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: 2010 2011 2012 2013 2014 2015 2016 2017 2018
COP 2010 Overview Narrative
SUBSTANTIALLY CHANGED FROM LAST YEAR The purpose of this cooperative agreement is to strengthen the national laboratory systems necessary to conduct quality assured surveillance for HIV infection, sexually transmitted infections (STIs), and tuberculosis (TB), as well as to expand the access to diagnostic and bio-clinical monitoring services.
To achieve these objectives the Namibia Institute of Pathology (NIP) will use funding through this IM to accomplish the following activities:
1. Develop a plan for the continued quality improvement of systems for surveillance of HIV, STD and TB. This will include improving the quality of testing at all levels of the NIP laboratory network. These activities will emphasize the standardization of training and operating procedures, equipment and supplies, laboratory information management systems, and a systematic staff proficiency testing scheme.
2. Improve and expand the use of dried blood spot technology for Early Infant Diagnosis in support of the prevention of mother-to-child transmission (PMTCT) and pediatric ART programs.
3. Expand and improve HIV rapid test evaluation and monitoring systems to include quality assurance schemes for testing, and staff proficiency evaluations.
4. Enhance and expand viral load and CD4 testing capacity, including use of point-of-care equipment.
5. Participate in a regional laboratory network to strengthen the quality of HIV and ART diagnostic and bio-clinical monitoring services.
6. Increase the capacity of the NIP to perform routine laboratory tests to monitor patients on ART for potential drug toxicity.
7. Develop the capacity of NIP to monitor HIV drug resistance, and to implement new serological technologies to estimate HIV incidence.
8. Organize national workshops, working groups and meetings with laboratory representatives from academia and the private sector to exchange information, develop consensus on mutual goals and objectives, and facilitate quality control measures regarding HIV/AIDS, STDs and TB activities.
How the Implementing Mechanism is linked to the Partnership Framework goals and benchmarks over the life of its agreement/award.
Through support for quality bio-clinical monitoring and training, this implementing mechanism is key to the USG commitments related to the PF goal of "scaling up and enhancing antiretroviral treatment services (including pre-ART) as well as reducing TB/HIV co-infection" The technical assistance delivered through this IM will specifically aid the GRN and the USG to meet the following PF objectives:
1) Enhance the quality of ART care through quality assured bio-clinical monitoring.
2) Expand coverage of screening for TB/HIV co-infection.
The implementing Mechanism's geographic coverage and target population:
This mechanism is designed to provide national coverage through the NIP network of laboratories. APHL will work with NIP and other partners to provide training to staff working in all of the NIP laboratories. The gap analyses and mentoring assistance will be rolled out in a targeted manner, depending on identified needs.
Key contributions to Health System Strengthening:
Strengthening an integrated laboratory network and providing quality and accessible laboratory services to the country, will contribute to improvements in ART and TB drug adherence and patient monitoring. These clinical improvements will, over time, contribute to a reduction in costs.
Implementing Mechanism's cross-cutting programs and key issues:
Strengthening laboratory capacity for the public healthcare system assures that services are accessible, equitable, effective, affordable, and of high quality for all. Strategic planning has also been identified as a priority for NIP and the Ministry of Health and Social Services (MOHSS) in the new National Strategic Framework for HIV/AIDS (NSF). Direct TA to NIP staff will build local human resource capacity, another key objective in the NSF.
The Implementing Mechanism's strategy to become more cost efficient over time:
The Namibia Institute of Pathology (NIP) is a public limited company established by Act of Parliament in 1999. NIP started operations in December 2000 and has assumed responsibility for 37 MOHSS laboratories since then. This approach has avoided the creation of a parallel laboratory structure within the HIV/AIDS response. NIP's budget is structured to recover a substantial portion of its costs through reimbursements from public and private insurance plans. This innovative cost-recovery system is a model that could be adapted by other GRN programs which could charge fees for services provided to the private sector.
Monitoring and evaluation:
All CDC cooperative agreement grantees must submit a detailed work plan with their annual continuation application. This work plan must be based on PEPFAR indicators and aligned with targets set for each country. All IDP consortium members must also submit bi-annual status reports to the IDP program manager in Atlanta. These reports are shared with CDC program managers in Namibia and used to inform any year-on-year changes to the work plan.
Salary support to the Namibia Institute of Pathology (NIP) for a dedicated laboratory technologist to perform viral load tests.
Continuing Activity
Estimated Budget = $33,250
ADDITIONAL DETAIL:
With a growing number of patients on ART in Namibia, viral load testing has become an increasingly critical part of bio-clinical monitoring. In 2006, the national ART treatment guidelines were updated to include viral load testing for patients in whom treatment failure is suspected. With USG support, NIP has equipped a state-of-the-art molecular biology lab with viral load testing capacity. Anticipating increasing demand for viral load testing, a dedicated laboratory technician will be supported in COP11 to ensure NIP may meet this demand. At least 20,000 viral load tests are expected in COP11.
Ongoing quality assurance (QA) support for rapid testing.
Estimated Budget = $149,179
Salary support for six staff, including a one senior QA manager; three QA medical technologists; and one administrative assistant.
Estimated Budget = $164,386
Ongoing QA for Rapid Testing These activities support the expansion of provider-initiated testing and counseling (PITC), outreach testing (e.g., mobile and door-to-door) as well as existing HCT. The MOHSS requires retesting of 5% of all rapid HIV testing done as part of external quality monitoring. All HCT facilities are enrolled in the EQA scheme and are expected to submit the 5% specimens for retesting using ELISA at NIP. Additionally, NIP provides proficiency panels and Quality Control sets to all rapid test sites and compiles EQA reports for the program.
Salary Support for Staff The QA staff will be responsible for the validation of any new RT technologies introduced in Namibia, and for making recommendations to the MOHSS on the RT algorithm and selection of test kits. These QA experts will also support training and post-training certification of all MOHSS/new start/NGO personnel who administer rapid tests; preparation, distribution, and analysis of quality controls and proficiency panels; retesting of 5% of all rapid tests done at sites by ELISA; proficiency follow-up with rapid test sites and personnel; and; submission of reports on rapid test QA to the MOHSS HCT unit.
Salary support for a dedicated technologist at the Namibia Institute of Pathology (NIP) in support of early infant HIV diagnosis (EID) by PCR.
Estimated Budget = $35,000
Dedicated laboratory technologist to support EID. NIP is responsible for the provision of all HIV-related testing technologies for the public sector. Laboratory staff has been trained in PCR, new equipment has been procured, specimens are being processed, and health workers have been trained in the collection of DBS specimens. Approximately 20,000 EID PCR tests will be performed in COP 11. The laboratory technologist will be dedicated to ensuring all of these tests are performed in a quality assured and timely manner. The CDC laboratory technical advisor will provide supportive supervision and mentoring. Additional mentoring and supervision may be provided throughout the year by technical experts funded through the International Laboratory Branch Consortium (see APHL, ASCP and CLSI narratives).
An automated system for notification of tests results to health facilities will be developed in conjunction with the Namibia Institute of Pathology (NIP). This activity will support: 1) an assessment for the appropriate technology and compatibility with the laboratory information system (LIS) employed by NIP and the broader MEDITECH system, 2) pilot activities in selected health facilities, and 3) initiation of implementation of the system.
New Activity = $350,000
The MEDITECH revisions described above will be aimed at integrating data captured by the NIP laboratory information system (LIS) and the broader health information system (MEDITECH). Linking the LIS to ARV clinics will allow clinicians to access lab results as soon as they are available. This system will be especially valuable for pregnant women attending antenatal clinics. This will reduce waiting time for patients and contribute to a reduction in the number of patients lost to follow-up. In collaboration with MOHSS, this work will include the development of a standardized unique identification system to improve tracking of patient records and laboratory records.
Renovation of peripheral laboratories and maintenance of laboratory testing equipment.
Estimated Budget = $457,465
Salary support for two laboratory trainers based at the Namibia Institute of Pathology (NIP).
Estimated Budget = $74,097
Salary support for one training administrative assistant based at NIP.
Estimated Budget = $20,057
Salary support for a program officer based at NIP.
Estimated Budget = $33,081
1) Renovation of Peripheral Laboratories; procurement and maintenance of equipment: NIP will continue to strengthen its peripheral laboratories by renovating and procuring equipment to make diagnostics and basic bio-clinical monitoring services accessible to remote areas. Increased access to laboratory services will minimize costs, delays and risk of loss associated with transporting samples to central testing facilities. COP11 funds will also be used to maintain laboratory equipment purchased for these sites in previous years.
2) Salary support. COP11 funds will support the following NIP salaries:
Two laboratory trainers;
One administrative assistant assigned to the training unit; and
One program officer assigned to the training unit.
These positions will support the NIP training unit to leverage external TA in training provided by International partners (ASCP, ASM, and CLSI). The training unit will focus on in service training (internships), and practical training for Polytechnic of Namibia laboratory tech students.
Salary support for TB laboratory staff based in the Namibia Institute of Pathology (NIP)
Central Lab Supervisor.
Estimated Budget = $44,350
TB quality assurance medical technologist.
Six laboratory assistants.
Estimated Budget = $66,000
Salary Support for NIP TB staff. The following NIP positions will be supported:
One TB Central Lab Supervisor. The TB Lab supervisor is responsible for the day-to-day management of the TB Reference Laboratory, providing leadership to the team, overseeing implementation of all activities including the evaluation of new technology, assessing the competency of technologists, training, updating SOPs and compiling reports.
One medical technologist for Quality Assurance. The TB QA technologist is responsible for monitoring the implementation of quality assurance indicators at all NIP TB microscopy and culture labs, managing proficiency testing results, doing blind slides rechecking, and site supervisions.
Six laboratory assistants. The Laboratory assistants are deployed as microscopist and lab aids at district level laboratories. These are good examples of task shifting in the context of lack of qualified lab technologists.
