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.
The funds will be used to fund the current USAID contract will MEDS to provide additional ARVs and drugs for opportunistic infections to over 75,000 patients on ART in Kenya as the mission completes the solicitation and award of a follow-on contract to procure ARVs and drugs for opportunistic infections in the remaining part of the Emergency Plan.
Table 3.3.06:
Need Narrative.
Table 3.3.11: Program Planning Overview Program Area: HIV/AIDS Treatment/ARV Services Budget Code: HTXS Program Area Code: 11 Total Planned Funding for Program Area: $ 73,284,974.00
Program Area Context:
Key Result 1: Direct support of ART for 158,000 people, including 22,000 children, and indirect support for an additional 10,000 people Key Result 2: Improved linkages between treatment sites and strengthened referral systems based on the network model Key Result 3: Classroom and practical training in adult and pediatric HIV treatment using national training materials coordinated through the National AIDS and STD Control Program (NASCOP) Key Result 4: Coordination with other donors including the Japan International Cooperation Agency and the UK Department for International Development to improve infrastructure Key Result 5: Continued support for critical staffing requirements to improve quality of care
CURRENT PROGRAM CONTEXT Kenya has rapidly expanded HIV care and treatment services in the last two years, increasing the number of Kenyans receiving antiretroviral therapy (ART) from 24,000 in September 2004 to 72,000 in March 2006 at 205 sites. 60% of sites are Government of Kenya Ministry of Health (GOK/MOH) facilities. At present, 80 sites (~40% of all treatment sites) have started ART in over 5,000 children. In FY 2007, the total number of Kenyans receiving ART will increase to approximately 158,000 (including 22,000 children), the number of ART sites will plateau at about 400, and the number of ART sites managing pediatric care will increase to 180 (~45% of all sites). The EP will provide direct support to over 80% of the 400 ART sites and indirect support to nearly all sites. Kenya has achieved success in the development of a standard care package consisting of ART and basic health care services, outlined in Palliative Care: Basic Health Care and Support (Table 3.3.06).
NEW INITIATIVES The primary new FY 2007 initiative will be an ambitious "Prevention with Positives" (PwP) program. This will include development and implementation of a health care curriculum incorporating consistent prevention messages regarding HIV status disclosure and joint plans for preventing partner transmission for use at all treatment facilities. The curriculum and training will be based upon a successful FY 2006 pilot at Kenyatta National Hospital and Kericho District Hospital. Other initiatives will include expansion of ART to special or marginalized patients such as refugees and the mentally ill. Finally, public private partnerships will be piloted or expanded in selected sites (e.g. Aga Khan in Mombasa, sugar plantations in Nyanza Province) and facilitated between small private health outlets, known as Child and Family Wellness Shops through the Global Development Alliance.
NEW PROGRAM EMPHASES Strengthened support for health care delivery systems, including referral mechanisms, so that support provided by larger health care delivery centers enhances the capacity of associated regional health care centers will be a 2007 priority. Currently, well-defined regional networks are overseen by NASCOP Provincial ART Officers (PARTOs) who determine regional ART activities including assessment and assignment of ART centers, supervision, and coordination of forums where health care providers share experiences and obtain continuing medical education. In FY 2007, in line with the MOH Second National Health Sector Strategic Plan (NHSSP II 2006-2010), a key emphasis will be decentralization of ART services to lower level facilities for ART initiation and follow-up. Stable ART patients will be referred "down the network" to lower level facilities to decongest large hospitals and primary treatment facilities. In this scenario, a number of health centers will be strengthened to offer comprehensive HIV care and treatment services. In addition to appropriate patient referrals, EP funds will be used to develop regional activities such as quality assurance, clinical mentoring, and supervision based upon the network model.
In FY 2007 increasing emphasis will be placed on linking the network of HIV treatment sites to PMTCT and OVC programs. Currently, several PMTCT programs in the Rift Valley and Nyanza Provinces either successfully refer HIV + women to HIV treatment facilities or directly incorporate care and treatment into
the PMTCT program. These PMTCT linkages with HIV treatment will be strengthened and expanded countrywide. Similarly, HIV+ OVC will be identified in both existing and new OVC programs and referred to HIV treatment facilities for appropriate staging and treatment.
A key FY 2007 emphasis will be pediatric diagnosis and treatment. National access to and expansion of DNA PCR testing through dried blood spots for infant diagnosis will increase identification and enrollment of very young treatment candidates. A national curriculum for pediatric treatment has been developed, and 1,576 providers have received classroom training by March 31, 2006. Many providers have also received practical, clinic-focused training. Additional training, attachment, and mentorship activities will increase through the Kenya Pediatric Association.
Finally, emphasis will be given to improving community involvement by increasing the number and involvement of Persons Living with HIV/AIDS groups, psychosocial support groups, continued linkages with community education through counseling and testing, general HIV treatment awareness activities, and wrap around food programs and income generating activities.
BARRIERS ENCOUNTERED/STRATEGIES FOR RESOLUTION Key barriers include: insufficient human resources, inadequate space, limited quality laboratory services, and weak infrastructure. Most treatment sites are understaffed, and existing staff are becoming overburdened. Large treatment centers are operating in cramped conditions, and the physical structures of laboratories, pharmacies, and in-patient treatment units require substantial renovations. Ongoing resolution strategies that will continue in FY 2007 include support to the MOH to add staff (through Capacity Project) and improving site infrastructure and capacity.
Another key barrier encountered is government drug procurement, commodity management, and quality assessment. Global Fund drug procurements are beginning to materialize but GOK had announced intent to support only 42,500 patients with non-PEPFAR sources through December 2008 (but see ARV drugs program narrative for more recent promising developments, including GOK announcement of intention to cater for 34,000 patients with its own resources).
In the past, antiretrovirals (ARV) were procured without sufficient information regarding drug quality. This has been addressed by strengthening MOH capacity to evaluate ARVs both before and after procurement and this will be a continuing priority. Another related barrier is the variety of ART formulations available, which causes confusion for clinicians, pharmacies, and patients. In FY 2007, the Kenya team will work to rationalize and standardize drug provision to minimize the extent a single site has patients on drugs from multiple sources.
WORK OF HOST GOVERNMENT AND OTHER DONORS All EP activities are closely coordinated with NASCOP. Global Fund resources will support limited drug procurement; lab equipment for Provincial and District Hospitals; vehicles for supervision/program implementation; and a limited number of health care provider salaries. The World Health Organization (technical support in integrated TB/HIV activities), the UK Department for International Development (training, ART communication, and infrastructure), the Japan International Cooperation Agency (limited infrastructure improvements), Doctors Without Borders/Medecins Sans Frontieres (treatment for ~10,000 patients), and the Clinton Foundation (pediatric treatment, access to reduced prices for drugs, hiring of nurses) provide additional support for ART scale up.
Program Area Target: Number of service outlets providing antiretroviral therapy 322 Number of individuals who ever received antiretroviral therapy by the end of 190,000 the reporting period Number of individuals receiving antiretroviral therapy by the end of the 159,260 reporting period Number of individuals newly initiating antiretroviral therapy during the 83,000 reporting period Total number of health workers trained to deliver ART services, according to 3,000 national and/or international standards
Table 3.3.11:
