participation of all VCT sites in External Quality Assurance (EQA) proficiency
testing implemented by NPHL.
Activity 2: NPHL will also provide QA/QC to ARV and palliative care laboratories using the same kinds of
activities, i.e. regular supervisory visits to the laboratory network, EQA proficiency testing for CD4. In FY09,
NPHL will enroll in an EQA/PT program for CD4 and start an EQA program for blood chemistry and
hematology. After protocols for the EQA program are developed, EQA panels for CD4 enumeration will be
sent out to participating ARV and palliative care laboratories. Corrective action will be conducted in case of
error and/or discordance. NPHL has hired and trained 10 regional departmental lab technicians to provide
regular QA/QC supervisory visits, train and troubleshoot. NPHL will assist the USG to launch new ARV and
palliative care sites by conducting site assessment, conducting training, coordinate with SCMS for lab
commodity delivery, and perform supervisory QA/QC visits.
Activity 3: NPHL will continue to maintain inventories for all laboratory equipment at ARV and palliative care
sites under the MSPP network and at the NPHL. A biomedical engineering service unit which has been
established during COP07 is responsible for 1) evaluating lab equipment, 2) installing new ARV automated
lab equipment, 3) maintaining, troubleshooting and repairing equipment at all sites except the GHESKIO
network where such staff are already available, 5) maintaining bio-safety cabinets at the NPHL, 6) training
laboratory personnel how to routinely maintain common lab equipment, and 7) procuring equipment
maintenance service contracts as appropriate.
Activity 4: Significant improvements in electrical backups, water filtration systems, and security have been
made. Due to greater confidence in temperature monitoring and alarm systems on freezers, NPHL is
getting positioned to initiate and maintain a repository of specimens (eg, serum specimens and MDR/XDR
TB strains) to support future surveillance activities and studies.
Activity 5: NPHL will continue to set up bacteriology and parasitology laboratories to enhance diagnosis of
opportunistic infection associated with HIV/AIDS. In addition to the advanced bacteriology lab at NPHL, 3
departmental centers of excellence will also develop the capacity to culture and identify bacterial pathogens
and perform drug susceptibility testing. NPHL is developing an advanced parasitology lab with the capacity
to perform serology assays, but simple parasitology testing for intestinal helminthes and protozoa will be
done at all10 departmental laboratories.
Activity 6: In collaboration with GHESKIO, INHSAC and other USG partners, NPHL will train 150 lab
personnel and health care workers to perform HIV and syphilis rapid tests, as well as the DPS QA/QC.
Additionally, NPHL will train 40 technicians for all relevant laboratory areas including CD4 counts,
hematology, blood chemistry, parasitology and bacteriology. Forty people will also be trained in laboratory
equipment maintenance (see Activity 3). All training is a one week course. Training modules in lab-related
subjects are developed by partners in conjunction with NPHL and include good laboratory practices and
methods for preventive maintenance of equipment.
Activity 7: NPHL will continue to support the salaries of staff recruited in COP08, including one
epidemiologist, four microbiologists (to work at HIV, bacteriology, parasitology and mycobacteriology
laboratories), two biomedical engineering staff, one laboratory manager, as well as the additional
management and supportive staff approved in COP08.
Activity 8: In preparation for possible future implemention of viral load and HIV drug resistance testing,
NPHL will plan for a feasibility study.
Activity 9: NPHL will continue to strengthen the integration of the national laboratory and the department of
epidemiology in coordinating a data management unit at NPHL. This unit will collect and manage both
routine laboratory and surveillance data.
Continuing Activity: 17206
17206 12429.08 HHS/Centers for Ministre de la 7689 6218.08 National $2,610,000
12429 12429.07 HHS/Centers for Ministre de la 6218 6218.07 National Lab $1,750,000
Emphasis Areas
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $800,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.16:
Partnership Framework 20% (5 million in total). This activity will focus on the development and
implementation of the Lab Management Information System (LMIS) at the National Public Health
Laboratory.
New/Continuing Activity: New Activity
Continuing Activity:
Table 3.3.17:
