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:
+ Reaching Men As Partners by targeting 4,137 spouses of pregnant women
+ Providing Antiretroviral treatment for all infants and young children below 18 months who test HIV positive
by DNA PCR and initiating pregnant women in WHO stage 3 & 4 and those with CD 4 count of less than
350 on HAART.
+ The program will support and strengthen functional lab networks, decentralization and task shifting in
initiation and provision of ART within MCH for mothers and their HIV infected infants in an effort to improve
access to HIV care and treatment services including ART and will pilot extended HAART to cover the
breastfeeding period.
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. Other personnel targeted for training are the
mentor mothers and other peer counselors.
COP 2008
1. LIST OF RELATED ACTIVITIES
This activity is linked to the KEMRI ARV program, KEMRI laboratory program, KEMRI TB/HIV program and
VCT.
2. ACTIVITY DESCRIPTION
In 09 COP, CARE continues to offer comprehensive PMTCT services in Siaya district, reaching all public
health facilities, a few faith-based and one private health facility in the district.
In the SAPR covering the period October 07 to March 08, ANC HIV prevalence in Siaya District was 20.4%.
Siaya has 1 district hospital, 2 sub-district hospitals, 10 health centers, 20 dispensaries, 6 mission hospitals
and 1 private hospital with comprehensive PMTCT services. CARE International currently supports PMTCT
activities in 42 health facilities: 35 public health facilities, 6 mission hospitals and 1 private hospital. In FY 09
CARE will extend PMTCT services to the new mushrooming health facilities built by constituency
development funds (CDF). The project is a collaborative effort with the Ministry of Health (MOH). The MOH
is responsible for the provision of health facilities and health workers who are trained to provide
comprehensive PMTCT services. CARE provides technical assistance and advice on effective models of
care and provides strategic oversight. CARE Kenya builds the capacity of the MOH facilities staff to deliver
high-quality, efficient and comprehensive PMTCT services, ensures linkages with other PMTCT service
providers and communities, promotes early infant diagnosis with appropriate guidance on infant nutrition,
ensures linkage of mother and infected infants to care and treatment, and facilitates supportive supervision.
In FY 2009, CARE International will consolidate PMTCT support to all existing public health facilities, and
will refurbish and equip these as needed. CARE will focus on all the 4 prongs of PMTCT, with emphasis on
primary prevention within the ANC (prong 1), prevention of unwanted pregnancies by strengthening linkage
to FP (prong 2) and linkage to care and treatment for mother, partner, infant and other children at home
(prong 4). In prong 3, the main focus will be on routine counseling and testing of pregnant women in
antenatal clinics (ANC) and in maternity units, WHO clinical staging of HIV positive women, provision of
cotrimoxazole and antiretroviral prophylaxis to HIV positive women and exposed infants. Emphasis will be
laid on provision of a more efficacious regimen (sdNVP + AZT) or HAART to eligible women and counseling
on infant nutrition. The program will provide HIV counseling and testing to 20,685 (93%) of 22,145 pregnant
women, and provide antiretroviral prophylaxis to 4,222 (93%) of 4,519 HIV-positive women. Of these 2,111
will receive sdNVP+AZT, 844 women HAART and 1,267 sdNVP. HIV infected and exposed infants will be
followed up postnatally. The care package for HIV infected mothers in post-natal follow up will include
counseling on appropriate infant feeding practices, linkage to care and treatment, and linkage to family
planning services. The care package for HIV exposed infants will include early infant diagnosis and initiation
of cotrimoxazole from 6 weeks, to a target of 4,222 infants. All infants below 18 months who test positive by
DNA PCR will be started on antiretroviral treatment. CARE will train 96 health service providers in
comprehensive PMTCT (96 on DBS, 30 on safe water systems, 48 on post exposure care and post
exposure prophylaxis, 48 on family planning (re-orientation) and 96 on nutritional counseling for exposed
babies). Care will train over 300 community members including youth groups, teachers, CORPS and peer
counselors on various skills required for support groups, disclosure counseling, public speaking and peer
education. Additionally, CARE will organize and coordinate mobile PMTCT and early infant diagnosis
services to the facilities without adequate staffing or infrastructure, and promote linkage from PMTCT to
care and treatment. Identified infected infant-mother pairs will be linked to care and treatment. CARE will
initiate pediatric antiretroviral treatment in mature high volume PMTCT sites, and establish a facility-lab
courier network for DBS to improve efficiency in specimen collection and return of results Funds will be
used for start up of paediatric care and treatment within the MCH in high volume mature PMTCT sites. This
will help increase the number of infants and children accessing diagnosis, care and antiretroviral therapy,
and towards achieving the 09 COP EID targets of 2,111 and rapid scale up of children on ARTs. Funds will
be used to support training 96 HCP on PMTCT including DBS, printing of the new combined mother-baby
health booklets; dissemination of national algorithm and Lab tool for EID, procurement of test-kits for rapid
tests, reagents, supplies and logistics for EID and DTC, and logistics for administration of pediatric ART and
care from the MCH. In COP 2009, CARE International will consolidate PMTCT activities to enhance male
partner involvement using special invitation cards to the partners. CARE will counsel and test 4,137 men as
partners, and will pilot use of extended HAART to make breastfeeding safer. CARE will use PLWHA to form
support groups. Some PLWHAs who have successfully gone through PMTCT will be trained as "Mother to
Mothers" to enhance PMTCT advocacy and community follow up of women and their infant to promote
adherence, return for EID, FP and exclusive breastfeeding for 6 months. Within the facilities, CARE
International will enhance supervision to achieve the targets for CT and NVP uptake. In addition, CARE will
leverage resources available through their Safe Water Systems (SWS) program that focuses on making
water safe through disinfection and safe storage to avoid contamination. Safe water vessels and
disinfectant will be provided to women in the PMTCT program. This will improve the safety of infant weaning
and reduce diarrhea morbidity. A community mobilization and education component will be included to
Activity Narrative: increase awareness so that community members can make informed choices on issues to do with
techniques of disinfecting water, proper hygiene behavior and proper use of safe water storage facilities.
CARE has a microfinance arm "Kungu kod Holo" where women with HIV who have gone through PMTCT
contribute to and get small loans from, making them economically empowered.
3. CONTRIBUTIONS TO OVERALL PROGRAM AREA
Community participation and male involvement will significantly contribute to PEPFAR goals for primary
prevention, access to care and treatment, and support of those affected and infected. This activity will
contribute 1.6% to the 09 COP overall Emergency Plan PMTCT targets for Kenya (1.3 million).
4. LINKS TO OTHER ACTIVITIES
This activity is linked to the KEMRI ARV program, KEMRI laboratory program, KEMRI TB/HIV program, and
VCT. PMTCT services include counseling and testing which is largely diagnostic, provision of ARV
prophylaxis and appropriate referrals for the management of opportunistic infections and HIV/AIDS
treatment. All HIV-positive mothers and their family members will be referred to the ART program for on-
going care, treatment and support. DBS samples will be packaged and shipped to KEMRI laboratories
doing PCR, while samples for CD4 will be sent to regional laboratories doing CD4 count. Patients
suspected to have TB will be screened and referred for TB treatment. Partners of HIV positive mothers will
be encouraged to come for testing at PMTCT site or to go for VCT.
5. POPULATIONS BEING TARGETED
This activity targets adults, pregnant women, HIV+ pregnant women, HIV exposed and HIV+ infants (0-4
years). The PMTCT+ initiatives will also target HIV affected families through providing mechanism for
improving access to care of the family members of the HIV+ women. Public health care workers including
doctors, nurses and other health care workers for example clinical officers, nutritionists, and social workers,
will also be targeted for training using the nationally adopted NASCOP/CDC/WHO approved training
packages, to equip them with knowledge and skills to provide comprehensive HIV prevention and care
services.
6. KEY LEGISLATIVE ISSUES ADDRESSED
Key legislative issues include increasing gender equity in HIV/AIDS programs, reduction of stigma and
discrimination, linking care and support programs to income generation activities, and microfinance
programs for women.
7. EMPHASIS AREAS
Major emphasis will be placed on Data Quality Assurance and Supportive Supervision; lesser emphasis will
be placed on Commodity procurement, Community Mobilization/Participation, Development of
Network/Linkages/Referral systems and Training.
New/Continuing Activity: Continuing Activity
Continuing Activity: 14736
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
14736 4181.08 HHS/Centers for CARE 6931 368.08 $500,000
Disease Control & International
Prevention
6851 4181.07 HHS/Centers for CARE 4210 368.07 $400,000
4181 4181.06 HHS/Centers for CARE 3236 368.06 $300,000
Emphasis Areas
Gender
* Increasing gender equity in HIV/AIDS programs
* Increasing women's access to income and productive resources
* Reducing violence and coercion
Health-related Wraparound Programs
* Child Survival Activities
* Family Planning
* Malaria (PMI)
* Safe Motherhood
* TB
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $90,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
