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:
+ Increased emphasis on provision of comprehensive PMTCT services in the lower level facilities and
strategies to increase the uptake of HIV testing and counseling to male partners of women attending ANC
services.
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,
counselors, clinical officers, nutrition officers, social workers and health record Clerks.
COP 2008
1. LIST OF RELATED ACTIVITIES
This activity will relate to ARV services through CDC KEMRI, CDC KEMRI laboratory services, CDC KEMRI
VCT, CDC KEMRI TB/HIV and to ARV Services by APHIA II Nyanza.
2. ACTIVITY DESCRIPTION
The International Medical Corps (IMC) will continue to support the implementation of PMTCT activities, with
a geographical focus on the Suba District in Nyanza Province. Suba is a hard-to-reach area in Nyanza
Province with a mainland and six main islands which include Rusinga, Mfangano, Remba and Ringiti within
Lake Victoria. The infrastructure is particularly poor with very bad roads, and movement between the
islands and mainland requires use of a boat, making access to health facilities difficult. Subas are a fishing
community with very high HIV prevalence rates among women: 41% in the 2003 KDHS and 20.8% as per
PMTCT programme data. IMC is currently supporting PMTCT activities in 35 out of 37 public health facilities
in the district. The PMTCT activities of IMC relate to counseling and testing of pregnant women in antenatal
clinics (ANC) and in maternity units, and provision of antiretroviral prophylaxis to HIV-positive women and
exposed infants. IMC is also involved in postnatal follow-up of mother-infant pairs, testing of the woman's
partner and other children, and linking those eligible to care and treatment. In FY 2009, IMC-supported
facilities will counsel and test 8,216 (93%) of 8,796 pregnant women, perform WHO clinical staging and
provide antiretroviral prophylaxis for 1,711 (93%) of 1,832 HIV positive pregnant women. Of these 1711
women, IMC will provide sdNVP and AZT to 856 HIV-positive women, link 342 women with CD4 count
below 350 cells/mm3 or in WHO stage 3 and 4 to antiretroviral therapy (HAART), and provide a minimum of
513 pregnant women with sdNVP. IMC will support EID for HIV through PCR testing to all the exposed
infants in accordance with the national algorithm. For the infant, IMC will focus on initiation of cotrimoxazole
and doing DBS for PCR at six weeks. Infants found to be HIV positive at six weeks or thereafter will be
linked to pediatric HIV care and treatment if they are eligible. All HIV-positive children will be initiated on
ARVs at 18 months irrespective of CD4 counts. The postnatal care package for the mother will include
counseling on appropriate maternal and infant feeding practices according to national PMTCT and nutrition
guidelines, linkage to family planning services and linkage to care and ARV treatment. IMC will enhance
male involvement through invitation by cards, men as partners (MAP), establishment of a male only clinic
and through home based counseling and testing. These efforts will reach 1643 men with CT services. Home
-based counseling and testing will be conducted and antenatal women found positive will be referred to the
nearest health facility for PMTCT program. IMC will use the national PMTCT curriculum, and NASCOP
(MOH) clinical and reporting guidelines, and will continue to participate in the MOH's Technical Working
Group to ensure coordination of activities between the sites it supports and the MOH at the district and
national level. In FY 2009, IMC will have scaled up to all 35 health facilities in the district, and will focus on
consolidation of PMTCT core activities. Despite being in all health facilities, achieving universal access will
be a challenge due to the difficult terrain, and there would still be unmet CT need of about 6000. IMC will
use other approaches including mobile PMTCT clinics using boats and establishing a network with
traditional birth attendants and community health workers to refer mothers for PMTCT services at the
nearest health facility, as well as expand home based counseling and testing. IMC will address all the four
prongs of PMTCT, and lay emphasis on primary prevention, prevention of unwanted pregnancies and
enhance linkage to care and treatment for mother, partner and children. IMC will use people living with
HIV/AIDS (PLWHAs) for peer counseling, formation of support groups, and for demand creation for PMTCT
services. IMC will engage in task shifting using PLWHA to take up some of the less technical tasks of the
HCP. A mother-to-mother (M2M) initiative will be implemented and in each facility 2 HIV-positive women will
be identified and recruited to provide counseling, adherence counseling and outreach services. IMC will
conduct orientation of the DHMTs and health care providers on Family Planning Integration and STI
Management within PMTCT settings. The HCPs and DHMTs will also be orientated on current interventions
like more efficacious regimen, early infant diagnosis, counseling on infant feeding especially when PCR
results show HIV negative and integration of FP into PMTCT. Emphasis will be laid on behavior change and
positive prevention. IMC has trained 60 nurses and will train a total of 90 by end FY '07. In FY 08 IMC will
train 30 nurses in basic PMTCT, and 15 VCT counselors who will be used in home based counseling, a way
of increasing couple counseling and male involvement. Community workers will be an additional resource
to supplement the scarcity of Ministry of Health (MOH) personnel.
3. CONTRIBUTIONS TO OVERALL PROGRAM AREA
PMTCT in Suba District 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 0.6% of the 2009
overall Emergency Plan PMTCT targets for Kenya (1.3 million). The expansion of the scope of services to
include early infant diagnosis and male involvement will be an important entry point for other members of
the woman's family to be identified and linked to care and ARV treatment.
4. LINKS TO OTHER ACTIVITIES
VCT, and CDC KEMRI TB/HIV and to ARV Services by APHIA II Nyanza. Linkages to antiretroviral
treatment centers, known as Comprehensive Care Clinics (CCC), will be strengthened to ensure immediate
and appropriate care for the woman, exposed infants, and family members, optimizing the utilization of
complementary services created through PEPFAR funding.
Activity Narrative: 5. POPULATIONS BEING TARGETED
This activity targets children less than five years, adolescents of reproductive age 15-24, adults, pregnant
women and people living with HIV. Health care providers including doctors, nurses, and other health care
workers will be targeted for training on PMTCT using the national NASCOP CDC/WHO based curriculum.
6. KEY LEGISLATIVE ISSUES ADDRESSED
This activity will increase gender equity in HIV/AIDS programming through provision of HIV counseling and
testing services of pregnant women, and improved access to other HIV care programs for the HIV infected
woman, her infant and other family members. It will also reduce violence and coercion through stigma at the
community level.
7. EMPHASIS AREAS
This activity includes emphasis on quality assurance and supportive supervision as well as emphasis on
Development of Network/Linkages/Referral Systems; Community Mobilization/Participation, wrap around
programs with Food/Nutrition, PMI through distribution of insecticide treated nets at the MCH, safe
motherhood through focused antenatal care, other Family planning initiatives and TB screening and referral
for treatment and care. Equity will be promoted through identification of vulnerable groups and factors that
make specific groups particularly vulnerable. Gender-related vulnerabilities will be identified and analyzed
and described and incorporated into all interventions. This includes MAP, gender-based violence and
cultural barriers that are related to gender norms.
New/Continuing Activity: Continuing Activity
Continuing Activity: 14836
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
14836 4239.08 HHS/Centers for International 6955 662.08 $330,000
Disease Control & Medical Corps
Prevention
6906 4239.07 HHS/Centers for International 4234 662.07 $100,000
4239 4239.06 HHS/Centers for International 3256 662.06 $300,000
Emphasis Areas
Gender
* Increasing gender equity in HIV/AIDS programs
* 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 $10,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
+ This activity will incorporate $28,000 to partner with HIV Free Generation activities that focus on youth.
+ All Voluntary Medical Male Circumcision (VMMC) activities described in the FY08 narrative are now
incorporated in their own narratives in FY09 under VMMC.
+ Specific prevention messages targeting women, men and discordant couples will be incorporated into the
Home Based Counseling and Testing. interventions. Specific messages will be developed for each group
including adults above the age of 55.
+ Specific AB messages will target both adult men and women with the aim to reduce the number of
multiple concurrent partners.
The only changes to the program since approval in the 2007 COP are:
•Geographic coverage has been revised (or expanded) to include Migori district.
•FY 2007 PLUS UP ADDITIONS: This plus-up will support expanded activities currently implemented by
the International Medical Corp in Suba district, Nyanza as described in the 2007 COP. IMC is currently
undertaking a district-wide door-to-door family level testing for all of Suba district. This strategic opportunity
will allow for prevention education to be provided at family level as well as at community level as
mobilization for the door-to-door testing is carried on. IMC will therefore implement the Families Matter!
intervention to help parents discuss HIV prevention matters with their adolescent children, including
extended family members who live under their custody. This intervention will cater for the highly vulnerable
adolescent orphans who are an increasing population of highly vulnerable youth in Suba district. A related
challenge in Suba is gender-based violence, particularly inflicted upon adolescent orphans and other
vulnerable children living with hosts, relations and friends. Anti-rape and anti-sexual abuse campaigns will
be conducted as part of the general prevention education. (Gender-based violence $100,000).
•$28,000 of this activity is programmed with funds from the $7 million FY 2008 plus up for the Healthy Youth
Programs Initiative.
This activity relates to activities in Counseling and Testing (#6907) and Prevention of Mother-to-Child
Transmission (#6906).
The International Medical Corps (IMC) is already working in the areas of PMCT, CT, and TB/HIV in Suba
District. IMC has recently begun providing VCT on a number of islands in Lake Victoria with high
concentrations of young male fishermen, fish mongers, and informal commercial sex workers. On some of
these islands, the ratio of men to women is as high as six men to one woman. Outreach VCT to these
islands has been well accepted, with as much as 20% of the populations on some islands accepting testing.
HIV rates in VCT clients are very high; on some islands, over 40% of the women and over 20% of the men
tested are HIV infected. IMC has also found that there are many concurrent partnerships and sexual
networks, factors which may contribute to high HIV incidence. Additionally, the prevalence of other STDs
among the sexually active population is very high at 40%. IMC will intensify community outreach and
targeted behavioral interventions for high-risk groups in Suba, primarily focusing on the beach community.
It will work with the migratory populations to try to interrupt the high HIV incidence on these islands. IMC
proposes to reach these fisher folks and commercial sex workers on 45 beach landings on 12 islands on the
Suba part of Lake Victoria. IMC will work in close collaboration with CDC and other implementing partners
in Suba to ensure synergy and appropriate linkages between the various services available. IMC will train
348 beach workers from amongst the local community to enable them carry out intensive activities aimed at
significantly reducing sexual risk behaviors among 100,000 individuals. 350 condom outlets will be
established.
The program will reach 100,000 at risk individuals, train 348 people and establish 350 condom outlets.
This activity is linked to activities in Counseling and Testing (#6907) and Prevention of Mother-to-Child
5. POPULATIONS BEING TARGETED
The target population is primarily mobile populations, including business community and community
leaders. Commercial sex workers and their partners will be targeted as will public health care workers and
traditional healers. Given the high prevalence in Suba district, PLWHAs and HIV/AIDS affected families will
be targeted. Adult men and women, out of school youth and discordant couples will be targeted.
This project will address social norms and behaviors and reducing violence and coercion. This activity will
also make a contribution towards reducing stigma and discrimination.
Community mobilization is a major emphasis area, while human resources, training and information,
education and communication and needs assessment are minor emphases.
Continuing Activity: 14837
14837 6610.08 HHS/Centers for International 6955 662.08 $275,000
6908 6610.07 HHS/Centers for International 4234 662.07 $175,000
6610 6610.06 HHS/Centers for International 3256 662.06 $50,000
* Addressing male norms and behaviors
Table 3.3.03:
+ IMC's activities in Nairobi Province will be transitioned to other partners to avoid duplication of efforts and
maximize USG resources. IMC's activities in Coast and Nyanza Provinces will require improved
coordination and more strategic partnerships with other USG programs in support of existing MOH District
and Provincial TB/HIV work plans. Clarity on these approaches and updated targets and budgets are
provided below.
This activity relates to activities in CT, PMTCT, Adult Care and Support, Pediatric Care and Support,
Pediatric/ARV Services
IMC complements national efforts to deliver essential services for hard-to-reach and high-risk populations
with limited access to health services. In Nyanza Province, IMC provides essential TB/HIV care to needy
fishing communities in Suba District mainland and several islands in Lake Victoria with high TB and HIV
rates. In Coast Province, IMC will build on its investments on health staff training and on infrastructure to
complement efforts of other TB/HIV partners to achieve regional targets. At present, IMC's support in Coast
Province is essential to achieving satisfactory coverage in largely underserved and remotely settled
communities. To achieve improved coordination and partnerships, IMC's contributions will be well described
in respective District work plans formulated under auspices of stakeholders' forums and health management
teams.
In FY 09, IMC will further expand HIV care, treatment and prevention services for TB patients/suspects and
enhance TB screening for PLWHA at all TB and HIV service sites in Nyanza Province (Suba District) and
Coast Province (Taita, Taveta, Tana Delta and Tana North Districts). In collaboration with national HIV and
TB programs, IMC will ensure that providers continue to deliver consistent, quality and improved counseling
and testing messages and that access to CPT and ART is optimized for eligible TB patients. To reduce TB
burden among PLWHA, IMC, in partnerships with the national HIV, TB and laboratory programs, will
strengthen and expand TB screening at all HIV care sites and ensure that those meeting basic screening
criteria undergo complete TB diagnostic workups to allow appropriate clinical decisions. In line with overall
TB/HIV program priorities, IMC will target at least (50%) of PLWHA screened for TB, at least 50% access
to ART and universal access to CPT for those who qualify. This will result in 500 HIVTB co-infected clients
attending HIC care and treatment services being attended to and at least 1000 registered TB patients being
screened for HIV. IMC will build on these expanded activities to establish complementary partnerships and
better patient referral networks with national programs, other PEPFAR programs, other non PEPFAR
partners and local PLWHA organizations at all sites. Other activities will include strengthening community
participation and ownership, improving delivery of DOTS at community and household levels, tracing TB
treatment defaulters, strengthening referral linkages between community and facility-based TB and HIV
activities, improving infrastructure and expanding training of health workers. IMC will also initiate delivery of
HIV prevention through partner testing and protection of the HIV-free partner. IMC will continue to support
and expand access to quality free TB diagnostic services through staff training and logistic support for
improved coverage and quality of sputum microcopy EQA. IMC will also ensure that providers request for
culture and drug susceptibility for TB retreatment cases in a consistent and more coordinated manner.
Efforts will be made to optimize documentation and treatment of MDR-TB cases.
These activities will result in strengthened delivery of integrated HIV and TB services, including
strengthened referral systems, improved diagnostics and treatment of TB among HIV-positive patients and
of HIV in TB patients, strengthened capacity of health workers to provide integrated HIV and TB services
and strengthened capacity for program monitoring, evaluation and management of commodities.
These TB/HIV activities will be integrated with ongoing VCT, PMTCTand STI and ARV treatment services in
the respective Provinces in support of the national programs.
5. EMPHASIS AREAS
These include facility renovations, local organization capacity development, workplace programs, health-
related wrap arounds (TB, malaria) and human capacity development (in-service training, task shifting, and
staff retention activities).
New/Continuing Activity: New Activity
Continuing Activity:
Table 3.3.12:
ACTIVITY UNCHANGED FROM COP 2008
+ Geographic coverage has been expanded to include Migori district in Nyanza province. They will provide
the same services in Migori as in Suba. The same level of care and treatment services in Suba will also be
available in Migori, provided by UCSF which is the same PEPFAR funded agency for Suba. The good
partnership between IMC and UCSF (FACES) in Suba will therefore be extended to Migori.
+ The home based CT has been well received in Suba (with acceptance rates of over 90%), hence the
expansion to Migori. However, in order to strengthen referral to care and treatment, IMC in FY 2008 will
continue to support establishment of community based support groups for people living with HIV/AIDS. IMC
will also carry out follow up visits, especially to the homes with HIV positive people. During this second visit,
they will take evaluate the impact of the intervention using different t methodologies. Where necessary,
acceptable and logistically feasible, blood will be taken for CD4 testing at Suba district hospital. IMC will
also continue supporting Male Circumcision through its community level networks.
This activity relates to activities in PMTCT and TB/HIV.
In FY 2009, International Medical Corps (IMC) will continue to work in Suba, promoting uptake of
Counseling and Testing (CT) in medical facilities, fixed and outreach VCT outlets and through door- to- door
testing in both Suba and Migori districts. Door-to-door HIV testing was first piloted in Suba by IMC in FY
2006, because Suba had the highest HIV prevalence in Kenya. A door-to-door approach will identify large
numbers of previously undiagnosed individuals who will benefit from the rapidly emerging care opportunities
and will also increase couples counseling and testing and facilitate the identification of discordant couples.
Thus, the initiative will contribute towards realization of Kenya's national prevention, care, and treatment
targets. Through these multiple approaches for VCT, IMC will provide CT services to 80,000 individuals,
with at least 15,000 of them being referred for care and treatment. An estimated 3,000 discordant couples
will also be identified and counseled. Core activities will include establishment of 40 additional CT sites in
health facilities, provision of mobile VCT, door-to-door CT, strengthening the networks for referral of those
testing HIV positive to care. Support to the ten existing VCT sites operating in collaboration with local
community based organizations (CBO) will also continue. Periodic Mobile VCT to selected underserved
areas of the district will be provided as part of integrated outreach package coordinated jointly with Ministry
of Health and CDC/KEMRI GAP program for Nyanza. Service elements during such integrated outreach
activities will include CT, TB screening and referral, Prevention with positives interventions, PMTCT and
immunization. 80 new CT service providers will be trained to meet personnel requirements for new CT sites
and expansion of service through door- to-door testing. These activities will result in increased CT access
and better linkage of HIV positive persons to care. In FY 2008 IMC will strengthen its network with the local
CBOs to educate the community in Suba and Migori on the benefits of CT for prevention and care. In the
two districts stigma and fear remain major barriers to uptake of CT and utilization of available HIV/AIDS
care services. In order to address this challenge, IMC will work with the Ministry of Health and other
partners to institutionalize HIV testing as part of diagnostic work up of patients and to strengthen referral
linkages between door-to-door CT and care services. IMC will also strengthen compliance with national
guidelines for CT services, quality assurance and data management at all points of services delivery
including home settings. IMC will also work with local leaders, the religious community and the local media
to promote education and dissemination of information.
IMC's CT work in Suba and Migori, is appropriately targeted towards identifying large numbers of HIV
infected individuals who are potential beneficiaries of the prevention, care and treatment opportunities
created through President's Emergency Fund. The planned CT service output of 90,000 for FY 2008
represents a significant increase from FY 2006 target. At national level, it represents only a modest
contribution to the overall 2008 Emergency Plan CT targets for Kenya, but is highly relevant since it targets
a population with the highest HIV prevalence in the country. Planned mobile and door-to-door VCT will
improve equity in access to essential HIV/AIDS services and will help normalize HIV testing in this high
prevalence district. Linkages initiated with FY 2007 funds between CT services and care will be
strengthened to ensure achievement of Emergency plan targets.
The IMC CT activities in Suba District relate to IMC activities in PMTCT and TB/HIV activities and
collectively constitute an effective comprehensive response to HIV/AIDS epidemic in this area.
This activity targets a district with the highest HIV burden in Kenya and where practices that encourage HIV
spread such as widow inheritance and premarital sex are common. The district in focus is one where
HIV/AIDS services are not readily available to the entire population, partly because of the geography of the
area. For example a large part of the district is covered by the water of Lake Victoria, and therefore access
is by boat. In FY 2008 the main focus of IMC's effort in Suba will be door-to-door CT. This activity targets
the entire population and will be done in phases. The first phase was started in FY 2006, and the
acceleration phase was in FY 2007. The essence of this community-based CT work is to educate the entire
population in the district, with the family as the focus. By educating the entire family, IMC will be achieving
several strategic prevention, care and treatment objectives, the main ones being stigma reduction and
family support for people in care and treatment.
This activity will reduce gender based disparities in the provision of HIV/AIDS services. Part of this will be
done through the promotion of couple counseling and disclosure. Analysis of VCT client data at existing
IMC sites indicates a low service uptake by couples and low disclosure rate amongst sex partners. The
much increased availability of CT services through door-to-door testing, Mobile VCT and in health facilities
Activity Narrative: will help to reduce gender disparities in access to CT and reduce stigma.
The planned activities will require a major emphasis on human resources for successful implementation
since the target district has a severe shortage of service providers both in public and private. Resources to
expand human resource capacity to provide other essential HIV/AIDS services are also lacking. IMC will
therefore dedicate considerable efforts and funds during FY 2007 towards addressing human resource
deficit for its planned activities. Innovative approaches that increase access to CT within home settings and
within medical facilities in this area will be implemented. Minor emphasis will be on infrastructure, training of
service providers and enhancing linkages to care services outlets to match increased identification of HIV
positive individuals that will result from improved CT uptake in the district. Another minor emphasis will be in
the area of community mobilization. Part of the Kenya's MC roll-out strategy will be to build on existing
PEPFAR activities. IMC is currently implementing door-to-door testing in Suba District, Kenya's highest
prevalence district. Plus-up funding will be used to expand IMC's VCT work to target those who may be
eligible for MC services. IMC will develop and incorporate communication messages in their VCT package
about MC, together with referral information for facility and mobile service delivery which will also be
provided in Suba District with Plus-up support through IRDO. The MC mobile service provision will be
provided by mobile teams consisting of approximately five people (including 1 clinical officer, 1 VCT
counselor, 1 surgical nurse, 1 sterilizer/cleaner and 1 driver). These mobile teams will be coordinated with
IMC's HBVCT and mobilization efforts.
Continuing Activity: 14839
14839 4772.08 HHS/Centers for International 6955 662.08 $1,200,000
6907 4772.07 HHS/Centers for International 4234 662.07 $1,150,000
4772 4772.06 HHS/Centers for International 3256 662.06 $380,500
Table 3.3.14:
