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 HAS BEEN MODIFIED IN THE FOLLOWING WAYS FROM COP 2008:
+ Focus on PwP strategies to strengthen prevention activities
+ Support in the establishment of functional laboratory networks
+ Support to national quality assurance for HIV testing in PMTCT settings
SECONDARY CROSS-CUTTING BUDGET ATTRIBUTIONS
This activity supports key attributions in human capacity development through the training of health care
service providers on PMTCT and other HIV prevention and care topics in order to equip them with
knowledge and skills to provide quality PMTCT services. These service providers include Doctors, Nurses,
Clinical Officers, Nutrition Officers and Health Record clerks. This program also supports the pre-service
training of Doctors at the University of Nairobi Medical School.
COP 2008
1. LIST OF RELATED ACTIVITIES
This activity relates to University of Nairobi Department of Pediatrics ART Program; APHIA II Nairobi ART
Program; UCSF ART Program and TBD ART Program. All HIV-positive mothers, their infants and partners
who are eligible for treatment will be linked to the HIV/AIDS treatment and care services directly or through
referral.
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. In FY 08, UoN expanded geographical area of coverage to include
support of PMTCT activities in the districts of Nyando and Kisumu East in Nyanza province and supported
implementation of PMTCT in a total of 40 additional health facilities. In 2009 the program will continue to
support these activities in the same geographical area of focus, and will provide HIV counseling and testing
to a total of 51,024 (93%) of 54,625 pregnant women (21,469 in Nairobi, 16,147 in Kisumu East and 13,408
in Nyando District). All HIV-positive pregnant women shall have immunological and HIV clinical staging
done to identify the appropriate ARV prophylaxis regimen as per the national guidelines. The program will
target to provide a complete course of ARV prophylaxis to 7,818 (93%) of 8,370 HIV-positive pregnant
women. Of these HIV positive women 1,564 will be provided with Highly Active Antiretroviral Treatment
(HAART) and 3909 will receive the more efficacious ARV regimen of Zidovudine and Single Dose
Nevirapine (sd NVP) with the addition of 4 TC intrapartum and post natal period, while 2,345 will receive the
minimum intervention of sd Nevirapine. All HIV exposed infant will be given ARV prophylaxis in line with the
National PMTCT guidelines. The program will strengthen comprehensive PMTCT including couple
counseling and will target to reach at least 9,805 male partners with HIV counseling and testing services. To
improve the quality of life for HIV infected women, the program will wrap around other programs namely
Safe motherhood and Family planning as well as TB screening and linkage to treatment. In strengthening
the linkage between PMTCT and Pediatric HIV care services, the program shall support early infant HIV
infection diagnosis by use of Polymerase Chain Reaction (PCR) for 3,854 infants and link all eligible infants
to the pediatric ART program. The program shall strengthen the post natal HIV care clinic and shall support
at least 10 facilities in the Nyanza region to initiate this strategy. The program shall also work and
strengthen linkage with Child Survival activities to ensure that all infants and especially the HIV exposed
and infected access immunization, growth monitoring, safe water and Infant and Young Child feeding
services and support which will contribute to improved infant and child health outcomes. The mentor
mothers' initiative is another national effort aimed at improving Infant and Young Child Feeding especially
for the HIV exposed or infected child. The program will support the roll out of this strategy in at least 15
facilities in Nyanza. Improved access to laboratory services for HIV +ve women and their exposed infants is
an important step in ensuring accurate assessment for HIV care and treatment. The program will work with
the other PEPFAR funded partners, Ministry of Health and other implementing partners in establishing and
maintaining a functional laboratory network in the geographical area of focus. Intra-partum and immediate
post partum counseling and testing shall also be strengthened with a target of reaching 100% 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, in addition to strengthening
Prevention with Positives strategy. The program will support the training of 300 service providers on
PMTCT, Rationale use of ARVs, and Data collection and reporting in 42 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.
Finally the UoN program will support the establishment and administration of a national Quality Assurance
system for HIV testing in PMTCT settings. Although the country has a national QA system for HIV testing in
the traditional VCT sites, the PMTCT program which conducts over 800,000 HIV tests annually in MCH and
maternity units does not have any QA system in place. In 2009 COP, the PMTCT program is targeting to
reach at least 1,300,000 million pregnant women with HIV testing and counseling services in the country. It
is therefore important to set up a system to improve validity of rapid testing in PMTCT sites as the test
results are used for decision making in the care and follow up of the women and their infants. This activity
will therefore be expanded to incorporate a QA for PMTCT testing program that will be implemented by the
Department of Microbiology, University of Nairobi. The department will work with the USG agencies,
laboratory partners and country representatives to implement the national strategic plans for laboratory
quality systems and ensure that laboratory testing is available, accurate, reliable and timely. As a starting
point the Department of Microbiology will train staff at PMTCT settings in good laboratory practice and QA in
HIV testing and haemoglobin measurement. Regular support supervision, proficiency and validation testing
will be established for PMTCT sites across the country. Workshops will be conducted to evaluate EQA
performance, and improve performance. The department will further support the national QA plan by
working in close collaboration with the CDC GAP laboratory National Public Health Laboratory Services.
The department is expected to leverage its expertise to development and use of standard operating
procedures for specimen tracking, testing procedures, results reporting, equipment maintenance and
inventory. A total of $260,000 has been set aside for this activity.
Activity Narrative: 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 3.9% of 2009 overall Emergency plan PMTCT targets for Kenya and 9% of
ARV PMTCT prophylaxis. 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 and
treatment services.
4. LINKS TO OTHER ACTIVITES
5. POPULATIONS BEINGTARGETED
This activity targets Children less than 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-positive mothers.
New/Continuing Activity: Continuing Activity
Continuing Activity: 15033
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
15033 4147.08 HHS/Centers for University of 7017 303.08 Department of $1,100,000
Disease Control & Nairobi Obstetrics and
Prevention Gynecology
7097 4147.07 HHS/Centers for University of 4299 303.07 Department of $1,665,082
4147 4147.06 HHS/Centers for University of 3224 303.06 Department of $600,000
Emphasis Areas
Gender
* Addressing male norms and behaviors
* Increasing gender equity in HIV/AIDS programs
* Reducing violence and coercion
Health-related Wraparound Programs
* Family Planning
* Malaria (PMI)
* Safe Motherhood
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $81,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
This PHE activity,"Evaluation of the Impact of the National PMTCT program in Kenya," was approved for
inclusion in the COP. The PHE tracking ID associated with this activity is KE.07.0057. A copy of the
progress report is included in the Supporting Documents section.
Continuing Activity: 17823
17823 17823.08 HHS/Centers for University of 7017 303.08 Department of $228,700
Estimated amount of funding that is planned for Public Health Evaluation $0
ACTIVITY UNCHANGED FROM COP 2008
This activity relates to activities in Counseling and Testing, Condoms and Other Prevention, Palliative care
and ARV services.
The Partners in Prevention (PiP) team, based out of the University of Nairobi, has a wealth of experience
with discordant couples that uniquely places them in a position to take on the activities highlighted below:
With supplemental funds received in FY08, this team was requested to build on their experience and
expertise with discordant couples to concretize a standardized set of tools and materials for use in
discordant couples' support groups at a national level. They were also charged to leverage a mix of OP and
CT funds to link counseling and testing to discordant couples support groups, enabling a smooth connection
between a positive test result and support provided by such support groups for both the positive and
negative partners. The materials will contain standardized information not only on psychosocial and
positive living issues but also on HIV prevention and broader Prevention with Positives (PwP) concepts to
benefit both the negative and positive partners in the discordant couple. The materials developed will
include curriculum and training manuals, as well as implementation materials including job aids. These
tools and resources should be used to promote consistent messages so that any discordant couple may
have access to standardized information and resources throughout Kenya. These materials will also feed
into the National PwP Working Group's mandate to create a comprehensive PwP Toolkit. The materials
created will serve as a toolkit for training peer educators in discordant couples' interventions. Following the
development of these materials, funds may be used to print and disseminate them, as well as to provide
training to peer educators so that standardized prevention interventions can be rolled out to discordant
couples' support groups throughout the country. Materials will be used to train 300 peer educators (from
each of PiP's existing discordant couples support groups in Nairobi (120), Eldoret (40), Thika (20) and
Kisumu (120)). These peer educators will then create linkages with family testing and home-based
counseling and testing (HBCT) interventions, as well as care and treatment sites, to provide standardized
peer education services and support to discordant couples. Additionally, technical assistance and support
will be provided to existing discordant couples groups to strengthen and standardize their prevention
interventions. Peer education and technical assistance sessions will ultimately reach 10,000 individuals.
Each of these peer educators will serve as condom outlets regularly supplying condoms to the support
groups with which they work, thus resulting in 300 new condom outlets.
3. CONTRIBUTIONS TO OVERALL PROGRAM AREA
The Kenya AIDS Indicator Survey (KAIS) has revealed that among married individuals who are HIV-
infected, 45% have a partner who is not currently infected; this amounts to nearly 400,000 discordant
couples in Kenya. The uninfected partner in a discordant relationship is at extremely high risk of infection,
and both members of the couple face unique needs that are not currently addressed in any systematic
manner. This activity enables the provision of quality and standardized prevention services to discordant
couples.
4. LINKS TO OTHER ACTIVITIES
These interventions will have a strong link to couples counseling and testing activities, including home-
based counseling and testing. OP and CT will leverage funds to ensure an integrated and standardized
approach, enabling a smooth linkage between a positive test result and support provided by such support
groups. Additionally, this activity will link with care and treatment programs so as to capture identified
discordant couples and related support groups. This activity will also link with activities of Discordant
Couples of Kenya, a sub-partner of CHF in FY08 and an anticipated sub-partner of the Umbrella TBD.
5. POPULATIONS BEING TARGETED
This activity will specifically target discordant couples in Kenya; this population comprises one of the most
highly vulnerable groups in the country. Discordant couples will be reached through existing discordant
couples' support groups as well as by identification through linkages with counseling and testing as well as
care and treatment sites. Discordant couples will then benefit from targeted prevention messages and
interventions designed by the team at University of Nairobi and rolled out through trained peer educators.
6. KEY LEGISLATIVE ISSUES ADDRESSED
The primary legislative issue is addressing gender equity, and reduction in stigma and discrimination in
HIV/AIDS programs.
7. EMPHASIS AREAS
This activity includes emphasis on quality assurance, curriculum development and training. Other activities
include production of information, education and communication.
Continuing Activity: 19436
19436 19436.08 HHS/Centers for University of 7017 303.08 Department of $50,000
Table 3.3.03:
This activity is linked to other IS activities (#7010, #8824, #8821).
2. ACTIVITY DESCRIPTION This activity relates to the prevention of HIV transmission by medical injections
through acquisition of strategic information by the generation of a sound evidence base on injection
practices in a spectrum of health care facilities across the country including provincial, district and faith-
based hospitals, health centers, nursing homes and dispensaries. The University of Nairobi, Clinical
Epidemiology Unit (CEU) will implement this activity. CEU was established in 1989 within the College of
Health Sciences, University of Nairobi, and is a member of the International Clinical Epidemiology Network
(INCLEN), founded in 1980 with support from the Rockefeller Foundation. It is comprised of a team of
medical and public health specialists brought together by the common need of creating a pool of experts in
health research development. Its multidisciplinary nature permits the provision of a wide range of quality
services in health research, training, study design, data collection, data analysis and translation of research
findings into health action through policy change and practice. Two targeted evaluations will be conducted
by the CEU to determine: 1. Injection practices, factors that influence demand for injections, prescription of
injections and reuse of injection equipment in Kenya, injection use in the informal sector and the prevalence
of needle stick injuries. The direct and indirect cost of injectable therapy as compared to alternative routes
of medication will be determined with a view to advocating for rational injection use and review of national
treatment guidelines and Essential Drugs Lists. 2. Attitudes, beliefs and practices related to the use of
suppositories in Kenya. Information from this activity will guide the development of information, education
and communication material targeting policy makers, health care workers and the community with the aim
of changing misconceptions about injections and promoting rational injection use and safe injection
practices.
3. CONTRIBUTIONS TO OVERALL PROGRAM AREA Strategic information from this activity will guide
intervention programs in Injection Safety as well as all HIV/AIDS prevention and treatment and infection
prevention and control interventions in the Ministry of Health. Additionally, the strategic information will form
a basis for monitoring and evaluating the success of injection safety interventions. As the HIV treatment
program is scaled up and brings more HIV/AIDS patients to health care facilities, measures must be put in
to place to protect health care workers and other patients from nosocomial infections. This program will
contribute to the aversion of up to 5% new cases of HIV in the country.
This activity is linked to injection safety initiatives implemented by the Ministry of Health, National AIDS and
STI Control Program (NASCOP) (#7010), Danya International (#8824) and JHPIEGO (#8821) and to
PEPFAR care and treatment programs.
This activity targets all health care workers, nurses, doctors, clinical officers, lab personnel, health care
waste handlers, policy makers and the general public.
6. EMPHASIS AREAS
This activity consists of two targeted evaluations and minor emphasis in advocacy, development and
dissemination of policies, guidelines and protocols for best practice and evidence-based approaches. This
activity will also contribute to local organization capacity development.
New/Continuing Activity: New Activity
Continuing Activity:
Table 3.3.05:
ACTIVITY UNCHANGED FROM COP 2008:
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
antiretroviral treatment (ART). As scale-up of ART services has increased substantially among adults,
pediatric ART services have lagged behind. As of March 2008, only 240 (60%) of 400 ART sites were
providing pediatric services to ~18,000 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. The University of Nairobi Obstetrics and Gynecology (UNOG)
Department has been identified as the prime partner for this activity. The Protocol is being developed by
UNOG in collaboration with other implementing partners, CDC, other USG agencies, and National AIDS
and STD Control Program and should be completed in FY08. The completion of data collection using COP
08 funding is anticipated. Additional funding is requested in FY09 COP for data analysis and report writing.
These activities will contribute to the programmatic evaluation of the national Pediatric care and ART.
results of these evaluation will be used to improve pediatric care and treatment enrollment
This activity relates to national pediatric care and support, pediatric ARV services and PMTCT services
supported by the National AIDS and STD Control program (NASCOP) and PMTCT services supported by
this partner.
These activities target, children and, infants.
This activity addresses legislative issues related to stigma and discrimination through community
sensitization activities.
This activity will collect strategic information about pediatric patients.
Continuing Activity: 17156
17156 17156.08 HHS/Centers for University of 7017 303.08 Department of $100,000
Table 3.3.11:
