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 3.3.01:
Table 3.3.08:
Table 3.3.09:
Program Budget Code: 11 - PDTX Treatment: Pediatric Treatment
Total Planned Funding for Program Budget Code: $302,000
Total Planned Funding for Program Budget Code: $0
Table 3.3.11:
Program Budget Code: 12 - HVTB Care: TB/HIV
Total Planned Funding for Program Budget Code: $1,275,000
Program Area Narrative:
Overview
Lesotho has the 5th highest incidence of TB in the world and it is estimated that 80% of TB patients are co-infected with HIV. TB
control activities in Lesotho are decentralized to the country's 10 districts, and although Lesotho currently reports 100% DOTS
coverage, the National TB program (NTP) is weak, and the accuracy of data questionable. The NTP reports that 12,258 cases of
TB (all forms) were identified in 2007, with a case notification rate of 541/100,000 population; and the case notification rate for
new sputum smear positive cases was 227/100,000. The case detection rate for Lesotho currently stands at 80%, well above the
globally set target of 70%. The NTP registered 3,162 sputum smear positive cases for TB treatment in 2006, of which 73% (2,294)
were successfully treated (cure rate of 59%, well below the 85% target) and a high death rate of 10%. Using drug-resistance data
from KwaZulu-Natal, a neighboring province of South Africa, and applying it to Lesotho's 2005 TB incidence, an estimated 950
new MDR-TB patients will be diagnosed in Lesotho each year.
Lesotho's NTP functions within the Disease Control Unit, which is also responsible for the management of the majority of the
country's communicable and non-communicable disease control programs. The NTP Manager reports to the head of the Disease
Control Division, who reports to the Director of Primary Health Care, who reports directly to the Director General (DG) of Health
Services. By contrast, the HIV/AIDS Directorate is a completely separate entity which reports directly to the DG. The parallel and
unequal position of these programs has resulted in limited collaboration, although PEPFAR/Lesotho is advocating for closer
coordination. The NTP has focused its TB/HIV efforts on scaling up two main collaborative activities:
1) HIV testing for patients with TB,
2) CPT and ART for patients with TB disease and HIV infection.
In 2007, 51% of newly registered TB patients were tested for HIV, of whom 80% were positive. Among patients with TB and HIV,
70% received CPT, and approximately 19% were on ART. The NTP has begun regular collaborative meetings with the HIV/AIDS
directorate and plans to have district TB coordinators and HIV coordinators conduct joint supervision visits to improve TB/HIV
integration.
A recent assessment by CDC reported that the Central Laboratory (CL) has insufficient staff, space, and equipment. The CL is
unable to meet the demand for culture or DST, and space limitation has been identified as a significant safety issue. These
insufficiencies are a barrier to scaling up diagnosis and treatment of smear-positive, smear-negative, and extra-pulmonary TB, as
well as drug resistant TB. The MCC will be building a new National Reference Laboratory (NRL), but it will not be ready to
perform essential laboratory services until 2011. In the interim, the NTP plans to decentralize laboratory capacity to diagnose and
treat both susceptible and resistant TB, by increasing the capacity of three regional labs to perform culture and DST.
PIH currently provides staff and TA to the CL, and manages the only MDR inpatient treatment facility in Lesotho. They are also
active in programs that support community-based treatment for TB and drug resistant TB. Global Fund Round 8 funding has been
requested to develop and support three additional MDR treatment sites around the country. The NTP's efforts to expand central
and regional capacity to diagnose and treat MDR TB are part of a plan to assume responsibility (from PIH) for management of
MDR TB in Lesotho.
Current USG Program
University Research Corporation (URC) is the primary PEPFAR funded partner for TB/HIV in Lesotho and is currently working in
six districts at ten hospitals, six public health clinics, and two private clinics. URC has provided technical support to the NTP to
develop a National Tuberculosis Policy Manual, National DOTS Expansion Strategic Plan, TB/HIV Strategic Plan, and other
essential documents, In addition, it has provided technical assistance to the implementation of the national Drug Resistance
Survey (currently in progress). A primary role of URC is training staff at hospitals and health centers, particularly ART clinic
nurses and private healthcare professionals, in TB diagnosis and treatment. URC has also trained TB officers and District TB/HIV
coordinators in the use of the Electronic TB Register (ETR) which was developed by WHAM Technologies through support of
CDC. The ETR is managed by the NTP, although the USG continues to fund WHAM for system maintenance and support. All
districts have now trained in ETR and are using this system in tandem with written registers.
URC also participates in NTP supervisory support visits to public and private health facilities to check the accuracy of TB registers
and patient treatment cards, and to assist staff to resolve problems encountered in TB control. 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. URC also provides financial support for one of the laboratory technicians involved in TB and HIV diagnosis and
follow-up examinations.
USG 2009 Support
PEPFAR/Lesotho is currently working to identify the strongest partner within the TB sector in Lesotho to lead and coordinate its
work. As a result, TB/HIV funding is TBD in the FY 2009 COP. This partner will continue to prioritize PEPFAR's main objectives
consisting of HIV counseling and testing for TB suspects and TB testing for HIV-positives, as well as strengthening of appropriate
treatment and prevention services for those with TB infection and active disease. In addition, PEPFAR will redouble its efforts to
encourage close collaboration between HIV PMTCT, care, and treatment partners. Closer collaboration is needed between TB
implementing partners and all clinical services to reinforce screening and referrals to improve the overall quality of services to HIV
-positive TB patients. Referral and feedback systems , particularly with PMTCT will strengthened. PEPFAR will also engage the
NTP and its implementing partners to improve essential infection control measures to prevent TB transmission in HIV and primary
care facilities. PEPFAR will continue to support MDR TB surveillance and work with partners to effectively and efficiently manage
drug resistant TB.
Since lab capacity has been identified as a major challenge to the expansion of TB/HIV services and MDR TB diagnosis and
treatment, further investment is critical. The USG will continue building capacity within the Central Laboratory and at planned
regional laboratories. A new CDC lab advisor will work closely with the Laboratory Director and care providers to ensure that
essential laboratory services such as microscopy and culture, as well as drug susceptibility testing and molecular diagnostics
(where appropriate), are available. Linkages to external labs and both internal and external quality control will be developed.
More information about proposed lab activities is available in the Laboratory Strengthening program area narrative.
Leverage and Wraparounds
The Global Fund Round 2 grant provides funding to conduct surveillance for MDR TB. PEPFAR/Lesotho supports this
surveillance through Technical Assistance from the CDC Chief of Party, CDC Department of TB Elimination, and TA from URC.
PEPFAR also works in partnership with MCC, which plans to refurbish up to 150 health clinics and 14 hospitals over the next five
years. One example of this collaboration is that the ETR system used by the NTP and supported by PEPFAR will be integrated
into the HMIS being assessed by MCC. PEPFAR and MCC are also collaborating on the development of infection control policies
and guidelines to ensure appropriate measures are implemented in the newly renovated clinics and hospitals. To date, PEPFAR,
through CDC, has provided training on infection control to the Christian Health Association of Lesotho (CHAL) for CHAL's
community health centers, which are among those being refurbished by MCC.
The Foundation for Innovative Diagnostics (FIND), Partners in Health (PIH), GF, MCC, MOHSW and PEPFAR have been working
together to develop in-country TB culture and sensitivity testing capacity. A small but state-of-the-art interim facility has been built
by FIND and PIH for this purpose, but it is already over capacity, leading to backlogs and concern about contamination of
specimens. When the new MCC funded NRL is completed, equipment from this state-of-the-art lab will be moved there. However,
as noted above, construction will not be completed until 2011, and additional space, equipment, and trained technicians will need
to be identified and procured in the interim.
Proposed Compact Expansion
As PEPFAR/Lesotho moves forward to negotiate a Partnership Compact with GOL, we anticipate further strengthening of TB/HIV
activities including improvements related to the laboratory, referral and treatment of HIV/TB co-infected patients, MDR detection
and treatment, and surveillance activities. This will be accomplished primarily through human resource development activities
including supportive supervision and mentoring, local and distance learning, training of additional technicians and ancillary staff,
as well as task shifting when possible, implementation of quality assurance programs, and improved referral and follow-up
systems and infection control measures. As Compact negotiations are currently in early stages, we understand that we may need
to revise expectations, and will rely on the advice of our core team and DP "friend" as we move forward.
Table 3.3.12:
Table 3.3.18:
