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:
+Project will expand its scope to include targeted interventions addressing cross-generational sex, multiple
concurrent partnerships, gender-based violence and Prevention with Positives.
+This project will incorporate HIV-free generation youth activities in Nairobi, Central and Eastern province
sites. $56,000 is attributed to this activity.
COP 2008
The only changes to the program since approval in the 2007 COP are:
• The target population has been revised (or expanded) to include out-of-school girls in urban areas,
including domestic workers and married adolescents;
• Other changes include: mobilization of girls-only groups through additional female FOYs, focusing on out-
of-school girls in urban areas, including domestic workers and married adolescents.
• $56,000 of this activity is programmed with funds from the $7 million FY 2008 plus up for the Healthy
Youth Programs Initiative.
1. LIST OF RELATED ACTIVITIES
This activity relates to activities in Condoms and Other Prevention Activities (#7027) and Counseling and
Testing (#8753).
2. ACTIVITY DESCRIPTION
Population Council's (PC) ‘Friends of Youth' (FOY) Project, working in partnership with the Family Health
Options Kenya (FHOK) will reach 116,847 youth with abstinence and faithfulness messages through
training fifty new adult mentors and providing update trainings to all 300 Friends of Youth (FOYs), some of
whom will receive update training in counseling and testing. It builds on tested interventions that are
consistent with local cultures of adult-youth mentoring by enlisting the involvement of trusted adults and
older youth in the community to act as friends of youth. These FOYs will help to positively influencing safer
sexual behavior and changing community and social norms. The intervention employs a behavior change
model whose effectiveness has demonstrated effectiveness in delaying sexual initiation, increasing
secondary abstinence and reducing the number of sex partners among adolescents. The program links
youth with a trained adult mentor at village level. The program will work with 300 FOYs who will use an
informal curriculum-based approach using the ‘Life Skills Plus' curriculum. Each of the 300 FOYs will reach
at least twenty new youths each month to encourage abstinence and behavior change activities.
Additionally, the FOY project will train 100 youth in participatory theatre to enhance their involvement in
community HIV education activities. The project will expand its activities to the Embu municipality, which
bears close proximity to Nyeri and shares similar cultural practices. These activities will contribute to our
results of HIV preventive behaviors among youth improved, changed social and community norms to
promote HIV preventive behaviors in youth, and models for effective youth interventions tested. Significant
changes from FY 2006 to FY 2007 include scaling up to a new project site, Embu municipality as well as
integration of alcohol and substance abuse education and related services. This expansion will also enable
the FOY project to undertake baseline studies for a subsequent targeted evaluation. Data management will
be strengthened through establishing more effective linkages with other service delivery partners. An
important addition to the project will be establishing linkages for adolescent care and treatment in both
private and public heath care facilities. PC has done extensive work on effective youth interventions and this
project will scale up a successful youth-adult behavior change model in selected urban areas in Kenya.
Population Council will study the results of this project so that lessons can be learned about this approach
to youth HIV prevention. To help improve health services for young people, young people will be served
through selected private service providers through a coupon system in which referrals will be made
particularly through the youth center for free health services. This activity also includes support to the
Family Health Options Kenya who implements activities integral to the program for $80,000.
3. CONTRIBUTIONS TO OVERALL PROGRAM AREA
During the 2009 project period, a total of 116,847 individuals will be reached with an intensive curriculum-
based life skills training program through 300 FOYS/adult mentors trained. Community outreach programs
that promote abstinence and/or being faithful through five project sites namely Nyeri, Nyahururu, Thika,
Embu and Huruma slums in Nairobi will contribute to the Emergency Plan prevention targets.
4. LINKS TO OTHER ACTIVITIES
This activity relates to PC (FOY) other program areas, FOY AB activities will contribute to achievement of
targets in OP activity (#7027), CT activity (#8753). PC-FOY will continue strengthening the referral system
that encourages youth to adopt good health-seeking behavior by eliminating treatment cost barriers.
5. POPULATIONS BEING TARGETED
This activity will target young men and women of reproductive age who are mainly the FOYs as well as
youth including primary and secondary school students. It will continue to identify community leaders who
will be instrumental in the recruitment of friends of youth. Religious leaders and program managers will be
actively involved in this activity and the trusted adults selected will serve in a volunteer capacity and
continue to receive only a minimal honorarium and occasional incentives such as training. This activity will
continue to intensively involve teachers through its' in-school programs. The project will extend its coverage
to rural communities.
6. KEY LEGISLATIVE ISSUES ADDRESSED
This activity will address gender issues by increasing gender equity in its HIV/AIDS programs and will
continue to address male norms and behaviors, particularly ensuring that there is a greater involvement of
male youth in abstinence campaigns in its Life Skills training. It will work largely with volunteers.
7. EMPHASIS AREAS
Major emphasis will be on community mobilization. Minor emphasis will be on information, education and
communication. Through its partnership with FHOK, quality assurance and supportive supervision will be
offered alongside training. Human resources is a minor emphasis as the project has a thin staff structure
and relies heavily on the volunteer friends of youth to drive its implementation.
New/Continuing Activity: Continuing Activity
Continuing Activity: 14975
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
14975 4218.08 HHS/Centers for Population Council 6992 448.08 $557,000
Disease Control &
Prevention
7026 4218.07 HHS/Centers for Population Council 4275 448.07 $250,000
4218 4218.06 HHS/Centers for Population Council 3249 448.06 $150,000
Emphasis Areas
Gender
* Addressing male norms and behaviors
* Increasing gender equity in HIV/AIDS programs
Human Capacity Development
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.02:
+The project will expand its scope to include targeted interventions addressing cross-generational sex,
multiple concurrent partnerships, gender-based violence, working with men, boys and Prevention with
Positives
+The project will develop and scale up appropriate interventions responsive to the public health needs of
MSM, based on the findings of the MSM assessment being undertaken in FY08
sites. $100,000 is attributed to this activity.
•Geographic coverage has been revised (or expanded) to include Thika and Nyeri;
•The target population has been revised (or expanded) to include men who have sex with men; extremely
vulnerable girls and young women in urban areas;
•Other changes include: 1) programmatic assessments of MSM populations in regional towns of Thika and
Nyeri, where HIV prevalence is considerable and where the FOY program has a network of collaborating
service providers and outreach workers. 2) a programmatic assessment will be conducted in low income
and slum areas of Nairobi, where little MSM work has been undertaken but where transactional same sex
interactions are likely. Findings from the assessments will identify patterns of MSM behavior in regional
town and cities, inform context-appropriate programs, and provide direction for further surveillance surveys
among this population. Based on results from the assessments in three urban sites, the Council will work
collaborating service providers to make existing services responsive to the needs of MSM. 3) sensitization
of providers to the HIV prevention and RH needs of MSM and working with Liverpool VCT—who have
developed MSM services in Nairobi—to train providers. The Council will monitor and document the
experience of strengthening existing service providers in urban areas to meet the needs of MSM.
Documentation will include monitoring of performance, post training interviews with service providers and
interviews with clients. 4)Also, during the coming year, the Friends of Youth program will increase its focus
on the most vulnerable subsets of adolescent girls and young women, and will conduct exploratory program
assessments on non-formal transactional sex among girls and young women in urban areas, leading to
programmatic content addressing transactional sex.
•FY 2007 PLUS UP ADDITIONS: This plus-up will support the expansion of activities currently supported
as per the 2007 COP. Population Council's Friends of Youth (FOY) project will expand the scope of
working with high-risk youth with prevention interventions in its five major locations - Nyeri, Nyahururu,
Thika, Huruma/Mathare and Embu. The FOY project will target high-risk behaviors among youth in the said
locations to include working with youth in post-test clubs, youth groups with community education activities,
youth living on the streets and other young people engaged in high-risk behavior. This activity will also
allow increased support to the Family Health Options Kenya who facilitates increasing access to STI
treatment through a coupon referral system to local health providers. This activity will be closely linked with
counseling and testing and will target mobilizing young people with high-risk behaviors to improve
prevention of HIV transmission through self and partner testing.
•$100,000 of this activity is programmed with funds from the $7 million FY 2008 plus up for the Healthy
This activity relates to activities in Abstinence and Be Faithful Programs (#7026) and Counseling and
Population Council's (PC) ‘Friends of Youth' (FOY) Project working in partnership with the Family Health
Options Kenya (FHOK) will reach 97,633 youth with condoms and other prevention education and services.
It will train an additional 300 FOYs. It will expand its scope of the Friends of Youth (FOYs) to include using
the adult mentors (FOYs) to reach sexually active and at-risk youth education and service that focus on
sexual risk reduction. The effectiveness of the FOY activity in achieving behavior change for youth through
close adult mentorship has been evaluated for effectiveness and shown to result in adoption of safer sexual
behavior and is now being scaled up to previous control sites and other feasible areas. The program links
youth with a trained adult mentor at village level. The program will work with the existing 100 FOYs who will
use participatory approaches to involve youth in risk-reduction education, including condom promotion and
distribution. The project will therefore identify and target sexually active youth and other high-risk groups
within their target locations. They will increase support to STI treatment for youth by linking them to service
providers through an established coupon system that offers youth a significantly subsidized treatment cost
and hence eliminates the cost barrier to treatment. STI screening and treatment for individuals with HIV will
be intensified. It will also provide reproductive health information for young women testing positive to
prevent unintended pregnancies. Referral systems to HIV care and treatment services, including ART will
be improved to reduce viral load and the risk of HIV transmission. In addition, behavioral interventions
targeting individuals with HIV will be developed to help reduce the risk of transmission. These and other
efforts will ensure that Positive Prevention is a key focus among this high-risk group. Additionally, the FOY
project will provide update trainings for 200 youth in participatory theatre to enhance their involvement in
community HIV education activities. The project content will be further enriched to include intensified
education on alcohol and substance abuse. The project will expand its activities to the Embu municipality,
which bears close proximity to Nyeri and shares similar cultural practices upon which the project is
developed. Data management will be strengthened through establishing more effective linkages with other
service delivery partners. An important addition to the project will be establishing linkages for adolescent
care and treatment in both private and public heath care facilities. PC has done extensive work on effective
youth interventions and this project will scale up a successful youth-adult behavior change model in
selected urban areas in Kenya. This activity also includes support to the Family Health Options Kenya for
activities integral to the program for an amount of US$50,000.
During the 2009 project period, a total of 97,633 individuals will be reached with an intensive curriculum-
based life skills training program through an additional 300 FOYS/ adult mentors trained. 187 condom
Activity Narrative: outlets will be established.
This activity relates to PC-FOY other program areas: FOY AB activities (#7026) will contribute to
achievement of targets in this program activity and CT activity (#8753). PC-FOY will continue strengthening
the referral system that encourages youth to adopt good health-seeking behavior for STIs and subsequently
care as need may be. Linkages will be established with public health care facilities to supplement current
linkages that exist with private health service providers.
This activity will target young men and women of reproductive age as well as out-of-school youth and
partners/clients of CSWs. It will continue to identify community leaders who will be instrumental in the
recruitment of friends of youth. Religious leaders will be actively involved in this activity and the trusted
adults selected will serve in a volunteer capacity and continue to receive only a minimal honorarium and
occasional incentives such as training. Linkages will be established with health care providers in both the
private and public sector, particularly nurses. Support from community-based organizations mainly at sub-
locational level will continue to be enlisted to ensure that both parents and youth continue to be supportive
of this condoms and other prevention activity.
male youth in condoms and other prevention campaigns. It will also work at reducing violence and coercion
through reinforcing desirable behavior in its life skills training. Stigma and discrimination will be addressed
through all program activities.
Major emphasis will be on human resource. Minor emphasis will be made on community mobilization and
participation as well as on Information, Education and Communication. Linkages with other sectors,
especially the health sector and the development of referral systems will be enhanced. Training of FOYs
and youth will be other minor emphases.
Continuing Activity: 14976
14976 6582.08 HHS/Centers for Population Council 6992 448.08 $353,000
7027 6582.07 HHS/Centers for Population Council 4275 448.07 $260,000
6582 6582.06 HHS/Centers for Population Council 3249 448.06 $150,000
* Reducing violence and coercion
Table 3.3.03:
+ In 2008 this was a study that sought to assess the acceptance of self testing among health workers.
Knowledge of HIV status among health workers is seen to be beneficial in improving attitudes towards aids
patients and clients in health facilities. In 2009 population council will expand HIV testing beyond the study
sites, to cover the general health worker population in national, provincial and some district hospitals. These
services will be provided in at least 50 health facilities. At least 200 health providers will be trained and
sensitized to support the other health workers. Population Council will counsel and test 10,000 health
workers, both in public and faith based health facilities.
The only changes to the program since approval in the 2007 COP:
+ the geographical coverage has been expanded to include Mobile VCT outreaches which will be provided
from each of the VCT static sites.
This activity relates to activities in AB and OP.
In FY 2009, Population Council's (PC) ‘Friends of Youth' (FOY) Project working in partnership with the
Family Health Options Kenya (FHOK) will provide counseling and testing services to 5,000 individuals and
train 10 counselors to work in 5 sites. The provider centered workplace program will test an additional
10,000 Health Care Workers in 50 hospitals/health care centers. The Friends of Youth project initiated CT
activities in the previous year and will therefore strengthen the CT activities in the areas where they have
Emergency Plan supported AB and OP activities. These sites include Huruma in Nairobi, Nyeri, Nyahururu,
Thika and Embu. The FOY project also works in close collaboration with existing VCT sites. In its OP
activities, the FOY project works with a network of private health service providers to offer STI and
reproductive health services to young people. These health providers will receive training in DTC so that
they can integrate CT into the other health services, such as STI treatment. This activity will be closely
linked with the AB and OP activities in the same region. The project was evaluated in a previous phase and
it was found that this adult mentorship model was an effective strategy in transforming behavior among the
youth. This activity is now being expanded in scope and geographic coverage within the limits of feasibility.
The program will work with 100 youth organizations, and will use participatory approaches to involve youth
and adults in risk-reduction education, including education and promotion of the need for counseling and
testing. The FOY approach is organized along the Central Bureau of Statistics mapping and each youth
organization covers a well defined catchment area to assure a comprehensive coverage. Building on this
strategy, the FOY project will explore the feasibility of undertaking door to door testing, under the close
guidance of trained counselors. Through the close interaction between FOY and young people, the project
will therefore identify and target sexually active youth and other high-risk groups within their target locations
and encourage them to learn their status. PC has done extensive work on effective youth interventions and
this project will scale up a successful youth-adult behavior change model in selected urban areas in Kenya
which now includes counseling and testing. It builds on tested interventions that are consistent with local
cultures of adult-youth mentoring by enlisting the involvement of trusted adults and older youth in the
community to act as friends of youth by promoting safer sexual behavior and changing community and
social norms. Population Council will carefully study the results of this project so that lessons can be
learned about this approach to youth HIV prevention.
3. CONTRIBUTION TO OVERALL PROGRAM AREA
The work of FOY will be comprehensive with an important emphasis on youth. Beyond providing VCT and
DTC, they will also provide reproductive health and adult mentorship. Impartation of life skills will support
HIV prevention efforts.
The CT activities that will be implemented by FOY will be linked to other Emergency Plan supported HIV
prevention activities of Population Council (Friends of Youth). These include AB and OP. Community
mobilization and IEC activities will be done jointly. The youth programs will be used to encourage clients to
have an HIV test.
5. POPULATION BEING TARGETED
This activity will target out-of-school youth including street youth.
6. KEY LEGISLATIVE ISSSUES ADDRESED
This activity will mainly address gender equity in access to information and health care. It will also address
stigma and discrimination through increased information and awareness.
This activity will have a major emphasis on community mobilization and a minor emphasis in production of
IEC materials. FOY will work with adult mentors and youth leaders to enable the youth to access CT and
reproductive health services. They will integrate OP and AB information with CT so as to provide a
comprehensive package of services. Other minor emphasis areas are in training and human resources.
Continuing Activity: 14977
14977 8753.08 HHS/Centers for Population Council 6992 448.08 $50,000
8753 8753.07 HHS/Centers for Population Council 4275 448.07 $50,000
Table 3.3.14:
This PHE activity, "Assessing the feasibility of HIV self-testing among health workers in Kenya" was
approved for inclusion in the COP. The PHE tracking ID associated with this activity is KE.07.0035. A copy
of the progress report is included in the Supporting Documents section.
Continuing Activity: 17853
17853 17853.08 HHS/Centers for Population Council 6992 448.08 $200,000
Estimated amount of funding that is planned for Public Health Evaluation $0
+ Since only two locations (Malindi and Thika districts) can be covered using COP 2008 funds, additional
funds in COP 2009 will ensure a third location (Nakuru) is covered, with data analyzed and disseminated for
use by programs.
SECONDARY CROSS-CUTTING BUDGET ATTRIBUTIONS
This activity supports key cross-cutting attributions in human capacity development by training senior
NASCOP and NACC staff on the use of surveillance data to inform program design and targeted
intervention among the Most-At-Risk-Population.
1. ACTIVITY DESCRIPTION
In the 2007 COP, Kenya undertook the implementation of a national, population-based household survey.
This survey, which is in the field from July-October 2007 will provide uniquely valuable information for
prevention program planning and policy development within Kenya. The Kenya AIDS Indicator Survey
(KAIS) will capture information on a great swath of the population, however sub-groups of great importance
to the HIV epidemic will be missed by the KAIS because they do not reside in homes that can be mapped
and enumerated for the sampling scheme. Or their behaviors of interest are stigmatized and go unreported
during household interviews. The groups of greatest interest include men who have sex with men (MSM),
injection drug users (IDU), female sex workers (FSW) and truckers, who are often clients of FSW.
Epidemiologically, a temporally similar survey of these high risk groups will provide a better profile of the
HIV epidemic in Kenya and shed a brighter light on the transmission dynamics. Of equal importance is the
assessment of the many prevention programs funded in Kenya targeting some of these groups. In 2007,
the USG funded the ROADS project, Hope World Wide, and KANCO's RAY project to provide prevention
services for long distance truckers. Behavioral and biological surveillance of truckers will provide key
indicators specific to this group and allow the estimation of coverage by these projects. In a worrisome
development, Kenya and other East African states have become transshipment points for heroin and
cocaine. Seizures of illegal drugs have increased in each of the past 3 years. UNODC reported a >10%
increase in seizures in east Africa from 2000-2004. Few efforts to quantitatively measure the impact that
injection drug use may have on the Kenyan HIV epidemic have been reported. Current available
information comes from a rapid assessment and analysis and a mapping exercise along the coast. A single
survey of 120 IDU in Mombasa is reported and 1.7% were HIV infected. In Nairobi survey of 101 injectors,
52.5% were infected. More recent assessments indicate a rise in injection among heroin users which could
lead to increased transmission. A recent survey in Zanzibar, which is culturally similar, revealed an HIV
prevalence of 26% among IDU. We propose to survey IDU in 3 towns along the coast and into the interior
to assess the magnitude of the IDU problem and the potential transmission dynamics and contribution to the
epidemic and whether Kenya needs to increase focus on both prevention of injection drug use and HIV
among IDUs. Prevention services for FSW programmed in COP '07 included one program targeting women
who serve truckers (HWW) and another offering mobile VCT at night called Mobile and Moonlight VCT.
Male sex workers who have sex with men were recently surveyed in Mombasa by Population Council. The
findings indicated an exceedingly low level of knowledge about how to prevent HIV transmission including
the broad use of Vaseline as a lubricant with condoms. Little is known about the men who have sex with
men (MSM) population in Kenya.
For FY '08, the USG Kenya team proposes a set of behavioral and biological surveys of most at-risk
populations in about 3 towns with a focus on the coast, Nairobi and the Rift Valley provinces. The surveys
will be carried out by an NGO partner in collaboration the MOH. A standardized protocol will be developed
in collaboration with the funded partners and the USG/CDC team. Formative research will be conducted in
several locations to determine the best survey sites, to assure community buy-in and pilot some questions.
The surveys will use respondent driven sampling (RDS) to gather a probability-based sample, to enhance
the validity of findings. RDS is increasingly being used to sample hard to reach populations in sub-Saharan
Africa with recent success in Kampala (MSM), Uganda, Zanzibar (MSM, IDU, FSW), Tanzania, and Lusaka,
Zambia (MSM). The survey instrument will provide estimates for the target populations' risk and prevention
behaviors, knowledge, attitudes and access to HIV prevention services and/or treatment. Additionally, the
role the subpopulations play in the epidemic will be examined. At a minimum, respondents will be asked to
provide a blood specimen for HIV testing and they will receive pre- and post-test counseling with
appropriate referrals and their test results. Sample sizes will be calculated to provide sufficient power to
detect a change of 15% in preventive behaviors between this baseline survey and a future round in 2-3
years. A capture-recapture component will be built in to the protocol to permit estimates of the size of the
respective at-risk populations surveyed. Analyses will be reported to the surveyed communities as well as
the MOH and used to better target prevention services to important at-risk groups.
2. CONTRIBUTIONS TO OVERALL PROGRAM AREA
This activity will provide additional information to previous studies that have been carried out among MSM
and IDU along the Swahili coast and female sex workers in numerous parts of the country. A better
understanding of these populations will help determine if additional resources need to be focused on these
potentially high frequency "transmitters" of HIV. It is possible that, as a proportion of new infections, these
groups are underrepresented in prevention allocations.
3. LINKS TO OTHER ACTIVITIES
The surveys will include HVCT HIV counseling and testing for populations with reduced likelihood of testing.
This offers the opportunity to assess counseling modalities for hard to reach groups that require difference
messages from the general population such as injection drug users and men who have sex with men.
Linkage to prevention, care and treatment services will be provided. Additional prevention messages can be
delivered within the context of the survey from peer to peer, taking advantage of the contact with
populations that usually shy away from public health.
4. POPULATIONS BEING TARGETED
The activity targets most at risk populations, mainly MSMs, FSW and IDU in five towns in Kenya.
Activity Narrative: 5. EMPHASIS AREAS
The major emphasis is strategic information (Survey/Surveillance), while the minor emphases include
counseling and testing and HIV prevention for MARPs.
Continuing Activity: 18828
18828 18828.08 HHS/Centers for Population Council 6992 448.08 $300,000
Table 3.3.17:
