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.
A. Implementing Mechanism Narrative
This TBD will include a range of interventions in counseling and testing (CT), and condoms and other prevention (HVOP) including condom social marketing, and behavior change communication. Specific programs include a network of fixed-site and mobile counseling and testing services; a post-test club program that provides life skills activities to community groups that have been through counseling and testing together; sales and free distribution of branded and generic male and female condoms; and multi-channel communication in support of testing, condom use, and partner reduction.
Partnership Framework linkages
The TBD partner will support the USG/GoL Partnership Framework Agreement through interventions that feed directly into four partnership objectives increased access to and availability of counseling and testing (obj. 1.4); increased supply and distribution of condoms (obj. 1.7); scale up of male circumcision services (obj 1.6); and increased coverage of behavior change interventions (obj. 1.1). Benchmarks for these interventions reflect both output-level PEPFAR indicators and outcome-level objectives. The latter will be measured through annual population-based surveys, include increased use of HIV counseling and testing services and increased correct and consistent condom use, with intermediate shifts in key determinants of these behaviors.
Geographic coverage and target populations
Targeting will be informed by the Demographic and Health Survey (DHS); condom coverage and distribution studies; and population-based surveys that measure exposure to and impact of ongoing behavioral interventions. The data offered by these studies will support the implementing partner in segmenting potential audiences, separating "behavers" from "non-behavers," and allowing for identification of significant behavioral determinants within a given group. Regular programmatic monitoring and secondary data also contribute to program design decisions, including geographic areas of focus and target populations.
The counseling and testing and condom programs will be nationwide in scope, providing services, products, and behavior change interventions to men and women throughout Lesotho. The counseling and testing programming targets urban and peri-urban men 25-35 and their partners, while condom programming focuses primarily upon rural couples (men 25-35, women 18-35). In addition, the program will support small-scale counseling and testing and condom interventions with other vulnerable populations, including men in uniform and factory workers. MC activities, including both the national pilot program, will likely target men 18 and older who are not already medically circumcised.
Plans to become more cost-efficient over time
The model of integrated counseling and testing services proposed in this narrative centers upon a gradual shift from direct service provision to support, training, and mentoring for public sector providers, which will result in cost-savings over time. In its condom programming, the partner will ensure cost-efficiency through improved stock management and streamlined distribution systems that rely heavily upon key partners to draw from lessons learned in our commercial distribution systems.
Monitoring and evaluation
The TBD partner will monitor its interventions through robust programmatic MIS, as well as periodic spot checks and mystery client visits. All MIS data is entered into web-based databases, which minimize data entry errors, facilitate analysis, and ensure program staff buy-in to and use of data. All communication activities include extensive formative research, pretesting, and monitoring to ensure their appeal, appropriateness, and effectiveness. In addition to routine monitoring and process evaluation, the partner will perform annual product distribution studies and population-based surveys to inform program design and measure impact.
The TBD partner will implement a counseling and testing model that emphasizes mobile services; integration of counseling and testing with other services (including MC, TB screening, STI diagnosis and treatment, or primary preventative care); and capacity building of public sector counseling and testing services. Parallel to this, the TBD partner will support the public sector in becoming the core of fixed-site counseling and testing provision, through provider training and mentoring; quality assurance; and procurement support. Mobile units will provide client-initiated individual and couples' counseling and testing, while public sector sites will focus on provider-initiated counseling and testing. This dual-track model, in which the TBD partner provides mobile services and capacity building and the public sector provides fixed services, will allow for more effective coverage of the population as a whole, with women of reproductive age reached primarily through fixed sites and men, vulnerable groups, and young people reached through mobile services.
In order to effectively promote its counseling and testing services, the TBD partner will utilize a cadre of IPC agents for community mobilization activities promoting counseling and testing. These activities target men and couples in particular, and focus heavily upon addressing key determinants of testing behavior, including self-efficacy and social support.
The TBD partner will implement a post-test club pilot program, a structured IPC intervention through which selected community groups who have elected to seek counseling and testing together go through an eight-module sexual health curriculum. This curriculum promotes retesting and safer sexual behaviors following testing and is appropriate for both positives and negatives.
Sexual prevention activities in this TBD include promotion and distribution of male and female condoms. In addition to branded, commercially marketed condoms, the partner will distribute GoL condoms to health centers, and provides USG-donated condoms to local partners. The partner will also distribute USG-donated female condoms (FC).
Condom programming will be implemented nationwide, targeting men and women in union. Rural couples are particularly high priority, as they are less likely to use condoms than their urban and peri-urban counterparts. The mix of activities included in this condom programming portfolio are influenced by target audiences; the need for balanced product supply and demand; and adherence to the Total Market Approach, a principle which hypothesizes that the healthiest markets are those in which all market segments commercial, subsidized, and public sector complement each other and grow in parallel. PSI ensures the quality of its condom program through coverage and distribution studies and population-based surveys, as well as robust MIS.
In FY11, male condom activities will include sales of branded male condoms as well as an expanded role in the distribution of free issue GoL condoms to health centers nationwide. Distribution of GoL condoms will be complemented by increased efforts to valorize free condoms through targeted promotion using both mass media and an expanded cadre of IPC agents, who provide interactive activities for individuals and small groups using a toolkit of eight highly targeted activities.
The implementing partner will also seek to grow partnerships with groups serving the general population and vulnerable groups in order to ensure better access to condoms. The partner will distribute male and female condoms and conduct community mobilization events as appropriate through existing networks of community-based partners.
The partner will build upon momentum gained in the comprehensive female condom program in FY10. This intervention will employ a model proven in the region, using non-traditional distribution channels (usually hair salons); intensive interpersonal communication; and community promotional events. The partner will also work with churches and FBOs to ensure that the female condom and dual protection are addressed in premarital family planning counseling. Finally, the partner will train nurses in public sector clinics to promote the female condom in family planning counseling, and will provide job aids and client take-away materials for this purpose. This pilot program will increase prevention options for men and women in union, and may strengthen demand for male condoms, as most female condom users tend to employ male and female condoms interchangeably.
