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 2012
The Department of Defense (DOD) has worked with the Indian Armed Forces Medical Services (AFMS) since 2004 to strengthen the AFMS's existing program that provides HIV/AIDS prevention, care and treatment services to military personnel and their families. As with many militaries worldwide, the Indian Armed Forces personnel are an at-risk population since soldiers are generally young, mobile, separated from their families, and exposed to commercial sex workers. With a troop strength of nearly1.3 million, troop turnover, and an annual recruitment of 80,000 new recruits and their accompanying family dependents who are new to the military community, it is critical for the AFMS to develop a sustained HIV prevention, care and treatment program which can be accessed by military personnel and their families.
Key Ongoing Activities:
? HIV Education Program - AFMS supports an education program that trains peer leaders and counselors and produces and distributes IEC materials. Master Peer Leader Educators are trained through Train the Trainer workshops. They then train additional peer educators reaching at least 30,000 soldiers, dependents, and civilians through a "cascade" process. IEC materials are used in conjunction with counseling and discussion of life skills, including the importance of abstinence and/or fidelity, addressing gender stereotypes, male norms and behaviors, reduction in violence as well as stigma and discrimination. Modules. These materials are expected to reach over 40,000 soldiers through 93 IEC nodes as well as through peer educators and Integrated Counseling and Testing Centers. The IEC and training materials are military specific and conform to national guidelines.
? HIV/AIDS Treatment and Care Workshops for Healthcare Providers The AFMS has an on-going treatment and care program. The DOD supports four-day workshops for health professionals that focus on recent trends in prevention and treatment strategies for HIV patients in the civilian and military sectors. DOD also supports procurement of disposable medical supplies, including CD4 and Opportunistic Infection kits, so providers will have critical medical supplies for patient treatment and care.
? Laboratory Equipment and Maintenance The DOD supported AFMS by providing CD4 machines and testing equipment. Currently, DOD collaborates with AFMS to keep the equipment operating at full capacity, with a goal to transfer the titles of all equipment to AFMS. DOD will procure items such as FACS Count Reagent Kits and other disposable supplies required for continued equipment operation.
? Integrated Counseling and Testing Centers (ICTCs) AFMS is in the process of mainstreaming support for staff in their ICTCs. Initially established with support from NACO, the AFMS plans to initiate a limited expansion of these centers and assume the costs of training and supporting their staff. DOD will collaborate with AFMS to support these centers through a cost-sharing process as they transition to being fully integrated in the AFMS system.
? Monitoring and Reporting these ongoing activities will measure the impact of various prevention, care and treatment interventions conducted over the past three years and will awareness of and commitment to the importance of regular data collection, monitoring, reporting, and evidence-based planning.
Project Achievements and Innovations:
? Upgrading of key AFMS laboratories through provision of machines and test kits to expand HIV testing, clinical diagnosis of HIV/AIDS, and assessments to facilitate ongoing treatment of HIV positives
? Collaboration to support production of IEC materials and training for the AFMS's HIV training program that reaches around 40,000 troops and their families each year
? Support for military-to-military exchange through participation of AFMS staff in regional and global workshops and conferences on HIV/AIDS
? A significant innovation is the ongoing mainstreaming of Integrated Counseling and Testing Centers into the regular services of the AFMS. Under this system, the ICTCs will continue to be staffed by civilian counselors and laboratory technicians, who will be trained and supported directly through the AFMS.
CONTINUING ACTIVITY - NEW ACTIVITY NARRATIVE
SUMMARY
Activities under Adult Care focus on strengthening the human resource capacity of the Indian Armed Forces Medical Services (AFMS) to provide a high quality of health care and support to HIV-positive soldiers and to ensure that the AFMS has the critical medical supplies available while providing care and treatment services. These activities are a continuing collaboration between the US Department of Defense (DOD) and the AFMS to improve the human capacity to address HIV care and treatment at military medical facilities and ensure the availability of key medical supplies. DOD will continue to work closely with the Indian AFMS to improve and enhance the skills of healthcare providers, (including doctors) to manage, care, treat, and monitor HIV patients who are on antiretroviral treatment (ARV). DOD will procure medical supplies in consultation with AFMS.
ACTIVITIES AND EXPECTED RESULTS
The goal of the training workshops in treatment, care and support is to build the human resource capacity of military medical officers, nurses, and paramilitary medical personnel so that they are better able to care for and treat HIV-positive military staff and their families. Past HIV care and treatment workshops focused on topics that included medical adherence, post diagnosis counseling and psychological support.
ACTIVITY 1: HIV/AIDS Treatment and Care Workshop for Healthcare Providers
AFMS will continue to develop, refine, and implement the HIV care and treatment trainings. Two training workshops will be executed. These four-day workshops will focus on recent trends in prevention and treatment strategies for HIV patients in the civilian and military sectors. As in previous training, workshops program will includes sessions on "Antiretroviral Therapy Case Studies," "Monitoring Antiretroviral Therapy: Practices and Problems, " "Emerging Toxicity Syndromes in HIV in HIV Infection, " "Recent Concepts in Drug Resistance and Strategies to Maximize Drug Compliance." Building on past workshops, with FY09 funds, AFMS plans to carry out similar workshops for healthcare providers who did not attend the previous two workshops. At least 60 military medical providers will be trained.
Activities under Adult Treatment focus on strengthening the human resource capacity of the Indian Armed Forces Medical Services (AFMS) to provide a high quality of treatment to HIV-positive soldiers and to ensure that the AFMS has the critical medical supplies available while providing treatment and care services. These activities are a continuing collaboration between the US Department of Defense (DOD) and the AFMS to improve the human capacity to address HIV care and treatment at military medical facilities and ensuring the availability of key medical supplies. DOD will continue to work closely with the Indian AFMS to improve and enhance the skills of healthcare providers, including doctors, to manage, care, treat, and monitor HIV patients who are on antiretroviral treatment (ARV). DOD will procure the medical supplies in consultation with AFMS.
This activity area supports the training workshops in treatment, care and support that will be carried out by the AFMS. The purpose is to build the human resource capacity of military medical officers, nurses, and paramilitary medical personnel so that they are better able to treat and care for HIV-positive military staff and their families.
ACTIVITY2: Procurement of Disposable Medical Supplies for AFMS Medical Facilities
In consultation and coordination with the AFMS, the ODC will facilitate the procurement of disposable medical supplies, including CD4 and Opportunistic Infection kits so providers will have critical medical supplies for patient treatment and care. Once procured, the medical supplies will be given to the AFMS to distribute to military medical facilities. AFMS will report on the military medical facilities that benefit from the supplies and on usage. Funds will also support technical support and travel as required. At least four military medical facilities will benefit from these supplies.
DOD will continue to support VCT training for HIV counselors and procurement of HIV test kits and other disposal medical supplies. The COP will also support a new VCT activity: funding will be provided to the Armed Forces Medical Service (AFMS) to assist in maintaining and expanding its Integrated Counseling and Testing Centers (ICTCs). Support for the ICTCs will bridge the budget gap until AFMS can fully finance these centers in FY 2013; support will help to offset the costs of limited expansion of the ICTCs to key military service hospitals.
AFMS has conducted several successful counseling workshops, supported by PEPFAR. Over 185 military personnel and civilian staff serving the military community have been trained. As military staff is mobile and routinely reassigned, continued training is required to build the skills of new personnel, and in some cases to refresh the knowledge base of others. DOD in consultation with the AFMS, the US Embassy/Office of Defense Cooperation (ODC) in New Delhi has procured test kits and other medical supplies in previous years with PEPFAR funds. These activities remain an important part of the military to military partnership in the VCT arena and will continue in FY09 and FY10.
Support of AFMS' ICTCs is a new activity. Programming in this area reflects a significant change in the DOD component of PEPFAR COP FY10. COP funding will further develop the human resource capacity of AFMS by training and supporting staff at existing and additional ICTCS. We expect that the 20 existing centers will remain open at full operating capacity and at least 10 new centers will be opened. We expect AFMS to gradually increase its share of funding until it eventually retakes full control by FY 2013.
This increase has been proposed in consultation with AFMS and reflects growth in the program and a plan to eventually transition the program to full ownership by AFMS by FY 2013. In FY09, $220,000 of PEPFAR funds will support training and the ICTCs; $30,000 will be used for the procurement of test kits and other disposable medical supplies. In FY 2010, DOD will propose decreasing the HVCT program area by $50,000 a year until AFMS has full budgetary ownership of its ICTCs in FY 2013. This transition is necessary because MOD's budgeting process has not been responsive enough to respond to this shortfall in the short term. AFMS is confident that the MOD budgeting process will respond according to the new schedule. ICTCs are such a central part of the shared goals of AFMS and PEPFAR that it is essential to keep them developing according to existing plans despite this temporary setback.
ACTIVITY 1: Counseling and Testing In-Service Workshop
AFMS will execute one counseling and testing in-service workshop. As note, military staff is mobile and routinely reassigned, and continued training is required to build the skills of new personnel, and to refresh the knowledge base of others. At least 45 counselors, serving the military community will receive this training.
ACTIVITY 2: Support for Salaries of ICTC Staff
DOD will support ICTC staff with AFMS, through ODC/DOD support to AFMS. Twenty existing ICTCs will be supported and at least 10 more ICTCs will be opened with cost-shared resources.
The request to support the ICTCS is due to a major shift in National AIDS Control Organization (NACO) funding. NACO previously funded the salaries and training of the AFMS' ICTC staff, however, as part of its drive to mainstream HIV/AIDS program activities within relevant ministries, AFMS no longer receives NACO funds to carry out HIV/AIDS prevention, care, and treatment activities. Consequently, no staff support is provided for the AFMS's ICTCs. The AFMS identified support for the existing ICTCs and the planned expansion of these centers as a priority for developing and maintaining a successful military HIV/AIDS prevention program. Therefore, the DOD PEPFAR program proposes providing significant support to the AFMS to help offset the costs the ICTCs for a limited time. This will allow the ICTCs to continue to provide services at full capacity, as the AFMS develops a plan to fully fund them and initiates a limited expansion of these centers within key military hospitals.
While AFMS will still cover some of the costs of the ICTCs, the increased support is essential in sustaining the present level of service and ability to provide essential HIV testing, counseling and care. Without increasing support, ICTCs will face an uncertain fate, which will significantly setback AFMS' HIV/AIDS program as a whole. ICTCs are often the first step in determining HIV status, receiving and distributing IEC and BCC materials to service members and, as required, linking into AFMS' care and treatment activities. Support and eventual expansion of ICTCs to the military service hospitals will broaden access to voluntary counseling and testing (VCT) while also increasing demand for and awareness of HIV/AIDS prevention. These activities contribute to PEPFAR goals by improving access to and quality of VCT services in order to identify HIV-positive persons, increasing the number of health care workers trained in the provision of Parent Mother to Child Transmission (PMTCT) services, increasing the number of service outlets providing HIV-related care and support, increasing the number of individuals who receive counseling and testing for HIV, increasing the number of individuals trained in counseling and testing, and strengthening the overall heath system of the Indian Armed Forces.
ACTIVITY 3: Procurement of Test Kits and Supplies
DOD will coordinate the procurement of rapid test kits and medical supplies; AFMS will receive the medical supplies and distribute throughout the military health care system. At least, eight military facilities will receive test kits and supplies.
NEW ACTIVITY NARRATIVE: CONTINUING ACTIVITY
The objectives of this activity are to monitor and assess the effectiveness of the ongoing military HIV/AIDS prevention program, identify areas requiring additional support and greater attention by the Armed Forces Medical Service (AFMS) to improve its data collection and analysis capabilities. Support will be provided for the development, design, and implementation of a further mid-program review. A first mid-program review is currently underway, and its results will inform and guide the development and implementation of this second review, which will be implemented in 2011. Although this is not an annual request, it is anticipated that there will be additional efforts to collect and analyze data regarding the overall DOD PEPFAR India program to ensure that program activities are achieving expected results.
This activity will allow for a further mid-program review by funding a KAP survey to be implemented in 2011, similar to the one being conducted in late 2008. The results of this review will allow DOD and AFMS to assess the effectiveness of specific DOD PEPFAR/India program activities and help guide future programming. This activity builds upon and further develops AFMS's capacities to monitor, evaluate, and manage information, as well as perform situational analysis and evidence-based planning. These capacities improve health system management, and strengthen information systems and AFMS's overall monitoring and evaluation.
ACTIVITY 1: AFMS Behavioral Survey
In coordination with DOD, AFMS will conduct a behavioral survey aimed at developing the ability to follow health status, knowledge, attitude and practices (KAP). This will be similar to the survey implemented in August 2008, at the time of the review of the PEPFAR program with AFMS. One challenge that this activity faces is the sensitivity of the survey findings. The Indian Armed Forces are not eager to share information concerning their readiness and other related issues for security reasons. This challenge can be overcome through maintaining the strong, trusting relationship with key leaders at AFMS that DOD currently has. Obtaining agreement on how survey data will be released and used prior to survey review will be facilitated by DOD. While these surveys are not an annual request, it is anticipated that they or similar reviews will be used again at some point in the future.
ACTIVITY 2: Monitoring and Reporting
DOD will monitor and report on the implementation of the military component of the PEPFAR program. Some information will be taken from response to the KAP survey which will ask survey participants about IEC materials reach, utilization, comprehension, and peer education sessions. Monitoring and reporting on technical assistance will also be carried out.
Three results are expected from the Strategic Information program component. First, it will help measure the impact of various prevention, care and treatment interventions conducted over the past three years. Second, it will identify areas needing additional support. Finally, it will contribute to the sustainability of the program by further increasing awareness of and commitment to the importance of regular data collection, monitoring, reporting, and evidence-based planning.
The objective of this activity is to support the Armed Forces Medical Service's (AFMS) expanding HIV/AIDS prevention program. This will be achieved by providing support for the production and distribution of IEC materials for the armed forces and support to the Training of Trainers (TOT) program for secondary school children in Ministry of Defense (MOD) schools. These efforts build on past successes of the production and distribution of IEC material for the armed forces and continue support for HIV/AIDS prevention training for MOD secondary school students. Given the high priority that AFMS places on HIV prevention programs, this activity is a priority for the foreseeable future.
ACTIVITY 1: TOT program for secondary school children
AFMS will cost share to expand the TOT program to secondary school children in Ministry of Defense (MOD) schools. The life skills TOT program for secondary school children has been developed by AFMS in consultation with MOD school leaders, the National AIDS Control Organization (NACO) and local non-governmental organizations. The curriculum will be based on principles whose efficiency has been proven.
ACTIVITY 2: TOT Peer Education Workshops
Building on the HIV prevention education component for MOD-operated schools (funded by PEPFAR in FY08), AFMS will coordinate and execute TOT workshops designed for adolescents, focusing on life skills, gender stereotypes, and addressing male norms and behaviors to reach a minimum of 500 secondary-school children. In order to reach 500 school children, AFMS will train a minimum of 50 secondary school children to be master peer educators. These 50 master trainers will then train an additional 10 students. This is an activity that has been specifically requested by AFMS. We do not plan to report any targets under this technical area since most of the outreach for this population is with AFMS support and the trainings and materials are co-sponsored by the USG.
The objective of this continuing activity is to create a core group of Master Peer Leader Educators whose work spreads HIV/AIDS education within the Indian Armed Forces (IAF) and throughout soldiers' native communities as well. Peer leader education activities extend beyond improved knowledge and awareness to focus on changing norms of male behavior, reducing sexual violence and coercion and decreasing stigmatization and discrimination. This is accomplished through Training of Trainers (TOT) workshops, which will build on the success of workshops held over previous years. These workshops are an essential part of the Armed Forces Medical Service's (AFMS) HIV/AIDS prevention program and the DOD partnership with AFMS, and it is expected that HIV/AIDS peer leader education will continue for the foreseeable future. The activity is linked with the peer leader education activities, the counseling and testing activities, and the adult care and treatment programs and with the training workshops.
HVOP builds the human resources capacity of AFMS through peer leader education workshops.
This is a continuing activity from FY09 that is being modified as a result of a mid-program review and the pending results of an AFMS knowledge, attitude and practice (KAP) survey. IEC materials will be produced and distributed to support the broader objectives of AFMS's HIV prevention program.
ACTIVITY 1: Production and Distribution of IEC Materials
AFMS has trained and will continue to train peer leaders and counselors who facilitate the dissemination of IEC materials in conjunction with counseling and discussion of life skills, including addressing gender stereotypes, male norms and behaviors, reduction in violence as well as stigma and discrimination. This is an activity that has been specifically requested by AFMS. These materials are expected to reach over 30,000 soldiers through 93 IEC nodes as well as through peer educators and Integrated Counseling and Testing Centers.
AFMS will update the IEC materials based on a curriculum with a proven ability to reach soldiers and their families across India. The program will support the production and distribution of these materials.
ACTIVITY 2: Training of Trainer (TOT) Workshops
The AFMS will execute five TOT workshops that will train over 300 Master Peer Leader Educators. Each Master Peer Educator will then train an additional 10 peer educators for a total of 3,000 peer educators. This learning will 'cascade' down through the peer leaders reaching at least 30,000 soldiers, dependents, and civilians. The modules and IEC materials for peer leader education trainings are military specific, based on successful materials with proven efficiency and that conform to national guidelines. To support and ensure proper implementation of workshops, AFMS conducts pre and post-workshop knowledge assessments. Workshop participants will be provided with IEC materials to use and distribute when they return to their respective postings and speak on HIV/AIDS. It is expected that these workshops will reach the desired amount of people. Follow-up reviews will inform whether the desired effect of reaching beyond the peer leaders and their peers has been achieved.
Past workshops have included skits performed by local NGOs that demonstrate the roles and responsibilities of peer leaders, visits to local hospitals and clinics, testimonials of People living with HIV and AIDS (PLWHA) to reduce stigmatization and discrimination, practice sessions where peer educators practice being peer leaders, and question and answer sessions where soldiers are given real life choices and decisions facing soldiers and their dependents. Workshops also use videos and media to reinforce key messages and behavioral change objectives.
The workshops are designed to have an impact far beyond their immediate participants. First, those trained as Master Peer Leader Educators are specifically assigned to train 10 others when they return to their bases and these 10 each train another 10. Additionally, HIV/AIDS prevention activities have an all-India impact as soldiers come from all areas of India and are instructed to take Behavioral Change Communication (BCC) messages back to their local communities and villages.
The objective of this program area is to support the Armed Forces Medical Service (AFMS) in maintaining a comprehensive HIV laboratory capability within its health care system. This will be accomplished through the purchase of disposable laboratory supplies such as reagents and maintenance/service support for previously purchased equipment. This will build upon previous success in helping AFMS establish its current level of laboratory capabilities. The program will strive to transfer equipment titles to AFMS and seek alternative support to ensure laboratory maintenance and laboratory supplies.
The procurement of much needed laboratory equipment and consumables for use in AFMS facilities has continued for several years. This activity has evolved and matured to the point where new equipment is no longer a priority, but maintaining existing equipment is a present challenge because DOD still holds the titles to the laboratory equipment. This prevents AFMS from handling the maintenance itself. (The USG hand-receipt laboratory equipment is housed at AFMS laboratories and is used by AFMS staff in support of HIV/AIDS prevention.)
The biggest challenge this program faces is transferring the titles of previously purchased laboratory equipment to AFMS. There are a number of bureaucratic obstacles to this on both the US and Indian sides. Steps are being taken to remove these obstacles, but until this is done stopgap measures will be required to keep the equipment functioning. Nonetheless, we do anticipate overcoming these obstacles within the next two years for all procured equipment and transitioning this program to full AFMS control, while continuing to fill the gap in needed kits and consumables from PEPFAR funds.
ACTIVITY 1: Procurement
Working in consultation with the AFMS, DOD will procure items such as FACS Count Reagent Kits and other disposable supplies required for continued equipment operation.
ACTIVITY 2: Laboratory Equipment Maintenance
It is expected that this activity will keep all previously purchased equipment operating at full capacity to allow AFMS to maintain the effectiveness of its HIV testing operation.
The long-term goal is to transfer the titles of all equipment to AFMS, but until that time it is crucial that the equipment is maintained and serviced so that the labs remain fully operable. In working to transfer ownership, DOD seeks to ensure that all equipment is in working order. Working in consultation with the AFMS, DOD will procure laboratory equipment maintenance service contracts that will extend the life of previously procured equipment.
AFMS cannot repair or maintain equipment that it does not own due to MOD constraints. Of the requested $40,000, $10,000 will cover the cost of maintenance and $30,000 will go to short-term procurement.
