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.
National AIDS Control Organization (NACO) has identified priority thrust areas under its 3rd phase of National AIDS Control Program (NACP III) that includes providing high quality care, treatment and ART services within the national framework to PLHIVs that are accessible, appropriate and affordable.
Some of the major challenges faced in providing above services as the program has evolved during the program include rapid scale up of service delivery across the country, quality issues, limited skills and knowledge among practicing health-care providers, both in the public as well as the private sector. Besides, robust systems for clinical care and service delivery are lacking due to staff vacancies, supplies issues, quality issues etc.
USG will work with local government counterparts both at the State and National level and other NGO partners in fostering partnerships within the public and private sector for HIV diagnosis, clinical care services, capacity building of the healthcare staff (medical, paramedical and allied staff), private sector policies, public private partnership models, laboratory systems and innovative partnerships models.
This project will have the following key approaches:
a) Work collaboratively with the Government counterparts in providing TA in designing, planning and implementing HIV clinical care and ART service models.
b) Develop and innovate partnerships within the Public sector and PPP to strengthen and scale up HIV services delivery
c) Enhance clinical capacities among the hospital workforce for quality services delivery thro competent workforce
d) Provide high quality TA at the National and State level in establishing Centers of Excellence as tertiary centers of HIV services delivery, trainings and research.
e) Develop a unique ART program mentoring & human capacity development program
f) Systems and policy strengthening by providing consultancy, manpower and Technical assistance on a need basis at District, State and National level for Clinical services.
ACTIVITY I: Technical Support District level network (partner TBD) for institutional capacity building
In spite of several donors funding the various positive networks for programs, there has not been much emphasis on building the governance, institutional capacity financial management and vision building of these networks to cope with their program management.
Through a TBD (developmental partner), USG will focus on building institutional capacity of PLHA organizations affiliated to INP+ along with strengthening management, monitoring and evaluation and reporting systems. The activity will be within the states of Tamil Nadu, Karnataka and Andhra Pradesh.
It will explore the possibility of forming cluster level PLHA groups, who in turn will be represented in the DLN core group. This model is based on MYRADA's successful model of linking women SHGs with a community managed resource centre (CMRC). This CMRC is represented by SHG members and responds to their needs to provide services directly and arrange linkages. The model will include forming and strengthening PLHA groups at cluster level (Gram Panchayat or PHC level). The formed groups will then work with the DLN to ensure that they are adequately represented in the DLN governing structure. This model is going to be implemented in 2 districts of Karnataka in close partnership with the Karnataka Network of Positives (KNP+). In FY2010 and FY 2011, TBD (Developmental partner) and INP + will consolidate the learning from this model and determine if it can be replicated in other districts.
TBD (Developmental Partner) will also focus on strategies to strengthen the services managed by DLNs so that they function as effective community managed resource centers for their member PLHAs. Special training programs will be held for the staff of the district positive networks on palliative care programming, and how to plan and manage such a program in their network area. Included in the package will be trainings on positive prevention counseling using the USG-developed toolkit.
ACTIVITY II: Technical Support to Link Worker Program
? Link Worker Scheme - In order to reach rural Female Sex Workers (FSWs) and other high risk population in the rural areas and people living with HIV (PLHIVs) within the high HIV prevalence districts (A and B as per NACO guidelines), Link Worker Program is being implemented in the field through NGOs in the identified high risk villages in districts. The following are some important activities conducted through the program
? Core group interventions for high risk groups condoms, STI and awareness through Community Resource Persons (CRPs) and local volunteers.
? Program for adult men in informal groups and women in SHGs which includes basics of HIV and STIs for the adults, addressing stigma and discrimination, and roles of these populations in HIV prevention and care, and stigma reduction
? Youth interventions using the Celebrating Life curriculum to address life skills and role of youth in mitigating stigma and discrimination.
? Strengthening the community based institutions Gram Panchayat (GP) or the village council and Village Health and Sanitation committees (VHSC).
? Gram Panchayat sensitization programs in high risk villages
? Capacity building of VHSCs in collaboration with NRHM program
? Community based care and support for PLHAs and OVCs
? Counseling and Testing through Mobile Teams at select remote PHCs
The Link Worker program activities cuts across several program areas including PMTCT, TB/HIV, abstinence and being faithful, other sexual prevention, adult care and support and health system strengthening. It covers the adult men, women, youth, pregnant women, high risk groups, PLHIVs and OVCs in the village, as well as the VHSCs and Gram Panchayats. The other program areas also highlight specific activities being carried out through the Link Worker program.
MYRADA had developed a detailed strategy document to explain its processes in the Link Worker Program since the NACO operational guidelines did not have the "how" to implement details. This program is being implemented in 3 phases:
a. an initial 2 year phase of preparing the community and service delivery points;
b. a one year consolidation phase of strengthening the local structures in the community
c. a one year handing over and withdrawal phase
In order to ensure that the program does get integrated with the government-run general health delivery and social development system in the field, it is important to continue this activity in some districts and provide high quality intensive Technical Assistance to NGOs working in other high prevalent districts across the country.
Through a TBD (developmental partner), the following field level activities will be carried out in the demonstration sites
Working with High-Risk Groups: These high risk groups comprise female sex workers, men who have sex with men, IDUs and regular clients of sex workers. There is a focus to provide one to one outreach with these groups. The Link worker ensures that all those self identified receive information on HIV and related issues to reduce the risk, get an adequate supply of condoms (directly or through condom depots), and have a medical check-up regularly to rule out STIs. All sex workers are referred for voluntary counseling and testing (VCT). This has already been initiated in all the districts and will continue in this year.
Working with adult men, women and youth: This includes specific trainings for women in Self Help Groups (SHGs), adult men and youth in the villages. These trainings were to enable them to understand the dynamics of HIV transmission and prevention, as well as to get them to address issues related to stigma and discrimination.
Strengthening the Village Community Structures and Local Governance Units: It is important to strengthening the community institutions the Gram Panchayat and the VHSC. VHSC is group of representative members from women's groups, Gram Panchayat, and the local health department are selected by the general community to take up certain responsibilities in the village including: organizing regular awareness programs, setting up and maintaining condom outlets, addressing HIV facilitating co-factors such as alcohol abuse, and providing support and linkages to Most At Risk Populations and PLHAs. All Gram Panchayats and VHSCs in the high risk villages in the high HIV prevalence districts will undergo a standardized training and then have regular monthly meetings. This activity will be linked with advocating for policies on the formation of these sub committees with the Rural Development and Panchayat Raj Ministry.
Capacity Building of Outreach Staff Working with Most at Risk Populations: This is important to ensure all Link Workers and supervisors are equipped with knowledge and skills to address all high risk groups in the villages.
Summary
The Government of India had in 2007 revised the National estimates for prevalence of HIV/AIDS. At 0.33 percent among the adult population the estimated adult population living with HIV/AIDS is estimated to be about 2.5 million.
National AIDS Control Organization (NACO) has identified priority thrust areas under its 3rd phase of National AIDS Control Program (NACP III) that include, MARPs saturation, rapid scale up of services, improved program management systems, decentralization of program implementation and management to the district level, strengthened data, strategic information management systems and with a focus on access to quality services, mainstreaming of HIV services to other Health and non-health departments and integration with the existing General Health care delivery services.
One of the major challenges faced during the evolution of the program has been the limited skills and knowledge among practicing health-care providers, both in the public as well as the private sector. Besides, robust systems for clinical care and service delivery are lacking due to staff vacancies, supplies issues, quality issues etc.
To add to the challenges in the health care services delivery, in India, significant level of health services (60%) are sought in the Private sector that has remained untapped and unmonitored, with HIV/AIDS care and ART treatment services too being constrained by insufficient access to entry points, low treatment literacy among health workers and the general population, stigma and discrimination among the providers being high as well as non-uniformity of services and non-conformity to the national strategies, lax or lack of systematic reporting systems in the private sector data generation and lastly challenging compilation and reporting.
To address the above USG PEPFAR lists to implement following activities in the priority States and at the National level.
Activity 1: Technical Assistance and Support to Centers of Excellence at the National level
The agency to partner with State and National government counterparts to provide technical support in the form of direct skilled manpower who are placed as Technical Consultants at the Centre of Excellence (COE) or an organization to organization TA. Based on program priorities and COE needs this support will be in critical areas of Care and Treatment services delivery, trainings and TA for operational research within the COE. This will aim to improve and strengthen the systems within the CoE for high quality program implementation, monitoring and review of the care, Support and Treatment components in line with the national guidelines under NACP III. The broader goal of this will be to establish sustainable systems with adherence to national guidelines and build in-house capacities of the Govt. and Program staff through mentoring, on-the-job training assistance and supportive supervision.
Some key areas that will be focused on:
a. Logistics and Supply Chain & Systems management including Patients flow management; Supplies, Logistics & Inventory; Staffing / HR & performance / turn-over issues; Coordination /Liaising aspects between various hospital departments housing ART centers with Laboratory and other clinical departments and administrative wings.
b. TA for clinical aspects including quality of HIV care which includes both first line and Second line ART, adherence issues, switch of regimen, TB-HIV; infection control, lab upgrades, infection control and waste management, QA issues in diagnosis, treatment and care.
c. Facilitating staff capacity development thro Trainings for the various cadres of health care providers including Medical Graduates, Interns and Post Graduates.
d. Initiate other academic programs around the CoE for HIV/AIDS such as: Fortnightly journal clubs; Monthly CMEs; Monthly Grand ID rounds; periodic thematic integrated teaching sessions; periodic Guest lectures etc
e. TA for Operational Research
f. Provide TA in setting-up an HIV hotline for PLHIV support.
g. Will coordinate with the COE to initiate the State and / or National level HIV conference once in two years with multi-partner support, funding & NGOs
h. Will give TA to establish Virtual Resource Library utilizing the funds of COE
i. Will provide TA support to establish a Strategic Information Management Unit - basically a data management systems support at CoE level
Activity 2: Technical support to States and NACO for strengthening and providing high quality HIV care, treatment and ART services within the National program
Direct TA through consultants as technical experts, as well as organization to organization support at State and National level to build local internal organization staff capacities in planning, execution, reviewing and monitoring of Care, Support, Treatment and ART services delivery.
Specific activities within this support include: 1) building interest in evidence-based program planning with a primary focus on the Treatment outcomes which will include both first line and Second line ART; 2) Review the data from the ART, Community Care Centers and Link ART with APSACS staff, relevant NGOs, and district staff for timely program modification and decision making; 3) integrating the data from the CCC, ART and the Link ART centers for a definitive outcomes from the ART program implementation; 4) Take lead in coordinating the activities in The COE as per the National Guidelines of COE; 5) Evaluate the functioning of the CCCs ,ART centers and Link ART centers in the State along with the Care Support and Treatment team of SACS and; 6) Disseminating critical operational issues based on the evidence from the field to opinion leaders and program managers.
Activity 3: Technical support for enhancing clinical capacity for HIV care and treatment services providers e.g. Doctors, Nurses both in the Public and Private sector
In India HIV/AIDS care and treatment services continue to be constrained by insufficient access to counseling and testing services, due to the low treatment literacy among health workers and the general population, stigma and discrimination among the providers being high as well as in Private sector, non-uniformity of services and non-conformity to the national strategies, lax or lack of systematic reporting systems in the private sector data generation and lastly challenging compilation and reporting.
To bridge the HIV skills and knowledge gap among practicing health-care providers both in the Public as well as Private sector, in-service HIV training courses will be undertaken as an immediate response to an acute need for rapid HIV prevention, care, and treatment scale-up, training needs have evolved over time. Training programs with innovative, feasible and acceptable methodologies need to be built to provide sta? with regular updates on HIV knowledge into in resource-limited settings.
Activity 4: Integration of Private sector HIV services delivery models into the National program including those for diagnosis, care, treatment and ART
To establish and strengthen a meaningful role for private sector involvement in HIV/AIDS services delivery more effectively to address the issues and needs at the State as well as National level particularly relating to Care ,Support and Treatment. The purpose is to work in tandem with the local host Government State AIDS Control Society (SACS) and NACO to expand HIV/AIDS program interventions in the Private sector systematically and in an all inclusive manner bring the private sector into the fold of the public sector for delivering standardized HIV services as per the National guidelines.
This activity will also specifically facilitate networking of engaged and interested Private sector institutions to conduct training programs at the district level for physicians and nurses to manage PLHIVs in the private sector without stigma, Discrimination or Denial.
Activity 5: Establish ART centers under the partnership model
Concerted evidence based efforts to creatively advocate for and establish ART centers in the Private medical institutions as per the national protocols with funding support from the Government leveraging the existing resources from the Private sector, particularly to reach to the significant number of PLHIVs who seek services within the Private Sector and decongest the ART centers in public sector in order to enhance the quality of clinical services.
Activity 6: Establish and Operationalize of Link ART centers (LACs)
Will provide technical Assistance to the staff of LACs in terms of onsite mentorship and one to one interactions to tide over potential technical as well as operational barriers for implementation of quality program. The centers will be established in the existing Health system utilizing the services of existing human Resources the main obstacle would be lack of technical capacity of the staff in managing PLHIVs including OI and ART, Stigma and Discrimination, Documentation and data Management and weak supportive Supervision systems due to rapid scale up. On site mentoring would be the key strategy to establish LACs with TA addressing the above issues.
Activity 7: ART Training fellowship for in-service ART Medical Officers in the National program
There is an urgent need for trained quality ART clinical service providers, with the rapid expansion of ART centers undertaken by National AIDS control organization. To improve the quality of services in these ART centre, there is a requirement of a long term in-service training and mentoring. Long term training and follow up of ART Medical Officers is envisaged through a clinical fellowship planned as an on-the-job training for the ART Medical Officers who will come for regular contact sessions which will include theory lecture as well as intense bed side clinical teaching and soft skills. Also included will be field based / center based assignments to them to work in their respective ART centers e.g. on their routine data etc. This program will not only build individual capacities but will also establish institutional systems.
Summary:
This project is mandated with a major goal of building organizational capacities through policy and systems strengthening, capacity development of future health care providers, program staff and managers, providing technical support and sharing information at various levels.
Few key aspects prioritized under this will be training systems, policy and capacity development of staff with systems in place of quality services delivery aimed at ensure standards of care packages for PLHIVs. Also prioritized will be aspects of logistics and supply chain systems management. The program will provide the above systems strengthening support at SACS as well as NACO level, providing high quality expertise for HIV care, treatment and ART service delivery program through evidence-based program planning. Agency will be responsible for facilitating systems for enhancing clinical capacity for HIV care and treatment services providers from govt. and private sector and establishing ART centers under the partnership model. Agency will focus on integrating the ART, Link ART, CCC and ICTCs through Continuum of Care model.
Agency through the activities listed below, will aim to achieve above stated broader goals of building organizational as well as human capacity for strengthening systems for HIV programming at District, State and National level in India.
a) Logistics and Supply Chain & Systems management including Patients flow management; Supplies, Logistics & Inventory; Staffing / HR & performance / turn-over issues; coordination / liaising aspects between various hospital departments housing ART centers with laboratory and other clinical departments and administrative wings.
b) TA for clinical aspects including quality of HIV care which includes both first line and Second line ART ,Adherence issues, Switch of regimen, TB-HIV; infection control, lab upgrades, Infection control and waste management, QA issues in diagnosis, treatment & care.
c) Facilitating staff capacity development thro Trainings for the various cadres of health care providers including Medical Graduates, Interns and Post Graduates.
d) Initiate other academic programs around the CoE for HIV/AIDS such as: Fortnightly journal clubs; Monthly CMEs; Monthly Grand ID rounds; periodic thematic integrated teaching sessions; periodic Guest lectures etc
e) TA for Operational Research
f) Provide TA in setting-up an HIV hotline for PLHIV support.
g) Will coordinate with the COE to initiate the State and / or National level HIV conference once in two years with multi-partner support, funding & NGOs
h) Will give TA to establish Virtual Resource Library utilizing the funds of COE
i) Will provide TA support to establish a Strategic Information Management Unit - basically a data management systems support at CoE level
Direct technical assistance through consultants as technical experts as well as organization to organization support at State and National level to build local internal organization staff capacities in planning, execution, reviewing and monitoring of Care, Support, Treatment and ART services delivery.
Activity 7: Model for integration of HIV care services between ICTC, CCC and an ART center in two select districts
To develop a model in lines with the principle of "Continuum of Care" at the district level. The model will focus on integrating the various facility based services that exist within the National program including Counseling and Testing centers, CD4 centers, CCCs and ART. The Centre of excellence will be the nodal centre to coordinate the activities as a tertiary facility that will coordinate trainings, supervision, review and mentoring of the peripheral service delivery units.
