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
ACTIVITY UNCHANGED FROM COP 2008
SECONDARY CROSS-CUTTING BUDGET ATTRIBUTIONS
This activity supports key cross-cutting attributions in food and nutrition commodities supply ($2,700,000)
and human capacity development through its nutrition training program for health workers ($300,000).
COP 2008
+ This activity will now support all service delivery activities in HTXS, HBHC, and MTCT.
1. LIST OF RELATED ACTIVITIES
This activity relates to ARV Services, including APHIA II partners in all provinces, AMPATH, and various
CDC and DOD-supported ARV service delivery sites.
2. ACTIVITY DESCRIPTION
There is a proven role for nutrition in effective drug therapy and palliative care for people with HIV/AIDS. As
HIV infection progresses into AIDS disease, hyper-metabolic responses, mal-absorption of nutrients in the
gut, diarrhea, and anorexia all contribute to severe challenges to the intake and maintenance of adequate
nutrition (e.g., energy, protein, and micro nutrients). The effectiveness of drug response in patients being
treated for HIV/AIDS and OI is strongly dependant on their nutritional status, and is increasingly being
reported in peer-reviewed journals. It is also known that moderate to severe nutritional status of AIDS
patients is a significant independent predictor of mortality. Malnutrition at the start of antiretroviral treatment
(ART) is significantly associated with decreased survival and is not mediated by impaired immune
reconstitution (drugs alone). Medically-prescribed therapeutic food supplied by service facilities to
undernourished patients on ARVs and/or OI drugs will help increase drug response in patients and ensure
better nutritional and health outcomes. In addition, a primary reason for non-adherence to ART is the lack of
appropriate food to take with ARVs. Adequate food intake, though acknowledged as critical, is rarely offered
as a formal component of treatment. Most programs that include nutrition in their HIV/AIDS programs have
nutrition counseling only, which does not address the needs of patients who are too ill and poor to access
nutritious food. With USAID support, the Ministry of Health's National AIDS and STD Control Program
(NASCOP) have adopted a protocol for medical staff and nutritionists for Food by Prescription (FBP), as
well as which includes the protocol. The protocol has strict entry and exit criteria for patients which include
factors such as HIV status, nutritional status, OVC status, and whether they are pregnant or within 6 months
postpartum.
The prior implementing partner trained program and health staff at facilities and in OVC programs on the
FBP protocol, anthropometric monitoring of patients, reporting requirements, and storage of food products.
This partner will continue to monitor existing sites in their implementation of FBP, and will train staff at
additional sites as necessary until the national curriculum is implemented nationwide. At the behest of
NASCOP, this partner will assist NASCOP with the implementation of the national curriculum. This project
will maintain a comprehensive database of FBP clients to track their progress and inform research on the
impact of food in ART programs. Data from the previous partners indicate that within this program most
patients will have improved health and nutritional status within six months during which they receive food
support. FBP food will be manufactured and distributed to target populations at identified priority sites
(based on prevalence of HIV and prevalence of malnutrition). The food will be subject to quality tests at
various stages of production, including end-product, and the implementer of this project will have a food
certified in quality by the Kenya Bureau of Standards (KBS). This partner will also ensure that FBP clients
have clean water with which to prepare or consume their food, and that facilities implementing FBP have
the necessary anthropometric measurement tools to qualify and monitor patients (BMI charts, Z-score
charts, scales, height measures, MUAC tapes). Food will be packaged to ensure quality, minimize stigma,
and reduce the likelihood of household sharing. This project will implement activities in 60 sites, and reach
at least 15,000 PLWHA and OVC. Some sites will be PMTCT sites, and focus on reaching malnourished
HIV positive pregnant and post-partum women to help with a better outcome for both the mother and the
infant.
3. CONTRIBUTIONS TO OVERALL PROGRAME AREAS
This project will contribute to a comprehensive spectrum of palliative care to 15,000 of the 1,250,000 HIV-
infected/affected Kenyans. Working at 60 sites, this partner will reach at least 15,000 people. A total of 100
health facility staff will receive comprehensive training in FBP and anthropometrics.
4. LINKS TO OTHER ACTIVITIES
This activity links with other PEPFAR partners that provide ART in health facilities or that support OVCs.
These include all of the APHIA II partners, and various DOD and CDC-supported service delivery sites.
5. POPULATIONS BEING TARGETED
The target populations include adults, living with HIV/AIDS, including pregnant and postpartum women,
OVC, and public sector nurses, nutritionists, pharmacists, and program staff (for training). Some faith-based
mission facilities will also be targeted.
6. KEY LEGISLATIVE ISSUES ADDRESSED
The key legislative issues that will be addressed include Gender and Stigma and Discrimination and the
wraparound issue of food. Data will be collected to show the breakdown of women and men receiving
therapeutic nutrition and strategies will be developed to ensure that an equitable number of women receive
it. Stigma and Discrimination will be addressed by providing nutrition to PLWHAs leading to improvement in
their health and nutrition status; this provides an opportunity for clients (particularly heads of households) to
improve their economic status by returning to the work force. This activity is directly related to increasing
food and nutritional resources for HIV infected and affected individuals.
7. EMPHASIS AREAS
The major area of emphasis is Food/Nutrition. Minor areas include Logistics (distribution to health service
sites and OVC program sites), and Training (health facility and OVC program staff).
New/Continuing Activity: Continuing Activity
Continuing Activity: 14707
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
14707 4247.08 U.S. Agency for To Be Determined 6916 1125.08 Nutrition and
International HIV/AIDS
Development
6902 4247.07 U.S. Agency for To Be Determined 4231 1125.07 Nutrition and
4247 4247.06 U.S. Agency for Insta Products 3260 1125.06 $700,000
International
Emphasis Areas
Health-related Wraparound Programs
* Family Planning
* Safe Motherhood
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $300,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Estimated amount of funding that is planned for Food and Nutrition: Commodities $2,700,000
Economic Strengthening
Education
Water
Table 3.3.08:
ACTIVITY UNCHANGED FROM COP 2008:
SECONDARY CROSS-CUTTING BUDGET ATTRIBUTIONS:
This activity supports key cross-cutting attributions in food and nutrition commodities supply ($220,000) and
human capacity development through its nutrition training program for health workers ($30,000)
Other changes:
This activity relates to all HTXS and PDTX activities, including APHIA II partners in all provinces (#8765,
#8774, #8792, #8797, #8805, #8813, #8826), AMPATH, and various CDC and DOD-supported ARV service
delivery sites.
HIV infection progresses into AIDS, hyper-metabolic responses, mal-absorption of nutrients in the gut,
diarrhea, and anorexia all contribute to severe challenges to the intake and maintenance of adequate
nutrition,(e.g., energy, protein, and micro nutrients). The effectiveness of drug response in patients being
treated for HIV/AIDS and Opportunistic Infections is strongly dependant on their nutritional status, and is
increasingly being reported in peer-reviewed journals. It is also known that moderate to severe nutritional
status of AIDS patients is a significant, independent predictor of mortality. Malnutrition at the start of
antiretroviral treatment (ART) is significantly associated with decreased survival and is not mediated by
impaired immune reconstitution (drugs alone). Medically-prescribed therapeutic food supplied by service
facilities to undernourished patients on ARVs and/or OI drugs will help increase drug response in patients
and ensure better nutritional and health outcomes. In addition, a primary reason for non-adherence to ART
is the lack of appropriate food to take with anti-retroviral drugs. Adequate food intake, though acknowledged
as critical, is rarely offered as a formal component of treatment. Most programs that include nutrition in their
HIV/AIDS programs have nutrition counseling only, which does not address the needs of patients who are
too ill and poor to access nutritious food. With USAID support, the Ministry of Health's National AIDS and
STD Control Program (NASCOP) have adopted a protocol for medical staff and nutritionists for Food by
Prescription (FBP), which includes the protocol. The protocol has strict entry and exit criteria for patients
which include factors such as HIV status, nutritional status, OVC status, and whether they are pregnant or
within 6 months postpartum. The prior implementing partner trained program and health staff at facilities
and in OVC programs on the FBP protocol, anthropometric monitoring of patients, reporting requirements,
and storage of food products. This partner will continue to monitor existing sites in their implementation of
FBP, and will train staff at additional sites as necessary until the national curriculum is implemented
nationwide. At the behest of NASCOP, this partner will assist NASCOP with the implementation of the
national curriculum. This project will maintain a comprehensive database of FBP clients to track their
progress and inform research on the impact of food in ART programs. Data from the previous partners
indicate that within this program most patients experienced improved health and nutritional status within six
months during which they receive food support. FBP food will be manufactured and distributed to target
populations at identified priority sites (based on prevalence of HIV and prevalence of malnutrition). The food
will be subject to quality tests at various stages of production, including end-product, and the implementer of
this project will have a food certified in quality by the Kenya Bureau of Standards (KBS). This partner will
also ensure that FBP clients have clean water with which to prepare or consume their food, and that
facilities implementing FBP have the necessary anthropometric measurement tools to qualify and monitor
patients (BMI charts, Z-score charts, scales, height measures, MUAC tapes). Food will be packaged to
ensure quality, minimize stigma, and reduce the likelihood of household sharing. This project will implement
activities in 60 sites, and reach at least 3,000 children and OVC. Some sites will be PMTCT sites, and focus
on reaching malnourished HIV positive pregnant and post-partum women to help with a better outcome for
both the mother and the infant.
This project will contribute to a comprehensive spectrum of palliative care to 3,000 Kenyan children working
at 60 sites. 10 health facility staff will receive comprehensive training in FBP and anthropometrics.
These include all of the APHIA II partners ((#8765, #8774, #8792, #8797, #8805, #8813, #8826), and
various DOD and CDC-supported service delivery sites.
The target populations include children living with HIV/AIDS, OVC and public sector nurses, nutritionists,
pharmacists, and program staff (for training). Some faith-based mission facilities will also be targeted.
The key legislative issues that will be addressed include Stigma and Discrimination and the wraparound
issue of food. Stigma and Discrimination will be addressed by providing nutrition to Children living with HIV
and OVCs leading to improvement in their health and nutrition status. This activity is directly related to
increasing food and nutritional resources for HIV infected and affected individuals.
Estimated amount of funding that is planned for Human Capacity Development $30,000
Estimated amount of funding that is planned for Food and Nutrition: Commodities $220,000
Table 3.3.10:
1. ACTIVITY DESCRIPTION & EMPHASIS AREAS
Increasingly the food security needs of OVC in Kenya are being met through community programs, yet links
between these programs and clinical services remain weak, which limits the extent to which households
caring for OVC and currently receiving food and nutrition from the USAID funded Nutrition and HIV Program
(NHP) are able to link to longer term food security programs. Furthermore, food insecurity among OVC and
their households is increasingly becoming an urban problem, which is exacerbated by the food price crisis,
yet effective urban models for improving food security are often lacking. Since 2006, the PEPFAR NHP
program has provided food and nutrition services to over 50,000 clients of whom 39% (19,500) are OVC.
The NHP program is expected to expand over the next five years and will focus on working with Community
Based Organizations (CBOs) and Non-Governmental Organizations (NGOs) that are working with OVC. It
is anticipated that an increased number of OVC requiring food and nutritional services will be identified as a
result of this expansion. Food prices have increased by 40% in Kenya since June 2007, and inflation is at
15%. With the increase in food prices and taking into account current program resources, the NHP will be
unable to meet all the food and nutritional needs of PLWHA and OVC that will have been identified as a
result of this expansion. To further exacerbate the problem, the food price crisis is likely to lead to an
increased number of OVC in urban areas who are food insecure and at the same time increase the duration
of stay in the NHP program. Though the government has implemented approaches to address the effect of
the food prices, most have not impacted the poor who buy small quantities of foods on daily or weekly basis
(e.g. a 90 kg sack of maize costs Kshs 3,820/$ 58 which averages at Kshs 42/Kilo but in the Mathare Slums
of Nairobi, a kg of maize costs Kshs 54). The activity will document possible approaches for addressing
food security in urban areas and develop a methodology and tools for communicating the related skills and
knowledge to groups and service providers supporting OVC. Establish a continuum of care model for the
needs of food insecure OVC and their families in Kenya (e.g. management of acute malnutrition through
therapeutic and supplementary foods ? micronutrient supplementation ? food security/livelihood support).
This work will build on ongoing efforts by USAID's Office of Food for Peace (FFP) examining strategies for
food assistance in urban settings, an effort made more urgent by the food price crisis. As part of the
continuum of care, support the development of a Community Management of Acute Malnutrition (CMAM)
model for urban settings that is coordinated and consistent with the NHP program approach and that links
clients directly to livelihood strengthening services. The activity will aim to foster strategic alliances that will
ensure a continuum of care and support for OVC which will include organizations working in nutrition and
income generation activities in urban and peri-urban settings and will build capacity of NGOs that work in
nutrition and food security to provide services to OVC and their families, thereby increasing food security for
OVC at the household level. This will include developing the educational and counseling skills of existing
community care staff in OVC care, developing eligibility criteria for OVC eligibility for food supplement
support at the community level, while promoting collaboration and referral linkages between health facility
sites and community support programs that provide food resources. The activity will target 6,250 OVC and
their households. The expected outcome is increased access to food supplements for targeted OVC living
in urban and peri-urban areas and increased food security for households caring for these OVC through the
identification and implementation of community based approaches for addressing food security among OVC
in urban and peri-urban settings. The major area of emphasis is Food/Nutrition. Minor areas include
Logistics (distribution to OVC program sites), and Training of OVC program staff).
2. CONTRIBUTIONS TO OVERALL PROGRAM AREA
This project will contribute to a comprehensive support to 6,250 OVC receiving other essential services from
APHIA II programs. 550 Community care staff will receive educational and counseling skills.
3. LINKS TO OTHER ACTIVITIES
This activity will link to APHIA II programs in the country (#9029, #9041, #9048, #9053, #9056, #9067,
#9071, #9073) which are specifically targeting orphans and vulnerable children.
4. POPULATIONS BEING TARGETED
This activity specifically targets orphans and vulnerable children. In addition this activity will build capacity of
NGOs that work in nutrition and food security to provide services to OVC and their families, thereby
increasing food security for OVC at the household level.
5. SECONDARY CROSS-CUTTING BUDGET ATTRIBUTIONS
This activity will 100% of its budget ($ 500,000) towards procurement of food supplements for particularly
malnourished OVC based on a prescribed targeting system.
New/Continuing Activity: New Activity
Continuing Activity:
Gender
* Increasing gender equity in HIV/AIDS programs
Estimated amount of funding that is planned for Food and Nutrition: Commodities $500,000
Table 3.3.13:
