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
NEW/REPLACEMENT NARRATIVE
This continuing activity supports the National ART Program by providing a dedicated technologist to perform
viral load tests.
The Namibia Institute of Pathology (NIP) is responsible for provision of all HIV-related testing technologies
for the public sector at the national level. During February 2006, the national ART treatment guidelines
were updated to include viral load testing for patients suspected to be failing treatment. With the growing
number of patients on ARVs in Namibia, viral load testing has become an increasingly critical part of bio-
clinical monitoring. Guidelines have included more routine measurement of HIV-1 viral load at 6 months on
ART patients and screening for treatment failure. With the help of USG, NIP has equipped a state-of-the-art
molecular biology lab with viral load testing capacity. Anticipating increasing demand for viral load testing,
the dedicated lab technician hired and placed at NIP to perform this service will continue to be supported. It
is expected that over 12,000 viral load tests will be performed in FY09 and this technologist is needed for
NIP to have sufficient capacity to meet demand. This person will continue to receive technical assistance
from the CDC laboratory scientist assigned to NIP.
New/Continuing Activity: Continuing Activity
Continuing Activity: 16166
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
16166 7975.08 HHS/Centers for Namibia Institute 7367 1404.08 Cooperative $35,000
Disease Control & of Pathology Agreement
Prevention U62/CCU02441
9
7975 7975.07 HHS/Centers for Namibia Institute 4384 1404.07 Cooperative $40,000
Emphasis Areas
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $35,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.09:
This is a continuing activity and provides funding for the salary of a dedicated technologist in support of
early infant HIV diagnosis by PCR.
for the public sector. During COP FY 2005, the diagnostic algorithm for using dried blood spots (DBS) and
PCR for pediatric diagnosis was developed and field-tested in Namibia. During COP FY 2006, the Ministry
of Health and Social Services (MOHSS) PMTCT program and NIP introduced this method for testing
symptomatic infants and screening HIV-exposed infants at six weeks of age. Laboratory staff have been
trained in PCR, new equipment has been procured, specimens are being processed, and the rollout of
decentralized training of health workers in the collection of DBS is ongoing. It is expected that 20,000
diagnostic PCR tests will be performed in COP FY 2009 and a dedicated technologist is needed for the
laboratory to have sufficient capacity in response to increasing demand. This person is being supported with
technical assistance from the CDC laboratory scientist assigned to NIP.
Continuing Activity: 16163
16163 7927.08 HHS/Centers for Namibia Institute 7367 1404.08 Cooperative $40,000
7927 7927.07 HHS/Centers for Namibia Institute 4384 1404.07 Cooperative $40,000
Table 3.3.10:
Namibia has one of the highest rates of tuberculosis in the world and TB currently is the leading cause of
death for persons living with HIV. In addition to multi-drug resistant (MDR) TB, Namibia is facing the added
challenge of identifying and responding to the emergence of extensively drug resistant (XDR) TB. There is
also a continuous need to improve the laboratory surveillance of MDR/XDR TB cases and reporting to the
National TB Control Programme (NTCP).
This is a continuing activity from FY 2008 COP and has five components: (1) strengthening the Namibia
Institute of Pathology (NIP) tuberculosis laboratories by procurement of equipment; (2) expanding TB
diagnostic techniques; (3) improving quality assurance (QA) by hiring a QA staff person; (4) strengthening
bio-safety; and (5) supporting TB laboratory staff. (USG support for TA and other costs for TB drug
resistance surveillance in COP 09 is described in the MOHSS Strategic Information narrative. NIP cost
analysis is to be undertaken with COP 08 resources by APHL and MOHSS.)
1. Continue to strengthen the Namibia Institute of Pathology (NIP) tuberculosis laboratories. This
component will continue to improve NIP's capacity to process a greater volume of testing. In FY 2007 COP,
five MGIT 960 instruments were purchased and installed in the laboratory to replace the BACTEC 460
radiometric system, and the lower-capacity BactAlert instruments. Also in FY 2007 COP, two consultants
from the American Society of Microbiology spent three months in the TB Lab assisting with culture/DST and
quality assurance. This support resulted in more accurate testing of patient specimens. However, there is
a continued need to decentralize the TB culture and sensitivity testing to some high-burden areas served by
peripheral laboratories. Two high burden sites have been identified and two more MGIT 960 instruments
will be purchased to establish testing in these laboratories.
2. Expand TB diagnostic techniques. Rapid identification of MDR/XDR TB cases is important for better
patients' management. This component will continue to roll out fluorescence microscopy at TB laboratories
and expand the use of rapid TB diagnosis techniques at NIP, specifically Hain line probe assay. In FY 2008
COP, fluorescence microscopy was introduced at some of the high burden sites and rapid TB diagnosis
techniques were evaluated. In FY 2009 COP, at least 10 fluorescent microscopes will be procured.
3. Improve the Quality Assurance (QA) component of TB diagnosis. The QA for TB diagnostic testing has
been found to be a weakness by previous consultancies and assessments. In FY 2007 COP and FY 2008
COP, funding was allocated to hire a TB QA person dedicated to basic smear microscopy. With the
expansion of C/DST it is expected that the QA person will take a lead role in overall QA related to TB Lab
testing.
4. Strengthen bio-safety, TB specimen transport, and waste management. One of the primary concerns
during the TB laboratory assessments was bio-safety. In FY 2007 and FY 2008 COP bio-safety cabinets
were purchased for all NIP laboratories performing TB diagnosis. In FY 2009 COP, additional renovations
and improvements in labs will be conducted to improve safety. With MDR/XDR TB cases detected in
Namibia by NIP labs, it is important to have measures in place to protect the health workers as well as
avoiding risky handling of TB suspects' specimens. With its own resources, NIP has implemented a health
and safety policy that covers screening for TB for staff with potential occupational exposure.
5. Support salaries of two medical technologists, one for QA (see activity 3) and one as the TB Central Lab
Supervisor. Salaries for six laboratory assistants will also be supported. These staff members are part of
NIP's staff establishment, and as such, they are supervised as part of the NIP structure. The CDC
laboratory technical advisor who is placed at NIP mentors these and other NIP staff on a day-to-day basis.
Continuing Activity: 16164
16164 7971.08 HHS/Centers for Namibia Institute 7367 1404.08 Cooperative $265,000
7971 7971.07 HHS/Centers for Namibia Institute 4384 1404.07 Cooperative $848,500
Health-related Wraparound Programs
* TB
Estimated amount of funding that is planned for Human Capacity Development $160,000
Table 3.3.12:
This is a continuing activity that contains two components which serve as the foundation for the quality
assurance (QA) provided at the national level to all rapid HIV testing sites in Namibia. In FY09, funding is
being requested for: (1) ongoing rapid testing (RT) QA support (evaluation of new RT kits, preparation of
starter packs, provision of quality controls and proficiency panels, oversight of certification processes,
ELISA tests for 5% retesting of all rapid tests performed, and supervision of RT sites); (2) salary support for
7 staff (1 national communicable disease (CD) QA manager, 1 national HIV RT QA manager, 3 QA medical
technologists, and 2 administrative assistants).
These activities support rapid and extensive expansion of provider-initiated testing and counseling (PITC)
as well as existing VCT. The NIP is responsible for validation of any new RT technologies before being
used in Namibia and for making recommendations to the Ministry of Health and Social Services (MOHSS)
on the RT algorithm and selection of test kits; training and post-training certification of all rapid testers
before they can issue results to clients; site inspection of all new RT sites to ensure that they meet the
minimum standards; preparation, distribution, and follow-up analysis of quality controls and proficiency
panels that are sent to RT sites; retesting of 5% of all rapid tests done at sites by ELISA and addressing any
performance issues with the tester; and submission of reports on rapid test QA to the MOHSS CT unit.
To date a total of 1,043 testers including health workers and community counselors have been successfully
trained. Among these, 887 have been certified and 156 are in the process of certification. From July 2008
to September 2008, 3,234 retests were performed for testers' certification and 1,566 retests performed as
part of the current quality assurance standard which requires 10% retesting. NIP and the MOHSS have
since agreed to lower the retesting standard to 5%. During the same period, 148 sets of External Quality
Assurance proficiency panels and 370 Quality Control sets were sent out to the RT sites.
Continuing Activity: 16165
16165 7992.08 HHS/Centers for Namibia Institute 7367 1404.08 Cooperative $920,000
7992 7992.07 HHS/Centers for Namibia Institute 4384 1404.07 Cooperative $691,000
Estimated amount of funding that is planned for Human Capacity Development $165,000
Table 3.3.14:
This activity contains four components: (1) procurement and maintenance of equipment; (2) renovation of
laboratories; (3) laboratory training; and (4) salary support for laboratory trainers and an administrative
assistant.
1. Namibia's antiretroviral treatment program is rapidly expanding with emphasis on bringing these services
closer to patients in remote areas. By its mandate, the Namibia Institute of Pathology (NIP) is required to
support the treatment program wherever it is launched. NIP will continue to strengthen its peripheral
laboratories in providing diagnostics and basic bio-clinical monitoring services accessible to the patients in
remote areas. This will minimize transport of samples to central testing facilities and improve turnaround
time. Funds will be used to procure and maintain laboratory equipment for this purpose.
2. Renovations of the molecular diagnostic laboratory and selected peripheral NIP laboratories will
accommodate the high volume of testing, make work places safer for laboratory workers, and improve
turnaround times.
3. Support the NIP laboratory training unit to handle logistics of all trainings. During FY07 and FY08,
ITECH was funded to provide logistical support to the training unit. This responsibility will be handled by
NIP's training unit in FY09, a more sustainable arrangement. Workshops will be organized with assistance
of the International Laboratory Branch (ILB) consortium partners. The presenting partner will be selected
depending on NIP's ongoing training needs. Potential areas for training will be: laboratory management,
including strategic planning for the national laboratory system (APHL); bio-monitoring assays such as CD4
methods and instrumentation, chemistry and hematology (ASCP); OI focusing on tuberculosis smear
microscopy, culture and drug susceptibility testing, and bio-safety (ASM); and standardized laboratory
methodology and quality assurance (CLSI). Funds will be allocated to send NIP staff to attend
complementary trainings at the African Center for Integrated Laboratory Training (ACILT) in Johannesburg
as well as relevant trainings outside of Namibia.
4. Support the salaries of the 2 technical trainers and the administrative assistant assigned to the training
unit.
Continuing Activity: 17320
17320 17320.08 HHS/Centers for Namibia Institute 7367 1404.08 Cooperative $826,000
Estimated amount of funding that is planned for Human Capacity Development $380,000
Table 3.3.16:
