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.
N/A
New/Continuing Activity: New Activity
Continuing Activity:
Program Budget Code: 10 - PDCS Care: Pediatric Care and Support
Total Planned Funding for Program Budget Code: $0
Program Area Narrative:
Program Budget Code: 11 - PDTX Treatment: Pediatric Treatment
Program Budget Code: 12 - HVTB Care: TB/HIV
Total Planned Funding for Program Budget Code: $155,000
Indonesia ranks third among countries that contribute 80% of the global TB burden. The 2008 WHO Global TB Report estimates
the incidence of TB at 253/100,000. The estimated cases are therefore approximately 535,000 of TB patients all form, of which
about 240,000 are new smear positive cases. Data on HIV infection among TB cases in Indonesia is limited. WHO estimates a
conservative figure of 0.8%; thus, of the 270,000 estimated HIV cases approximately 2,895 are infected with TB annually. Since
2004, USG funds have contributed to training HIV/AIDS health providers in TB (in collaboration with Sulianti Suroso Infectious
Diseases hospital), and testing among TB patients at PPTI in Jakarta. All patients received HIV education, nearly one-third
received HIV counseling and of those, almost 98% were tested for HIV. Of the 3656 TB patients who were tested for HIV, 642
persons or 18.4% of all TB patients tested positive. Among all positive TB/HIV persons, 49.4 % people receive ART.
High defaulter rates of TB patients treated in hospitals and irrational use of first-line and second-line TB drugs form major threats
to further development of MDR- and XDR-TB. The extent of the problem is still unknown due to lack of drug resistance
surveillance data. A Central Java survey supported by USAID indicates MDR-TB represents 1.5% of all TB infection. The first
case of XDR-TB was confirmed by reference laboratory in 2007; and it is widely believed that there are many more undocumented
cases of XDR in Indonesia. The health system has poor capacity to address MDR-TB due to constraints such as inadequate
laboratory capacity and facilities, unavailability of several second line drugs to treat MDR-TB, and insufficient capacity to deliver
DOTS-Plus. In addition, weak regulations have caused second-line TB drugs to be freely available on the market, and many
specialists use these second line TB drugs in first-line TB regimens.
While TB/HIV activities have been planned since 2000, implementation of pilot programs to start TB/HIV activities has been
delayed due to a range of constraints, including competing priorities for TB case finding and Directly Observed Treatment (DOTS)
expansion. Planned strategies for TB/HIV include: CT for all TB patients in high prevalence areas and TB screening for all
diagnosed PLWA; strengthened referral systems to ensure HIV care and treatment services for all co-infected TB patients;
intensified DOTS for all PLWHA with active TB disease; and TB infection control in congregate settings where HIV is prevalent. To
date, it has been difficult to establish effective cooperation between the NTP and HIV/AIDS as well as key stakeholders at the
district level. There is a working group on TB-HIV, but it has not been effective in establishing collaboration between TB and HIV
programs. In 2003, the TB-HIV working group produced a booklet on clinical manual for the Management of TB-HIV co-infection.
Indonesia has received 2 Global Fund TB grants. GFATM R1 ($68.8 million) supports general expansion of DOTS and GFATM
R5 Grant ($69.2 million) supports MDR-TB and TB-HIV interventions. In March 2007, the GFATM programs in Indonesia were
placed under restriction by the Global Fund Secretariat for irregularities. These restrictions were conditionally revoked in August,
2007 pending completion of a number of actions to be taken by the CCM and he PRs by October 15, 2007. The restriction caused
tremendous repercussions for the national TB program and have taken some time to overcome. The recently awarded Round 8
proposal ($93 million) includes a TB/HIV component. This grants primary objectives include, health systems strengthening, quality
DOTS service expansion, patient education and community participation improvement, high political commitment achieved
through strengthening partnerships, and improved case finding and management of TB/HIV co-infected patients. Strategies
specific for TB/HIV include strengthening the collaboration between the NTP and key stakeholders at the district level and scaling-
up of TB-HIV sero-prevalence surveys. The results of these surveys will enable the NTP to define specific interventions for
intensified TB case finding in PLWHA, prevention of TB infections in PLWHA, and prevention of HIV in TB patients.
In FY08, USG has supported TB activities in Indonesia through the TBCAP cooperative mechanism focusing on assistance in
DOTS expansion, capacity-building, training at the national and district levels, and a focus on TB/HIV. TBCAP and partners will
support TB/HIV activities based on the National TB/HIV Strategy. KNCV is the lead organization; FHI, the key USAID
implementing agency for HIV through the ASA program, assumes responsibility for programming in HIV/TB.
KNCV will play a leading role to support the assessment and establishment of TB DOTS and HIV/AIDS treatment linkages in
selected hospitals while USG/AIDS supported program will support HIV/AIDS, VCT, treatment, and care linkages to well
established DOTS in puskesmas in Papua and West Papua and three CoC model facilities. surveillance system, 3 I's among HIV,
support MDR TB prevention via improvement of TB/HIV treatment, Coordination at the national, provincial, and district levels will
be supported by TBCAP partners as well. The activities will include: national TB/HIV coordination efforts; national training on
TB/HIV implementation from curricula, guidelines, SOPs development and training of the national and provincial trainers; training
in three CoC model districts and Papua/West Papua; development of a TB/HIV referral system between TB and HIV service sites
particularly in district hospitals and puskesmas; and development of national M&E TB/HIV indicators and a M&E system.
In FY08, the USG, with support from TBCAP, provided TA to the NTP to expand cross sectional TB-HIV sero-prevalence surveys
and will expand to other sites in 2007-2008. Based on the results of the TB-HIV surveys and in accordance with international
standards and guidelines for TB-HIV collaborative activities, planned activities for FY 08 include: implementing policies for "opt-
out" HIV CT of all TB patients in those areas where the HIV sero-prevalence is found to be higher than 5%; establishing referral
systems between DOTS and CT units in these areas to ensure that all TB patients are routinely offered CT; and training staff in
DOTS units on interventions for TB-HIV co-infection.
The USG is focused on integrating TB screening and treatment into a one-stop Continuum of Care (CoC) model, which includes
services such as STI, CT, and case management for PLWA. Planned activities aim to improve coordination of care in different
settings, including intensified TB case finding in PLWA; prevention of TB infection in PLWA through infection control measures;
prevention of HIV in TB patients through HIV CT; and Cotrimoxazole Preventive Therapy for patients with dual diseases.
In FY 09, with KNCV support, USG will improve coordination between the national program and the sub-national levels to intensify
TB case findings and management of TB/HIV co-infection in facilities that provide CT and ARV services. Specific activities
include: establishing DOTS Units and Hospital DOTS teams in all government and private hospitals that provide HIV treatment
and care; including TB/DOTS principles & guidelines in HIV/AIDS training curricula for doctors and paramedical staff to assure
proper identification of TB suspects and establishing effective referral systems; and assisting with the development of guidelines
for infection control in hospitals and other institutions caring for TB and HIV co-infected patients.
In FY 2009, will continue its support to the CoC model in two TB clinics, PPTI Jakarta and BP4 Semarang to implement TB/HIV
among high risk and marginalized populations, as well as TB/HIV in the prisons and IDUs. Support in FY 2009 will cover: opt-out
HIV counseling and testing for all new TB patients attending PPTI clinics; technical support and mentoring for clinical
management of TB/HIV including ART; and linkage of TB/HIV care in communities through the IA networks of HBC. As part of the
shift to systems strengthening in Papua, TB/HIV will be part of integrated service program (i.e.; TB/HIV, support HIV prevention in
DOTS clinics, PMTCT, MNCH, Malaria in Pregnancy, and Safe Water and Hygiene) in two selected districts in Papua and West
Papua (Kabupaten Sorong and Jayapura). USG will also phase out support for internal networking between the DOTS units and
the CT unit for effective clinical TB/HIV care except in the USG-supported CoC referral hospitals.
Technical areas funded with USG FY 09 funds include: screening of TB among PLWHA and early TB treatment, Cotrimoxazole
preventive therapy for all new TB patients, promotion of TB with HIV to receive ARVs, adherence support in facilities and
communities, and promotion of opt out HIV testing among HIV high risk TB patients and TB patients in Tanah Papua. USG will
continue providing funds to support technical capacity building for the TB-HIV component of the TB grants from the GFATM
Round 5 which mainly focuses on TB/HIV seroprevalence surveillance among TB patients in high burden provinces across
Indonesia. Additionally, using TB funds, USG will support development of a national TB/HIV policy as well as developing a risk
assessment tool to screen out new TB patients who have low HIV/AIDS risk and refer only those TB patients with higher risk for
HIV/AIDS CT. In Papua, USG will support screening all TB patients for HIV in 10 districts.
Table 3.3.12:
