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.
ACTIVITY DESCRIPTION This activity is linked to the goal of reducing the burden of TB in HIV patients, the second objective of the WHO Interim Policy on Collaborative TB/HIV activities, as intensified TB case finding and TB care is offered to HIV positive patients.
WHO in collaboration with the federal and state ministries of health will use FY07 funds to continue the 3rd year of phased implementation of TBHIV activities initiated with FY05 funds. Using FY07 funds, WHO will continue to provide technical assistance to federal and state TB and HIV control programs to coordinate and implement TBHIV activities in 6 additional states. TBHIV activities will be initiated and implemented in 36 DOTS facilities, 12 ART sites and 6 community based organizations providing HIV/AIDS care and support services. In each state there will be a network of 2 ART sites with referral links to 6 DOTS facilities and 2 care and support organizations.
HIV Counseling and testing services will be established in 36 DOTS facilities. Health workers in DOTS facilities will have the capacity to diagnose HIV in TB suspects, treat HIV positive persons with active TB, and provide CPT and referral to ART clinics and care and support services.
Six community based organizations providing HIV/AIDS care and support services will be trained and mentored to identify and refer members with symptoms and signs of TB to DOTS facilities for diagnosis and treatment. Thirty-six community members will be trained as treatment supporters and will also facilitate links between community and facility based activities.
To ensure intensified case finding, screening and diagnosis of TB will be strengthened in 12 ART clinics, referral links established with DOTS services and TB infection control measures instituted.
Based on the patient load in the past year, it is anticipated that the 36 DOTS facilities will test an estimated 32,500 TB suspects for HIV. Of these about 6,000 persons will be dually infected and require treatment . A total of 234 health workers of different cadres, including state TB and HIV control officers and community workers, including PLWHA representatives will be trained to implement TBHIV activities.
By the end of FY07, and cumulating with, TBHIV activities in FY05 and FY06, a total of 18 states will have a network of 36 ART sites with capacity for referral / diagnosis and treatment of TB; 108 TB DOTS treatment clinics will provide counseling and testing services with referral to HIV care and treatment services; 18 HIV/AIDS care and support organizations will serve as community links for symptomatic screening and referral of HIV positive TB patients.
FY07 funds will also be used to strengthen coordination and reporting of TB and HIV activities in all the states supported by USG in TBHIV activities. State TB/HIV working groups will be established in the additional six states and at the same time the working groups already established in the 12 states during FY05 and FY06 will also be maintained. In addition, WHO and the FMOH will also use FY07 funds to establish state TB/HIV working groups in states where other PEPFAR partners are implementing collaborative TB/HIV activities. FY07 funds will also be used to conduct advocacy and sensitization for TBHIV activities at state and local government levels and annual coordination meetings of state AIDS and TB program coordinators with the National TB and HIV coordinators. Two dedicated National Professional Officers will be hired by WHO to provide technical assistance and facilitate, national, state and Local government mentoring, supervision and coordination of TBHIV activities. In collaboration with the FMOH, joint monitoring and supervision will be conducted and FY07 funds will also be utilized as required for on-going revision, printing and dissemination of national TBHIV reporting and recording forms.
CONTRIBUTIONS TO OVERALL PROGRAM AREA TB is the most common cause of morbidity and mortality among HIV positive persons. This activity focuses on reducing the burden TB in HIV patients and will contribute to the goals of the Government of Nigeria and the Emergency Plan targets.
While the DOTS strategy started by establishing TB clinics in primary health care facilities, the HIV/AIDS strategy started by establishing ART facilities at tertiary institutions, the result has been an incongruity between the location of DOTS clinics and ART facilities to the detriment of the dually infected. By linking TB and HIV services, this activity contributes to the Federal Governments strategy to have DOTS clinics and ART sites in the same facility or close by with a very strong referral mechanism.
LINKS TO OTHER ACTIVITIES This activity is linked to ART, counseling and testing, palliative care and community based care and support services.
This activity is linked to the goal of reducing the burden of TB in HIV patients, the second objective of the WHO Interim Policy on Collaborative TB/HIV activities, as intensified TB case finding and TB care is offered to HIV positive patients. It also contributes to reducing the burden of HIV in TB patients, the third objective of the Interim Policy, as the ART sites serve as referral facilities for the DOTS sites where CT takes place. Individuals identified as TB/HIV patients will be referred to appropriate TB and HIV health facilities in order to receive appropriate care and treatment.
This activity is also linked to the strategic direction of the National TB and Leprosy Control Program (NTBLCP) to establish DOTS clinics in all the ART sites in the country to reduce the incongruity in the availability of TB and HIV services and promote TB/HIV collaboration at the facility level.
POPULATIONS BEING TARGETED This activity targets HIV positive persons receiving treatment, care and support and HIV positive persons with active TB.
This activity also targets HIV patients who had hitherto not had access to TB screening and care. In Nigeria, TB is the commonest Opportunistic Infection (OI) in (PLWHA). This activity thus offers HIV patients a longer life free of the morbidity and mortality caused by TB.
KEY LEGISLATIVE ISSUES ADDRESSED This activity will work to increase equitable access to quality TB and HIV services to women, children, and other marginalized populations. It is also anticipated that the ready availability of such services will reduce stigma and discrimination that is associated with TB and HIV patients.
EMPHASIS AREAS This activity includes major emphasis on training. Minor emphasis will be on human resources and on development of network/linkages/referral systems, and infrastructure.
ACTIVITY DESCRIPTION This activity is linked to TB/HIV (#6811).
The Nigerian National HIV prevalence among TB patients is estimated at 27% (2005 National HIV Sentinel Survey) and stresses the importance of making HIV counseling and testing (CT) services available to such a high risk population.
WHO in collaboration with the federal and state ministries of health will use COP07 funds to continue the 3rd year of phased implementation of establishing CT services in DOTS sites initiated with COP05 funds. In COP07 WHO will support the Federal Ministry of Health (FMOH) to provide CT to 30,875 patients attending DOTS (Directly Observed Treatment Short Course) sites. COP 07 funds will be used to scale up activities to 6 additional new states while the ongoing activities already implemented in the 12 states will continue to be supported. New supported states will be selected in each of the 6 geopolitical zones based on HIV sero-prevalence, availability of ART and DOTS services.
The National strategy for HIV counseling and testing (Heart to Heart), which WHO will be implementing, adopts a total and comprehensive approach to client management. WHO will adopt a provider-initiated counseling and testing model and will implement a strategy that addresses issues surrounding discordant couples and implements techniques that encourage disclosure of HIV status. The national logo will be placed on DOTS sites that provide CT meeting the standard to be a Heart to Heart center.
WHO will build capacity of the General healthcare workers (GHW) at the DOTS facilities to provide adequate and appropriate HIV prevention messages to TB suspects and patients. HIV/AIDS information leaflets from NASCP will also be provided for all the clients attending these DOTS facilities for care.
The National TB and Leprosy Control Program (NTBLCP) and NASCP will work closely with the Society for Family Health (SFH) to ensure regular and free distribution of Male and Female Condoms to TB suspects and patients from the 36 DOTS facilities. The existing mechanism of Condom distribution used by NASCP will also be used to ensure adequate stock of condoms in all the 36 DOTS facilities.
A total of 72 General healthcare workers (GHW) from 36 DOTS sites will be trained on implementation of collaborative TB/HIV activities and on how to offer HIV counseling to all TB patients and suspects attending the DOTS facilities. The National VCT training curriculum will be used for CT training. In addition, 36 Laboratory staff from 18 TB Microscopy centers in the six expansion states will be trained on how to carry out HIV testing in line with the National HIV testing algorithm and National CT guidelines. All the training for CT are integrated into the TB/HIV training and therefore individuals trained are counted only once (under TB/HIV).To ensure that we maintain and sustain standards for HIV testing in the DOTS centers, HIV testing will be supervised by the Laboratory component of the National AIDS and STDs Control Programme (NASCP).
Regular supervision and monitoring from the Federal, State and LGAs (Local Government Areas) will be undertaken to ensure the quality of services provided in all the facilities including laboratories and of training provided, to correct any identified gap. There will also be regular meetings of the implementing facilities in the state to discuss any identified problems and to propose solutions.
A total of 108 TB DOTS treatment clinics (total sites initiated in COP 05, COP06, and COP07) will provide counseling and testing services with referral to HIV care and treatment services in 18 states. These CT sites will have a network of 36 ART sites with capacity for referral / diagnosis and treatment of TB; . WHO will procure non cold chain dependent test kits through the WHO AFRO/GENEVA procurement system. Test kits will be stored at the Central Medical store Oshodi, Lagos from where it will be distributed to states using a pull system. The distribution of HIV test kits will be done through the National TB and Leprosy Control Program (NTBLCP) which has an existing, functional, and efficient drug/supplies distribution system.
The approach of the Government of Nigeria (GON) to TB/HIV collaboration is that it is an
integral part of its health care system. The FMOH has already released 15,000 HIV test kits to be used solely in DOTS facilities. This will contribute to sustained TB/HIV Collaboration in Nigeria.
CONTRIBUTIONS TO OVERALL PROGRAM AREA CT services within DOTS centers will improve access to prevention among high risk population and in the possibility of identifying those eligible for care and support and ART. Overall this activity will contribute towards the National Emergency Plan's goal of providing HIV care to more than 1,500,000 persons while preventing 800,000 new infections by 2009.
LINKS TO OTHER ACTIVITIES This activity is linked to HVTB (3.3.07), HTXS (3.3.11) and HBHC (3.3.06) as WHO activities seek to reduce the burden of TB in HIV patients through intensified TB case finding and offering TB care to HIV positive patients. Individuals identified as TB/HIV patients will be referred to appropriate TB and HIV health facilities in order to receive appropriate care and treatment. This activity is also linked to the strategic direction of the National TB and Leprosy Control Program (NTBLCP) to establish DOTS clinics in all the ART sites in the country to reduce the incongruity in the availability of TB and HIV services and promote TB/HIV collaboration at the facility level.
POPULATIONS BEING TARGETED This activity targets TB patients and suspects from TB/DOTS center who represent a high risk population for HIV/AIDS. In Nigeria, TB is the commonest Opportunistic Infection (OI) in PLWHA, and the one that causes the most deaths. This activity thus offers HIV patients a longer life free of the morbidity and mortality caused by TB.
KEY LEGISLATIVE ISSUES ADDRESSED This activity will work to increase gender equity through equitable access to quality TB and HIV services to women, children, and other marginalized populations. It is also anticipated that the ready availability of such services will reduce stigma and discrimination that is associated with TB and HIV patients.
EMPHASIS AREAS This activity includes a major emphasis on training. Minor emphases will be on procurement, human resources, development of network/linkages/referral systems, and infrastructure.
