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
N/A
New/Continuing Activity: Continuing Activity
Continuing Activity: 18588
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
18588 11949.08 U.S. Agency for Elizabeth Glaser 8144 5957.08 Call to Action $500,000
International Pediatric AIDS project (EGPAF)
Development Foundation
11949 11949.07 U.S. Agency for Elizabeth Glaser 5957 5957.07 Partnership for $0
International Pediatric AIDS Family-Centered
Development Foundation HIV/AIDS
Program
Table 3.3.01:
n/a
Continuing Activity: 19078
19078 19078.08 U.S. Agency for Elizabeth Glaser 8216 8216.08 Call to Action $166,500
International Pediatric AIDS Project (EGPAF)
Table 3.3.08:
Continuing Activity: 19079
19079 19079.08 U.S. Agency for Elizabeth Glaser 8216 8216.08 Call to Action $166,500
Program Budget Code: 10 - PDCS Care: Pediatric Care and Support
Total Planned Funding for Program Budget Code: $272,000
Total Planned Funding for Program Budget Code: $0
Program Area Narrative:
OVERVIEW
Lesotho has made significant progress over the past three years in the areas of care, treatment and support for both adults and
infants. However, pediatric care and treatment is a relatively new area for Lesotho and specific data on HIV pediatrics is scarce.
According to UNAIDS (2008), 11, 801 children are living with HIV/AIDS. UNGASS (2007) estimates 3,520 children need
treatment, with only 26% receiving ART in November 2007. Data from PMTCT clinics (UNGASS 06-07) indicate that out of 167
health facilities, 19 hospitals and 116 health centers and private clinics are offering antenatal care (ANC), postnatal care (PNC)
and maternity services. PMTCT/HCT services were provided to 23,965 pregnant women in 2007. Twenty-five percent of infants
born to HIV-infected mothers are HIV-infected themselves (2005). In 2007, more than 3,437 HIV exposed children received DNA-
PCR testing, which is expected to be expanded to all health centers in 2008. DBS are collected at clinical facilities and sent to
South Africa for DNA-PCR, results in delays in the clinics. The national pediatric goal in Lesotho is to reduce new HIV infections
among children by 50% and to provide HIV services to all infected children and their families by 2011. The MOHSW has further
indicated the goals for 2011 of providing ARV prophylaxis to 100% of exposed infants; and that at least 80% of community health
workers and traditional birth attendants are capable to support PMTCT (MOHSW Health Sector HIV/AIDS Strategic Plan 2008-
2011).
In addition to PEPFAR, several international donors support GOL's PMTCT and pediatric HIV treatment programs, including the
Clinton Foundation (CHAI) and Baylor College of Medicine. The Baylor Center of Excellence opened in December 2005 and is
well known in Lesotho as the prime pediatric care, support and treatment hospital. UNICEF supports Baylor's outreach program to
deliver pediatric HIV care and treatment mentoring and training to five hospitals and staff from filter clinics in five districts.
UNICEF, in collaboration with CHAI and Baylor, has also undertaken in-service training of staff from 17 of 21 hospitals on DBS
testing. UNICEF also provides PMTCT and Pediatric HIV supplies, including Hemoglobino-meters, HIV rapid test kits, midwifery
kits and sterilization kits.
Systemic therapeutic and supplemental feeding programs do not exist in Lesotho, although some nutritional support is provided
by World Food Program (WFP). Approximately 5,510 households infected and affected by HIV are provided food packages, with
an estimated total of 25,160 beneficiaries. The food support is distributed via health centers once a month. An additional 350
children on ART are given food support through Queen II Hospital and Baylor.
CURRENT USG PROGRAMS
PEPFAR/Lesotho's pediatric care and treatment services are part of an integrated PMTCT program, and are implemented by
PMTCT partners EGPAF and ICAP. Through PMTCT programs and a system of referrals and networking newborns, under-fives
and older children are identified, diagnosed, and treated. USG partners link with CHAI and Baylor to refer HIV-positive children to
pediatric care and treatment. In FY 2008, EGPAF and ICAP increased their support to clinical sites that provide PMTCT and
pediatric care services, as well as strengthened referrals to and linkages with CHAI and Baylor. In addition, USG implemented a
stronger and more robust data reporting system over the course of FY 2008, which provides more accurate and timely data both
to PEPFAR and MOHSW.
USG FY 2009 PROGRAM
PEPFAR's plan to scale-up PMTCT services in 80-90% of clinical sites throughout Lesotho by the end of FY2009 is consistent
with the MOHSW's target of 100% PMTCT by 2011. Improving the quality of programs for both mothers and infants, improving
program monitoring and expanding community level activities will be a important part of this scale-up. PEPFAR partners also plan
to strengthen TB/HIV and nutrition programming to provide integrated services. Strengthening the monitoring and evaluation
systems of pediatric HIV and AIDS care services is another goal for FY2009. With more intensive work with family support groups
and community outreach activities, PEPFAR will be able to increase its provision of pediatric care, including providing nutritional
counseling, assessments and support, and expanding psychological and social support services.
PEPFAR plans to select a new prime partner for PMTCT during FY2009 (see PMTCT program area for more details). This new
partner will work to enhance and improve pediatric services. Of particular concern is the almost 50% of mothers that give birth in
the community. Making clinics more user friendly for both antenatal and birthing services, honoring cultural practices in the clinic,
training birth attendants in PMTCT, systematic follow-up of new-borns, etc. are some ideas to be implemented. Nutritional
assessment and counseling, including therapeutic and supplemental feeding programs will be another important component for
the new partner.
MOHSW is currently debating whether to allow nurses to prescribe ART for children. This change in policy would increase the
services available at health clinics and decrease referrals and possibilities of loss to follow-up.
LEVERAGING/WRAPAROUNDS
As discussed above, the Baylor Center of Excellence is the prime pediatric care, support and treatment hospital, which accepts
referrals from throughout Lesotho and does outreach to clinical facilities. The Clinton Foundation (CHAI) also provides
comprehensive pediatric services in some district hospitals and purchases all pediatric ARVs. UNICEF is the implementing
agency for the European Commission in services for children, including a voucher system for vulnerable children and their
families, which should start during FY 2009. WFP provides food packages for targeted adults and children for defined periods of
intervention. Collaboration and coordination is the responsibility of the National Pediatric Task Force. PEPFAR partners work in
collaboration with these programs to enhance their inputs and thus provides a more comprehensive package of services to
pediatric clients.
Of particular note is the expansion of the Baylor Center of Excellence, which will build pediatric to provide satellite clinics in each
of the 10 districts over the next few years. Their mentorship program in hospitals in Butha Buthe and Mokhotlong, where Baylor
doctors visit on a regular basis and provide 24 hour phone consultations is an effective model that can be replicated in other
services. These satellite clinics will be very useful in promoting comprehensive pediatric care throughout Lesotho.
PROPOSED COMPACT ACTIVITIES
As PEPFAR/Lesotho moves forward to negotiate a Partnership Compact with GOL, we anticipate that funding for pediatric care
and treatment will increase significantly in order to increase the number of infants receiving treatment services in PMTCT clinics.
We anticipate negotiations with GOL to increase the number of clinical sites at which PEPFAR is supporting services, as well as
improve the quality of services provided through improving human capacity, and strengthening linkages with community-based
HIV/AIDS support programs for better referrals of pregnant women and young children to clinical services. We plan to address
issues that impact children, including increasing access to care and treatment and scaling up provision of pediatric ART, as noted
in the Guidance documents we received from the Deputy Principals. As Compact negotiations are only at the early stages, we
understand that we may need to review our expectations, and will be in touch with our core team and DP "friend" as we move
forward.
OTHER QUALITATIVE ACCOMPLISHMENTS
1. New PMTCT Guidelines changed from single dose nevirapine (sd-NVP) to a multi-drug ARV prophylaxis regimen (AZT/3TC/sd-
NVP). USG partner, EGPAF, was instrumental in this effort and provided technical support to MOHSW in the roll-out.
2. New ANC and maternity registers were finalized. This effort contributes to upstream results in PMTCT, including pediatrics.
In addition to PEPFAR, several international donors support GOL's PMTCT and pediatric HIV treatment programs, including the C
Table 3.3.10:
New/Continuing Activity: New Activity
Continuing Activity:
Table 3.3.11:
