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.
Several areas of programming in Haiti present opportunities for important program evaluations. Currently planned evaluations include an assessment of rates of transmitted HIV drug resistance, an evaluation of rates of HSV in pregnant women in Haiti, and an assessment of the program effectiveness of a test and treat approach for prevention of mother to child transmission. Findings from these evaluations will inform strategies and/or protocol development to improve the quality of care provided to HIV patients in Haiti.
Syphilis test validation. In Haiti and elsewhere, syphilis contributes to HIV transmission and is an important contributor to neonatal mortality. Haiti has adopted rapid tests that detect treponemal antibodies, but use of these tests either leads to substantial overtreatment (since the test detects any past syphilis) or requires follow up testing that is logistically challenging. A new antibody test addresses some of these challenges and has been validated in China and other settings. These funds would support validation of the test for use in Haiti as precursor to introduction of this test for program use. Based on preliminary sample size calculations, validation would require testing of approximately 1400 samples. Costs are primarily related to specimen testing and results dissemination, estimated budget $50,000.
During FY 2012 CDC proposes to conduct an evaluation of a test and treat approach to prevention of mother to child transmission activities in Haiti. Haiti has recently adopted a B+ approach to PMTCT, that is pregnant women with HIV are offered long-term triple antiretroviral therapy (ART). In accordance with OGAC directives, Haiti seeks to evaluate the effectiveness of this approach. The evaluation will involve assessment of various program implementation elements (rates of testing, rates of initiation of ART, tolerability and adherence, knowledge and attitudes of staff and pregnant women) as well as an evaluation of the effectiveness of the intervention (rates of viral suppression in the women and rates of transmission to the infants). Costs will include enumerators, transport, stationery, and lab costs; estimated budget $300,000
CDC proposes also to measure the rates of HSV among pregnant women in Haiti. HSV is well recognized as a risk factor for HIV, but specific data about HSV rates in Haiti are very limited. This evaluation would involve testing for HSV of banked samples from previously conducted HIV surveillance among pregnant women. These data will help inform HIV prevention efforts in Haiti. Costs are primarily related to specimen testing and results dissemination, estimated budget $50,000.
During FY 2012 CDC will conduct and evaluation of transmitted drug resistance. WHO recommends three main approaches to monitoring of HIV drug resistance in national programs, including monitoring of early warning indicators (EWI) for drug resistance, monitoring of development of resistance on therapy, and monitoring of transmitted drug resistance, for example through testing of primagravida pregnant women (who serve as a proxy for persons with newly acquired HIV). Haiti has been able to conduct 2 rounds of EW, is reestablishing systems for ongoing EWI monitoring through the national electronic medical record, and is completing a monitoring survey, but to date has not been able to conduct a survey of transmitted drug resistance. These funds will support resistance testing for primagravida women from the 2012 ANC survey. Based on past experience, we anticipate that there will be samples from approximately 40 such women available for testing. Testing will be conducted at CDC Atlanta or at the WHO-accredited HIV resistance lab in Martinique; data will be analyzed and reported in accordance with WHO recommendations. Costs are primarily related to specimen transport and testing, estimated budget $100,000.
