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
THIS IS AN ONGOING ACTIVITY. THE NARRATIVE IS UNCHANGED EXCEPT FOR UPDATED
REFERENCES TO TARGETS AND BUDGETS.
The only change to the program since approval in the 2007 COP is an expansion in geographic coverage to
include Kisumu East and Nyando Districts.
1. LIST OF RELATED ACTIVITIES
ARV services (#7095)
2. ACTIVITY DESCRIPTION
UON, Department of Obstetrics and Gynecology has been supporting implementation of comprehensive
PMTCT services in Kenyatta National Hospital (KNH) and Pumwani Maternity Hospital (PMH), the two
largest maternity units in the country and has successfully integrated these services as part of routine care
for all women accessing services here. Following the country's rationalization of geographical coverage to
ensure efficient resource utilization, there has been an expansion in the program's geographical coverage
to include support to implementation of PMTCT services in Kisumu East and Nyando districts in Nyanza
Province. In FY 2008, the program will continue to support these activities and will provide HIV counseling
and testing to 43,070 pregnant women provide ARV prophylaxis to 7,262 HIV positive pregnant women. Of
these HIV positive women 1,452 will be provided with Highly Active Antiretroviral Treatment (HAART) and
3,631 will receive more efficacious ARV regimens, while 2,179 will receive the minimum intervention of sd
Nevirapine . The program will strengthen comprehensive PMTCT including couple counseling. In
strengthening the linkage between PMTCT and HIV care services, the program shall support early infant
HIV infection diagnosis by use of Polymerase Chain Reaction (PCR) for 3,631 infants and link all eligible
infants to the pediatric ART program. The program shall strengthen the post natal HIV care clinic and shall
support identified facilities to initiate this strategy. Intra-partum and immediate post partum counseling and
testing shall also be strengthened with a target of reaching 80% of all women attending delivery services at
the maternity units within the program area. Currently over 50% pregnant women admitted in the labor and
delivery units do not know their HIV status. The program will also promote couple counseling and testing to
identify discordant and concordant couples to improve primary prevention and facilitate linkage to HIV care
and treatment program for the eligible. The program will support the training of 300 service providers on
PMTCT, Rationale use of ARVs, and Data collection and reporting in 70 facilities. In line with the capacity
building mandate of the UoN, the program in collaboration with NASCOP and DRH will facilitate a structured
platform for regular review of PMTCT research to inform and guide national PMTCT policy and practice.
3. CONTRIBUTIONS TO OVERALL PROGRAM AREA
PMTCT activities in these two high volume national referral facilities and Nyando and Kisumu East districts
will contribute to approximately 4% of 2008 overall Emergency plan PMTCT targets for Kenya.
Strengthening HIV counseling and testing of women during labor and around delivery will increase the
number of HIV-positive women accessing HIV care services. Couple counseling and testing will contribute
to more men knowing their HIV status and those who are positive will be able to access other HIV care
services. This activity also contributes to expansion of pediatric HIV care services.
4. LINKS TO OTHER ACTIVITES
This activity relates to ART program (#7095). All HIV-positive mothers, their infants and partners who are
eligible for treatment will be referred to the HIV/AIDS treatment and care services
5. POPULATIONS BEINGTARGETED
This activity targets Children under 5 years, adolescents aged 15-24 years, adults, discordant couples,
people living with HIV/AIDS and pregnant women.
6. EMPHASIS AREAS/ KEY LEGISLATIVE ISSUES ADDRESSED
This activity will increase gender equity in HIV/AIDS programs through providing PMTCT services to
pregnant women and their partners. Other emphasis areas include capacity building through supporting in-
service training for providers on comprehensive PMTCT programming that addresses all the four prongs,
wrap around programs for family planning, malaria and safe motherhood through the provision of
comprehensive PMTCT package that addresses all these elements. The comprehensive PMTCT package
includes focused antenatal care that addresses safe mother hood issues, malaria prevention through the
provision of insecticide treated bed nets for the pregnant woman and intermittent presumptive treatment for
malaria, and increased access to family planning with a focus on dual method for the HIV + mothers .
PHE CONTINUING STUDY:
Project Title (This is part of a multi-country study with other sites in Zambia and Thailand): Effectiveness of
non-nucleoside reverse transcriptase inhibitors-containing HAART in women with prior exposure to
nevirapine for PMTCT (NRS PROJECT)
Name of Local Co- Investigator: CDC Kenya and University of Nairobi
Project Description:
This project evaluates the response to non-nucleoside reverse transcriptase inhibitors (NNRTI)-containing
HAART (i.e. Nevirapine or Efavirenz) among women over 18 years who have been exposed to single-dose
nevirapine for PMTCT versus non-exposed women. The project is part of a multi-site prospective
observational cohort study being carried out in the comprehensive care center at Kenyatta National Hospital
in Kenya. The project is expected to inform program implementation to guide decisions on management of
women who after receiving single-dose nevirapine for PMTCT require treatment with HAART.
Timeline:
FY 2008 = Year 3 of activity
Year started: 2006
Expected year of completion: 2010
Funding:
Funds received to date: USD 400,000.00
Funds expended to date: USD 243,000.00
Funds requested to complete the study:
FY 08: USD 150,000
Beyond FY 08: USD 300,000
Describe funds leveraged/contributed from other sources:
There were no funds which were received from any other source. However, Kenyatta National Hospital
provided the facilities and support staff for the study.
Status of Study:
Recruitment of the participants was completed by January 2007. A total of 229 women have been seen in
the study clinic, 187 (82%) consented for screening, 157 (84%) of the screened were eligible and 152 (97%)
of the eligible were enrolled. Currently 22 participants have completed the study, 111 are continuing with
follow up, 3 have been lost to follow up and 17 have died. Under the current protocol the last participant is
expected to be seen in March 2008. Of 113 patients evaluated at 6 months 12 (11%) have had treatment
failure.
Lessons Learned:
1. Preliminary results do not indicate a higher than expected rate of treatment failure in this population
2. Treatment failure is captured earlier with use of viral load
3. Mortality rate is high in patients initiating treatment late in the disease stage particularly in the first month
after initiating treatment
4. Women identified in PMTCT programs maybe accessing ART at an earlier disease stage
5. Poor adherence is a common reason for treatment failure
Information Dissemination Plan:
The results of the study will be published in a peer reviewed journal. Furthermore, the findings will be
presented in national, regional and international conferences and seminars by the investigators.
Planned FY 08 Activities:
Continue follow up to of this well described cohort for 3 more years to determine
1. Clinical and virologic failure rates of first and second line HAART regimens
2. Frequency and patterns of drug toxicity and their impact on adherence and regimen durability
3. Reproductive health decisions and outcomes of the women on HAART including contraception,
pregnancy, and abnormal cervical cytology
Budget:
Salaries: $74,623.60
Fringe benefits 25% of Salary: $18,655.90
Supplies: $19,560.00
Study tests: $27,500.00
Participant fare reimbursement:$4,800.00
Post test support clubs:$2,160.00
Others: $7,500.00
Total costs: $150,000.00
Budget Justification for FY2008
The budget is prepared according to local costs of materials and equipment. Salaries have been calculated
in accordance with annual salaries for personnel involved in the programme.
Salaries and fringe benefits:
In project leadership the principal investigator will oversee protocol review and implementation and
supervise all data collection, entry and analysis procedures in the site. The co-investigators, will assist in
protocol review and personnel administration.
In administration the administrator will liaise with the University of Nairobi on personnel and financial
matters, while the accountant will keep records of financial transactions, prepare financial reports and
ensure procurement procedures.
Activity Narrative: The research clinic will be ran by the research doctor, research nurse, clinical officer, and a research
receptionist who will be responsible for clinical care of study participants, conduct of research procedures
and retention of participants.
The laboratory manager and laboratory technician will be responsible for day-to-day running of the
laboratory, overall maintenance of laboratory equipment, ordering laboratory supplies, archiving and
shipping of specimens.
Data management will be led by the data manager and the M&E/IT manager who will be responsible for
creating data bases, data entry and cleaning.
Supplies:
Stationery, office utilities, clinic supplies and laboratory consumables will be used to carry out daily activities
of the study
Study tests:
Tests including viral load, full haemogram, liver function tests, renal function tests and CD4 counts will be
carried out for study purposes
Participant fare reimbursement:
Participants will be reimbursed fare as approved by the Kenyatta National Hospital ethics and research
committee whenever they make scheduled study visits
Post test support clubs:
These will be held monthly for enrolled participants to promote retention
Others:
Communication costs will include telephone and internet to communicate between the administrative office,
clinic and laboratory. Office rent will be paid for the program office from where all activities will be
coordinated. Office utilities will include electricity and water charges for the program office The UON will
operate specific accounts for the program funds, conduct internal audits annually and provide quarterly
financial reports. Department of obstetrics and gynecology will Provide teaching aids, training equipment,
materials and training venues. KNH will waive consultation fees for participants who are not able to afford.
Project Title: Evaluation of the Impact of the National PMTCT program in Kenya
This project evaluates PMTCT services in a random sample of 2000 mother-infant pairs attending MCH
clinics in Kenya. The evaluation addresses 3 main questions: 1) HIV prevalence among mothers and infants
(prevention impact) and 2) availability and uptake of services (PMTCT, family planning, HIV care and
treatment) and 3) impact of service delivery on HIV knowledge and risk behavior. HIV prevalence will be
determined by testing maternal and infant dry-blood-spots with HIV ELISA and HIV DNA PCR, respectively.
FY 2008 = Year 2 of activity
Year started: 2007
Expected year of completion: 2008
Funds expended to date: USD 12,500.00
FY 08: USD 228,700
Beyond FY 08: USD 0
No funds have been received from any other source.
Protocol development for the study is currently ongoing.
Pilot studies indicate that infant HIV infection rates at 9 months may grossly overestimate effectiveness of
PMTCT programs due to higher mortality of HIV infected infants.
The results of the study will be published in peer reviewed journals. The findings will be presented in
National, Regional and International conferences by the investigators. A stakeholders meeting is planned
at the end of data collection to disseminate the study findings.
To collect similar data from 3 communities in a high, medium and low HIV prevalence areas so as to
determine the extent of bias created by using a clinic based sample:
1.Over estimation of program impact by failing to reach mothers whose infants died or are too sick to attend
MCH
2.Under estimation of program impact by selecting for mother-infant pairs who likely to be seeking care due
to illness
Budget (USD):
Total salaries:$93,360.00
Fringe Benefits:$23340.00
Travel: $12,000.00
Supplies: $25,000.00
Laboratory costs:$15,000.00
Other costs: $60,000.00
Total: $228,700.00
Budget Justification for FY2008:
In project leadership the principal investigator will oversee protocol review and implementation; and
supervise all data collection, entry and analysis procedures in the site. The co-investigators will assist in
In the field data collection will be done by research assistants supervised by nurse counselors. And
coordinated by a field coordinator in each of the selected sites
The laboratory manager and laboratory technician, will be responsible for day-to-day running of the
Travel:
Activity Narrative: This will cover the cost of travel to and from the field sites.
Stationery, office utilities and field supplies will be used to carry out daily activities of the study
Tests on maternal and infant dry-blood spots including HIV DNA PCR for exposed infants and HIV ELISA
on maternal samples will be carried out for study purposes
Communication costs will include telephone and internet to communicate between Nairobi and the field
sites. Office rent will be paid for the program office from where all activities will be coordinated. Office
utilities will include electricity and water charges for the program office. Per diem will be paid to officers
outside their duty station and funds will also used to sensitize the community on the study.
Project Title: An Assessment of Injection Practices in Kenya
Name of Local Co- Investigators: Dr. Mark D. Joshi and Dr. James Kiarie
The Clinical Epidemiology Unit; University of Nairobi will perform this evaluation consisting of a national
survey based on collection of retrospective data on injection practices in formal and informal health care
delivery points and facilities. Health care facility records will be reviewed, key informants interviewed and
community focus group discussions conducted to assess attitudes, practices and adverse events related to
injections. Direct and indirect costs of therapeutic management via various routes of administration will be
determined. Reports generated through qualitative and quantitative data analysis will be disseminated to all
stakeholders through workshops, seminars and publications.
Funds received to date:$125,000
Funds expended to date: $46,000
FY 08:$60,000
Beyond FY08: $0
Principle investigators, accountant and project administrator work on project part time. Complement of their
salaries is met by the University of Nairobi. ($40,000)
Investigators have obtained ethical clearance from Kenyan authorities (University of Nairobi / Kenyatta
National Hospital and Ministry of Science and Technology ethical committees) and are now seeking ethical
approval from CDC Atlanta.
Pending.
The findings of this evaluation will be communicated to the Ministry of Health and other Kenyan
stakeholders through seminars and publication of a summary report.
Findings will also be published in appropriate peer review journals.
Planned FY08 Activities:
Field work and analysis will be completed in FY07. In FY08 the final report will be printed and disseminated
to the Ministry of Health and other stakeholders. These findings will serve to guide policy on injection use in
health care settings, training requirements, procurement of injectables and work place safety for health care
workers. Specific activities in FY08 include: printing of final report and dissemination seminars for Ministry of
Health, organizations implementing Injection Safety Programs and Medical professional associations
including nurses, doctors, clinical officers and pharmacists.
Budget Justification for FY2008 Budget (USD):
Salaries/ fringe benefits: $ 10,000
Equipment: $ 0
Supplies: $ 10,000
Travel: $ 15,000
Participant Incentives: $ 0
Laboratory Testing: $ 0
Other: (Printing) $ 25,000
Total: $ 60,000.00
Project Title: Assessment of Attitudes to use of Rectal Suppositories in Kenya
survey to examine factors that may hinder acceptance of rectal suppositories in preference to injections for
the treatment of malaria and other medical conditions. This information will guide the development of IEC
messages and training material to enhance acceptability of effective suppository treatments that will
contribute to rational injection use. This would contribute to the prevention of HIV transmission through
medical injections.
Reports generated will be disseminated to all stakeholders through workshops, seminars and publications.
Funds received to date:$75,000
Funds expended to date: $26,000
FY 08:$30,000
salaries is met by the University of Nairobi. ($3,000)
to the Ministry of Health and other stakeholders. These findings will serve to guide the development of IEC
messages targeting health workers and the community for rational injection use. Specific activities in FY08
include: printing of final report and dissemination seminars for Ministry of Health, organizations
implementing Injection Safety Programs and Medical professional associations including nurses, doctors,
clinical officers and pharmacists.
Salaries/ fringe benefits: $ 5,000
Supplies: $ 3,000
Travel: $ 7,000
Other: (Printing) $ 15,000
Total: $ 30,000.00
THIS IS A NEW ACTIVITY: LSTIK PEDIATRICS
This activity relates to activities in ARV Services.
It is estimated that there are 100,000-150,000 HIV-infected children in Kenya of which ~40,000 will require
ART. As scale-up of ART services has increased substantially among adults, pediatric ART services have
lagged behind. As of March 2006, only 190 (60%) of 314 ART sites were providing pediatric services to
10,000 children. Strategies to improve pediatric ART enrollment include pediatric counseling, pediatric ART
training and mentorship, caregiver programs, expansion of the early infant diagnosis, and pediatric testing
campaigns. Surveillance of pediatric care in Kenya will measure process and outcomes of enrollment into
care by pediatric patients. It will look at both community and facility referral systems, and include measures
of clinical/laboratory staging, retention, ART initiation and maintenance, morbidity and mortality. Protocol
development will be performed by CDC in collaboration with implementing partners, other USG agencies,
and NASCOP.
3. EMPHASIS AREAS/TARGET POPULATIONS
This activity will collect strategic information about pediatric patients.
