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.
N/A
New/Continuing Activity: New Activity
Continuing Activity:
Table 3.3.02:
Table 3.3.03:
Table 3.3.08:
Table 3.3.10:
Table 3.3.11:
Program Budget Code: 14 - HVCT Prevention: Counseling and Testing
Total Planned Funding for Program Budget Code: $1,400,000
Total Planned Funding for Program Budget Code: $0
Program Area Narrative:
OVERVIEW
Lesotho has a population just 1.8 million people and one of the highest HIV prevalence rates in the world. During the 2005
National HIV Sero-surveillance of "Women Attending Antenatal Care Services," HIV prevalence was estimated at 23% among the
adult population. It is believed that there are approximately 270,000 people living with HIV/AIDS in Lesotho (2006 UNAIDS
estimates). Most people do not know that they are infected with HIV or that there is treatment and care available. For many
reasons expanding HIV counseling and testing (HCT) services has been a difficult challenge throughout this mountainous country.
Most of the usual barriers to counseling and testing for HIV exist in Lesotho including a lack of knowledge, fear of social isolation,
stigma and the apprehension of being given a "death sentence". In addition, Lesotho also has its own set of special circumstances
that make a comprehensive HCT program problematic. Although geographically small, many people live in rural areas which are
difficult to reach and their contact with health care workers is limited. Almost half of women and men (49% each) who have never
been tested report wanting to be tested and most of them are living in rural areas; this represents a large pool of unmet need for
HCT (Lesotho DHS, 2004). These Basotho also do not have easy access to newspapers or television, and therefore are often
lacking important information regarding health care issues, including HIV.
In 2004, GOL launched the "Know Your Status" campaign, which initially called for all Basotho 12 years and older to be tested for
HIV by December 2007. The goal of the KYS campaign was for HCT to serve as the entry point to other HIV services. By the end
of the campaign, over 240,000 testing and counseling sessions were conducted for persons above 12 years of age thus reaching
19% of the target population of about 1.3 million people. Approximately 27,000 children were also tested, despite not being in the
KYS target population.
KYS was successful in testing a significant proportion of the population, bringing services to underserved communities, and
helping the 31% who tested positive to access ART and PMTCT services. The KYS brand is well-known, and the campaign has
had a visible and tangible effect in reducing stigma and increasing knowledge around HIV/AIDS. Following a WHO joint review of
KYS, MOHSW has determined that all HCT (PMTCT, VCT, and PITC) will fall under the KYS banner. USG and its partners will
follow this directive and use the term KYS as a reference to any HIV counseling and testing that is performed in Lesotho.
CURRENT USG PROGRAM
PEPFAR/Lesotho and its partners have provided significant assistance to MOHSW in the promotion of HCT. PSI is PEPFAR's
primary HCT partner, and is funded through CDC and DOD. Through PSI, PEPFAR has funded the operation of five stand-alone
"New Start" Centers, each with a mobile clinic. PSI mobile outreach programs provide client-initiated HCT services in every
district. PEPFAR has set standards and created operating procedures that have frequently been adopted by MOHSW; for
example, MOHSW recently adopted a HCT register developed by USG partner PSI, which will improve record-keeping and M&E
for HCT. PEPFAR provided technical assistance and played a leading role during the WHO joint review of the KYS campaign.
PEPFAR and its partners currently sit on the new HCT Steering Committee, which is developing the new framework for all HCT
activities in Lesotho. Through the workplace program CAPABLE, PSI provides VCT services to the following GoL agencies: LDF,
the Lesotho Revenue Authority, and The Ministry of Justice and Human Rights. PSI also provides financial support to the Lesotho
- Boston Health Alliance to conduct VCT services in Berea district.
In 2007, 51% of newly registered TB patients were tested for HIV, of whom 80% were positive. URC is providing financial support
for 20 lay counselors who are providing HIV testing and counseling services to TB suspects and patients in both public and private
health facilities in six districts of Lesotho. Further information about this program is available in the TB/HIV program area narrative.
USG FY 2009 PROGRAM:
In FY 2009, CDC and DOD will continue funding PSI to support MOHSW with the expansion of its HCT program, while
emphasizing the quality of HCT trainings and total quality assurance of the laboratory component. PEPFAR will assist in the
development of appropriate training packages for all cadres of health workers and lay personnel. There will also be an emphasis
on appropriate supervision, accurate and efficient reporting loops, better integration of HCT services at community health care
centers and quality assurance of the testing services.
A main focus of USG efforts will be to strengthen HCT services, including referrals. Rather than increasing the number of client-
initiated sites, PEPFAR will work through partners to make better use of existing stand-alone sites and expand quality services to
health facilities through franchising the New Start brand. In this new initiative, PSI will provide in-service training to MOHSW
counselors at New Start franchises and supportive mentoring by PSI master-counselors including with the LDF. They will also
provide refresher training and technical co-facilitation to LDF's 10 VCT Counselors. Franchise facilities will provide quality VCT
services, while increasing referrals to hospital services and linkages between the HCT clinic and STI, MCH, and TB service
providers. URC will be expanding its HCT services at TB facilities to include all 10 districts.
At the policy level, PEPFAR will continue working with the MOHSW to transition to provider-initiated HCT, especially at ante natal
clinics, TB clinics and hospitals, and STI facilities. Currently, Lesotho does not have a policy on opt-out PITC, but PEPFAR is
strongly advocating for a policy to be established and rolled out quickly, in order to expand counseling and testing services, as
well as the uptake of ART. HCT also will be part of the policy on male circumcision which will be developed with USG assistance.
PEPFAR implementing partners provide HCT services for PMTCT and TB and will expand services to include STI clinics
throughout the country.
LINKAGES AND WRAPAROUNDS:
PEPFAR is strengthening linkages between its HCT implementing partners and non-PEPFAR funded organizations providing ART
and TB services. HCT and PITC are expected to be an integral part of the services that will be available at the 14 outpatient
departments and approximately 130 community health centers that will be refurbished by MCC. The rollout of HCT services will be
coordinated with the rollout of these facilities.
PROPOSED COMPACT EXPANSION:
As PEPFAR/Lesotho moves forward to negotiate a Partnership Compact with GOL, we anticipate further strengthening CT
activities through human resource development activities. GOL is severely understaffed and under-resourced, and we anticipate
assisting in the development of a standardized curriculum for testing and counseling, improving quality assurance in Rapid
Testing and expanding supervision and mentoring at the community level in order to increase the quality of CT and provision of
services. If our Compact is approved, we anticipate assisting the GOL of its goal of reaching 80% of Basotho with quality CT
services, by 2011 and appropriately linking 80% of those tested with appropriate services. As Compact negotiations are only at
the early stages, we understand that we may need to revise expectations. As noted above, we plan to ensure the implementation
of policies that improve the uptake of counseling and testing, as noted in the Guidance documents we received from the Deputy
Principals.
OTHER QUALITATIVE ACCOMPLISHMENTS
-VCT marketing plan developed and launched by January 2009
-Franchise training curriculum modified for public sites by January 2009
-Franchise operating manual developed by January 209
-Two public franchise sites identified and accredited by March 2009
Table 3.3.14:
