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: 2008 2009
SUMMARY
This program area addresses prevention through abstinence and being faithful. Individuals are reached
through community outreach that promotes HIV/AIDS prevention through abstinence and/or being faithful
among the youth in the low-income populations at the six locations targeted by the project.
BACKGROUND
Founded in 1961, Project Concern International (PCI) is an international non-governmental and non-profit
organization that aims to prevent disease, improve community health and promote sustainable
development. PCI/India has worked in HIV/AIDS prevention, care and support, and treatment programming
since its inception in 1997 when it was established as a Charitable Society in India. In 2004, PCI initiated
the PATHWAY Program, "Comprehensive Community and Home-Based Care and Support for People
Living with HIV/AIDS (PLHAs) in India." The five-year program (September 2004-August 2009) was
designed to implement integrated community and home-based care (CHBC) and support, and HIV
prevention in three sites in the high prevalence states of Maharashtra, Tamil Nadu, and Andhra Pradesh.
Through supplemental funding from CDC in Year 2, this project was expanded to three additional project
sites in the northeastern states of India: Manipur (Churachandpur and Imphal) and Nagaland (Dimapur). In
Year 3 (September 2006-August 2007), CDC allocated additional resources to continue program activities
at the 6 targeted sites and to work with the National AIDS Control Organization (NACO) to improve and
upgrade its Strategic Information System (SIS) and train its personnel in the management of SIS and other
skill areas in high demand.
In FY08 activities will be directly implemented by PCI in Maharashtra (population covered, 450,000) and
Tamil Nadu (360,000). In Andhra Pradesh (600,000) and Northeastern states (642,000) project activities
will continue to be implemented through PCI sub-partners, who are local organizations with experience in
HIV/AIDS program implementation. The sub-partners are Lodi Multi Purpose Social Service Society, Sneha,
Pragathi Seva Samithi in Warangal in Andra Pradesh state; SASO, Shalom in Manipur, Akimbo Society in
Nagaland; Salem Network of Positive People in Salem,Tamil Nadu state, Network of Maharastra by People
Living with HIV/AIDS and Sevadham Trust in Pune in Maharashtra state.
ACTIVITIES AND EXPECTED RESULTS
ACTIVITY 1: Behavior Change Communication
Changing individual and community behaviors is key to HIV prevention. BCC project will play five different
but related roles in the PCI project's HIV/AIDS and STI programming: community dialogue, advocacy with
policy makers, provision of information and education, influencing the social response to stigma, and
communicating promotional information on services and products. Consistent messages from a variety of
legitimate sources will be disseminated in an interactive fashion to affect behavior change. Target
audiences will be segmented and BCC campaigns developed for each group.
PATHWAY's prevention approach includes behavior change communication, promoting abstinence, delay
in sexual debut, and being faithful to one uninfected partner. Prevention activities are integrated with
activities to increase community acceptance of PLHA and reduce stigma. Prevention services are delivered
in partnership with NGOs, CBOs, PLHA, and other community leaders, through a variety of channels
including mass awareness, one-to-group and group-to-group behavior change activities; information,
education and communication (IEC) materials and events; health camps; and mobile clinics. As part of the
program, Interactive Behavior Change Communication processes are held with communities in order to
develop tailored messages and approaches using a variety of communication channels to support positive
behaviors; promote and sustain individual, community, and societal behavior change; and maintain
appropriate behaviors. BCC programs will address stigma by involving motivated persons or groups, such
as PLHAs, sex workers and men who have sex with men, who can work effectively for change as policy
advocates and serve as caregivers and peer educators.
The Community Health Workers (CHW) and the Peer Educators (PEs) are all PLHA from targeted high-risk
low income communities. Most of them are women. They will mobilize out of school youth in the
communities through sports clubs, schools and colleges (target 20,000), women's self-help groups (target
20,000), and community recreation centers (target 10,000). The project is targeting 50,000 persons with this
activity.
ACTIVITY 2: Life Skill Education Sessions for Youth
PCI will link with the government education department to conduct Life Skills education sessions in 15
schools in Pune, Maharashtra for 8th and 9th grade students (12-14 years old). They are at risk as
revealed by studies in similar urban areas of the region showing early sexual debut. This activity will be
carried out in partnership with a private corporate agency, Zensar Technologies.
ACTIVITY 3: Building a Supportive Environment
Sessions on Abstinence and Being Faithful will also be conducted in the target communities, to support and
strengthen community norms of fidelity, reaching a targeted 20,000 persons. This activity contributes to
Objective 1b of the third National AIDS Control Program: prevention of new infections in the general
population.
This program area targets high-risk populations in the PCI target sites, through behavior change
communication and condom promotion activities. These activities aim to increase perception of risk and,
promote correct and consistent condom use to support a reduction in risk behaviors. The activities
contribute to the third National AIDS Control Plan's objective to prevent new infections in high-risk groups.
In FY08 26,000 persons will be reached through this intervention.
the PATHWAY project, "Comprehensive Community and Home-Based Care and Support for People Living
with HIV/AIDS (PLWHA) in India." The five-year project (September 2004-August 2009) was designed to
implement integrated community and home-based care (CHBC) and support, and HIV prevention in three
sites in the high prevalence states of Maharashtra, Tamil Nadu, and Andhra Pradesh.
at the 6 targeted sites, and to work with the National AIDS Control Organization (NACO) to improve and
upgrade its Strategic Information System (SIS) and train its personnel in SIS management and other skill
areas in high demand.
Tamil Nadu (360,000). In Andhra Pradesh (600,000) and the Northeastern states (642,000) activities will be
implemented through PCI sub-partners, who are local organizations with experience in HIV/AIDS program
implementation. The sub-partners are Lodi Multi Purpose Social Service Society, Sneha, Pragathi Seva
Samithi in Warangal, Andhra Pradesh; SASO, Shalom in Manipur; Akimbo Society in Nagaland; Salem
Network of Positive People in Salem, Tamil Nadu; Network of Maharashtra People Living with HIV/AIDS
and Sevadham Trust in Pune, Maharashtra.
ACTIVITY 1: Behavior Change Communication (BCC) and Peer Education
The objectives of the BCC approach are to: increase risk perception and reduce risky behavior; generate
demand for information and services related to STI and HIV prevention and care; promote community
dialogue at all levels on factors contributing to the epidemic and explore possible local solutions; and
change social norms around risk behavior and condom use. Interactive approaches and life planning skills
will be applied to enable behavior change. Key messages will be repeated by using multiple channels,
including face-to-face communication, such as counseling and peer education, to address deeply rooted
behaviors; mass media to reach a broad audience and introduce new behaviors; and edutainment
approaches to engage youth. Youth at risk will also be addressed through interactions with parents or other
role models. The BCC program will link with policy and advocacy activities at the community level.
Peer educators will be trained and supported by health workers to identify high risk groups and conduct
interpersonal communication (IPC) to deliver BCC messages related to; using a condom every time you
have sex, correct condom use, condom storage, and where to get condoms and health services. PEs also
make STI and VCT referrals, and promote and distribute condoms.
ACTIVITY 2: Promoting Condom Use for Most-at-Risk Populations (MARPs)
Condoms from the local District Health Office (DHO) or Reproductive Child Health (RCH) Department will
be accessed and made available to high risk groups in the project area, including sex workers, men at risk,
and PLHA. In addition to STI clinics, condom promotion and distribution will be implemented through a
system of outlets, such as tea shops, petty shops, hotels and workplace establishments. Barber shops,
public toilets, private practitioners' clinics, CBO and individual depot holders' homes will also continue to be
used as conduits for BCC activities and condom promotion. Placement of these outlets will be prioritized for
locations that show a high density of sexual networks and/or social interactions. A peer approach to condom
use demonstration and distribution will be used. Depot holders will be linked to the health office to enable
them to directly access condoms and promote sustainability of the initiative. The condom depot holders will
be further sensitized about STI and HIV/AIDS, and provided with IEC materials to distribute to customers
who frequent their establishments. Women depot holders will be identified and enrolled to enable access to
male condoms by women for their partners and ensure availability and access as the first step towards
condom negotiation
ACTIVITY 3: Linkages with Social Marketing Organizations
PCI and its partners will also explore collaborative opportunities to work with other organizations that
currently implement social marketing activities, to ensure that affordable condoms are made available to the
target group. This will include developing linkages between retailers and these organizations for training to
help reduce stigma associated with selling or buying condoms and thus motivate retailers to sell condoms.
Retailers will also be trained to deliver STI/HIV prevention messages, distribute IEC materials, conduct BCC
activities and refer customers to other preventive services, including STI clinics.
The PATHWAY project defines HIV-related palliative care as patient and family-centered care that
optimizes the quality of life of adults and children living with HIV through the active anticipation, prevention,
and treatment of pain, symptoms and suffering from the onset of HIV diagnosis through death. Palliative
care includes and goes beyond the medical management of infections and other complications of HIV/AIDS
to comprehensively address symptoms and suffering throughout the continuum of illness, with the
understanding that quality of life involves clinical, psychological, spiritual, and supportive care. The means
by which this is achieved will vary according to stage of illness. This program area focuses on the broad
spectrum of services provided as to reach the goal of PATHWAY: enhanced quality of life of PLHA.
Background:
Living with HIV/AIDS (PLWHA) in India." The five-year program (September 2004-August 2009) was
sites in the Northeastern states of India: Manipur (Churachandpur and Imphal) and Nagaland (Dimapur). In
Year 3 (September 2006-August 2007), CDC allocated additional resources, to continue program activities
at the six targeted sites, and to work with the National AIDS Control Organization (NACO) to improve and
In FY08 the activities will be directly implemented by PCI in Maharashtra (population covered, 450,000) and
Tamil Nadu (360,000), whereas in Andhra Pradesh (600,000) and the Northeastern states (642,000)
activities will be implemented through PCI sub-partners, who are local organizations with experience in
and Pragathi Seva Samithi in Warangal, Andhra Pradesh; SASO, and Shalom in Manipur; Akimbo Society
in Nagaland; the Salem Network of Positive People in Salem, Tamil Nadu; and the Network of Maharastra
People Living with HIV/AIDS and Sevadham Trust in Pune, Maharashtra.
The activities will target 5,500 PLHAs who will receive comprehensive palliative care services. They will
contribute to the third National AIDS Control Program's objective of providing expended care, support and
treatment services to a larger number of People Living with HIV/AIDS (PLHA).
ACTIVITY 1: Support for Clinical Care Services
Medical treatment will be continued in all PCI's target locations, serving PLHAs and individuals in need of
care from the targets communities. To avoid stigmatization, services will be open to all community
members in need, and will not be presented as exclusively targeting those with HIV/AIDS. Palliative and
curative treatment will be provided for: a) opportunistic infections; b) concurrent infections, including STIs,
reproductive tract infections, and other infections not directly related to HIV/AIDS. Treatment of PLHAs and
community members will also be provided through trained home-care providers, mobile clinic, and referrals
as appropriate. The mobile vans are staffed by a doctor and nurse. They provide all the health services
delivered at the on-site clinics except for anti-retrovirals (ARV). The vans visit each community on a fixed
schedule, frequency and duration.
ACTIVITY 2: Referral and Follow up for Anti-Retroviral Therapy (ART)
Through linkages with the Government of India (GOI)'s ART centers, PCI assists all PLHAs to enroll for
screening to determine their eligibility for ART. PATHWAY is currently tracking 1,160 PLHAs to ensure
regular WHO staging, CD4 monitoring where possible and adherence to ART. At Salem General Hospital,
a USG-supported counselor is available. Adherence monitoring and treatment literacy are monitored
through a network of the PATHWAY project's home-based care team, peer educators, and family members.
The number of PLHAs referred and tracked will increase in FY08 as stronger linkages are built with GOI
centers and with the Clinton Foundation's program to provide pediatric ART. The Clinton Foundation
provides nutrition and transportation to link those children in the PCI program who have AIDS with GOI ART
services.
ACTIVITY 3: Home-Based Care
Home visits are an important link for continuum of care for PLHA. The medical team of a doctor and a nurse
will make home visits for medical reasons if a client is unable to come to the mobile clinic. Home visits will
also be made to develop rapport with family members, involve them in home-based care and understand
the client's home environment. Program doctors, counselors, social workers, community health workers
and, perhaps most importantly, HIV-positive peer educators, will visit the PLHA home and provide training
and counsel to family members on myths and misconceptions about HIV/AIDS, and how to care for and
treat their infected family member(s). The project will continue to provide education on self care and family
care through its field staff - counselors, community health workers, and peer educators. This includes
information on safe drinking water, safe handling of food and hygiene behaviors, and training in the use Oral
Rehydration Solution (ORS).
ACTIVITY 4: Strengthen and Expand Palliative Care Linkages
The home-based care community health workers serve as the basic link between the mobile clinic and
community-based organizations (CBOs), local health care providers, Municipal Corporation health services
and other social sector workers. A formal referral system has been established to enable PLHA and family
members to move fluidly through the levels of medical and other care (nutrition, livelihood enhancement,
and others) provided by the various agents involved in the program. Government and private health care
providers involved in the referral system have been sensitized to the needs of PLHA and their families. An
extensive referral network of health and basic service organizations has been established to meet PLHA
needs that are beyond the scope of the PATHWAY project.
Activity Narrative: ACTIVITY 5: Community Empowerment and Training
Community empowerment begins with participation of the community stakeholders such as local medical
practitioners, local leaders, community PLHA peer educators, and CBOs. Gradually, these groups and their
membership have become part of the planning and implementation process of the PATHWAY project. To
further enhance the process of empowerment and ownership of the project by community stakeholders in
FY08, PCI will implement the following initiatives: a) Private practitioners in the communities will be selected
and doctors from the government sector will be involved in the provision of treatment for opportunistic
infections to PLHA. Nominal fees will be charged to PLHA for these services. The process will be facilitated
by the PATHWAY medical team to ensure that no PLHA in the targeted communities goes untreated. b)
Training and a drug supply will be provided to those doctors who are selected to fulfill these functions. c)
Peer educators are responsible for two to three communities for PLHA follow up and the provision of home-
based care services. They are already involved in peer counseling and ongoing counseling to PLHA and
will be given advanced training in pre and post-test counseling.
As a component of the Palliative Care Program, PCI has developed links with the Revised National TB
Control Program (RNTCP) to ensure that Directly Observed Treatment Short Course (DOTS) treatment is
provided at PCI project centers.
Pragathi Seva Samithi in Warangal in Andra Pradesh; SASO, Shalom in Manipur; Akimbo Society in
Nagaland; Salem Network of Positive People in Salem, Tamil Nadu; Network of Maharastra by People
Living with HIV/AIDS and Sevadham Trust in Pune, Maharashtra.
ACTIVITY: DOTS Provision for HIV/TB Co-Infected in Collaboration with RNTCP
The project has developed links with the Revised National TB Control Program. All PLHAs are screened for
TB. PATHWAY staff are trained to recognize symptoms of possible TB and to refer patients to the
RNTCP's TB center. Once diagnosed, patients receive six/nine months of medications, which are brought
to the PATHWAY community center where the drugs are administered through directly observed treatment
(DOT). If the patient is bedridden, the peer educators give them the medications in their home. In addition,
all TB patients identified in the communities are provided with DOTS through this partnership with the
government national TB program, and all are counseled and offered HIV testing. The number of HIV/TB co-
infected persons identified and treated in FY07 was 436.
In FY08, the project will further strengthen screening and cross-referral mechanisms to the TB program and
document the progress of co-infected cases. The project has also identified government schemes that are
available in the areas in which they operate and will link beneficiaries with some of the resources offered by
them.
The PCI project provides pre-test, post-test and follow-up counseling through its mobile clinic and home-
based care team, with follow-up counseling at PCI-supported community centers. The PCI medical team is
responsible for drawing blood and links with the National AIDS Research Institute for blood tests. FY08
funds will support an estimated 4,400 persons to receive CT services.
Counseling and testing (CT) for HIV/AIDS will be provided through the mobile clinic and the multi-purpose
community-based centers.
ACTIVITY 1: Providing Counseling and Testing Services.
Direct services will be provided by the PATHWAY project through its mobile clinic, staffed by the home-
based care team and at PATHWAY's community-based centers. VCT services include provision of pre-test,
post-test and follow-up counseling, drawing of blood samples by paramedic staff, coordination with the
Government of India supported National AIDS Research Institute (NARI) for testing of blood in Pune (NARI
provides this service free of cost and it is a more sustainable option) and referral linkages with the GOI's
Integrated Counseling and Testing Centers. Outside Pune, PCI uses rapid tests, with quality control through
cross-checking of samples in government facilities. In FY08, it is estimated that 3,500 persons will access
VCT. The contents and approach of counseling will be adapted to the needs of clients and is different for
individuals, couples (concordant and discordant sero-status), families, men, women and children. The
project will train counselors and provide ongoing support and supervision.
The Home Based Care team is comprised of a doctor, nurse, counselor, and social worker, and is
supported by the community health workers and peer educators. The front-line of home-visit support is the
peer educator, with medical staff, counseling staff, and others called in as needed. Professional
counselors, social workers, CHWs, and PEs conduct follow-up counseling at all PATHWAY-supported
community centers.
ACTIVITY 2: Increasing Demand for CT
The project's community-based approach creates an environment in which community members are
motivated and supported to find out their status, access health care and other support services, and link up
with other HIV positive people. Demand for CT will also be generated through public awareness campaigns,
sensitization of key stakeholders, strengthening outreach activities, improving the quality of service, client
centered and client friendly approaches, improving access to care and forming referral linkages.
Strategic Information Strengthening has been a strong component of PATHWAY's program from the start.
Data on PLHA activities, referrals, and clinical and psychosocial use of services are available from to
demonstrate the reach and range of the PATHWAY project. PCI will also continue to assist NACO and the
SACS in developing stronger epidemiological and Monitoring and Evaluation (M&E) systems supporting and
mentoring staff seconded to those organizations.
This activity contributes to the National AIDS Control Program Phase 3's (NACP -3) objective to strengthen
the nationwide Strategic Information Management System.
ACTIVITY 1: Strengthen Strategic Information in the National AIDS Control Organization (NACO) and the
SACS
Under the National AIDS Control Program Phase 3 (NACP-3) beginning in 2007, the goal is to halt and
reverse the epidemic in India over the next five years by integrating programs for prevention and care,
support and treatment. NACP-3 has four strategic objectives, one of which is strengthening a nation-wide
strategic information management system.
In May 2007, in close coordination and with guidance from CDC/India, PCI signed a one-year contract to
provide technical assistance for institutional strengthening of NACO, The technical assistance focuses on
strengthening effective management and implementation of NACP-3, and improving NACO's role and
function vis-à-vis its counterpart State AIDS Control Societies (SACS). Through HHS/CDC support, PCI will
continue to support staff at the national and state level, including epidemiologists, M&E officers, and
program officers. PCI will also provide close supervisory and mentorship support to these consultants.
Activities in this program area focus on technical assistance (TA) for HIV-related policy development and
HIV-related institutional capacity building. Project Concern International (PCI) will support consultants to
the National AIDS Control Organization (NACO) to assist with capacity building at the district and
community level, and will build the capacity of local organizations.
This activity contributes to the National AIDS Control Program Phase 3 (NACP-3)'s objective of
strengthening infrastructure, health systems and human resources in prevention, care and support, and
treatment programs at the district, state and national level.
ACTIVITY 1: Consultant Support to NACO for Program Management and Training
The PATHWAY program continues to evolve as a builder of organizational capacity and provider of
technical assistance and training. As noted under the Strategic Information narrative, PCI is supporting
several consultants to NACO in various program areas, including epidemiologists, monitoring and
evaluation officers, and program officers. PCI will also continue to assist with capacity-building at the
district and community level for a wide array of government, NGO and private sector players in HIV/AIDS
prevention, care and support. For example, several of PCI's trainers, who are working as field managers
and officers for the program in the Northeast and the South, are frequently called on to conduct training
programs for the State AIDS Control Societies (SACS), municipal government, and local NGOs.
ACTIVITY 2: Building the Technical Capacity of Local Organizations
PCI, in collaboration with I-TECH, developed and pilot tested training manuals in home-based care. These
training modules have been adopted by all nine of PCI's sub-partners and are also being used at the
national level. Given the high demand and need for training, this component of the program will be
strengthened and expanded: in FY08 54 local organizations, who are sub-partners of the Clinton
Foundation's Children Living with AIDS Initiative, are expected to be trained using these materials. In FY08,
the PATHWAY program will also emphasize building linkages and providing training opportunities in home-
based care and support for the SACS and the District AIDS Prevention and Control Units (the new district-
level HIV/AIDS management bodies, under NACP-3).
ACTIVITY 3: On-Site Learning
The PATHWAY projects in Pune and Salem have over a period of time gained experience in capacity
building for a variety of stakeholders. The community centers in these locations are increasingly requested
by the SACS and partner NGOs to provide on-site learning experience and training and are evolving into a
regional capacity building and immersion learning site. This role is expected to be further developed with
FY08 funding.
