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 also relates to activities in Health System Strengthening and PMTCT.
This activity will implement PMTCT activities in three states consisting of 2 sites each to provide
comprehensive HIV and AIDS prevention, treatment and care. This activity will provide counseling, testing
and referral services to 3000 pregnant women. 132 pregnant women will be placed on antiretroviral (ARV)
prophylaxis and HAART. Consideration will be given to strengthening the quality of service delivery in order
to promote the best outcomes.
This activity will include, as a part of the standard package of care, routine provider initiated opt-out HIV
counseling and testing (HCT) in antenatal clinics (ANC) for all presenting pregnant women and in labor and
delivery wards (L&D) and the immediate post-delivery setting for women of unknown HIV status with referral
for family planning services. Same day results will be provided to clients. This activity will use group and
individual pre- and posttest counseling strategies and rapid testing based on the national testing algorithm.
Partner testing and couple counseling will be offered as part of PMTCT services to enhance disclosure.
The awardee will also establish community and faith-based linkages and will utilize community and home
based care services to promote partner testing. Clients will have access to free laboratory services
including CD4 counts and STI screening. Free medications including those for OIs as needed and
hematinics will also be provided. In addition to receiving PMTCT services, each woman will be referred to
ART clinic for further follow-up treatment and care. Her children will be eligible to access OVC services
referral for care.
Referral systems that incorporate active follow-up will be put in place to ensure that women requiring
HAART are not lost during referral for ARV services. Referral coordinators will be identified at sites and in
the communities with their capacities built to carry out needed services. This activity will explore the training
and utilization of traditional birth attendants (TBAs) using an appropriate curriculum. This national TBA
training curriculum when available will be used to develop skills in conducting safe delivery practices and
recognizing early signs of obstetric complications, in addition to the mother-to-mother support groups that
the awardee will establish at each site to reach HIV-positive women who choose to deliver outside of the
health facility. Trained TBAs will be supervised and monitored by trained health workers in order to ensure
that they refer complications and positive pregnant women to the hospital for quality and safe obstetric care.
TBAs will also raise awareness and create demand for PMTCT. A focal person at each facility will be
responsible for coordinating the tracing of HIV-positive mothers and their infants in the community and
linking them back to care. The HIV-positive mothers and their infants will be linked postpartum to ART care
and support services which will utilize a family-centered care model.
Emphasis will be laid on counseling on infant feeding options (exclusive breast-feeding for six months or
breast milk substitute if Affordable, Feasible, Acceptable, Safe and Sustainable - AFASS) for identified HIV
positive pregnant women. For the anticipated number of women not requiring HAART for their own health,
the current WHO recommended short course two drug ARV option will be provided. This includes ZDV from
28 weeks with intra-partum sdNVP and a 7-day ZDV/3TC post-partum tail or ZDV/3TC from 34-36 weeks
with intra-partum sdNVP and a 7-day ZDV/3TC post-partum tail. Infant prophylaxis will consist of single
dose NVP and ZDV for 6 weeks.
HIV exposed infants will be referred for early infant diagnosis (EID) to the pediatric clinic of the health
facilities for testing in line with the National Early Infant Diagnosis scale-up plan from six weeks of age using
DBS. Implementation of the EID scale-up will be done under the guidance of the GON and in conjunction
with other IPs who will be conducting the laboratory testing. Awardee will collaborate with Clinton
Foundation as appropriate for commodities and logistics support of the EID program. Exposed infants will
be actively linked to pediatric care and treatment, while their families will be referred to age-appropriate
OVC services. In COP09, PMTCT focal persons at the facilities will keep records of all exposed infants at
enrollment soon after birth; informing HIV-positive mothers of the six weeks exact dates for DBS collection.
The partner will ensure necessary training is given to 36 identified staff.
Support groups consisting of HIV positive individuals will be established in communities including identified
HIV positive pregnant women and mothers and will train five members each from six communities where
the sites are located in HCT skills. These 30 trained members of the PMTCT support groups will be
engaged in tracking unbooked pregnant women and infants in the community, linking them to sites where
they can access HCT, PMTCT and EID/DBS collection for their exposed infants and linked to pediatric care
and treatment.
Full and accurate information will be provided on family planning and prevention services. Women
accessing family planning services will be offered or referred for HIV Counseling and Testing. Infants of
positive mothers will be linked to immunization services and other childcare services. Cotrimoxazole
prophylaxis will be provided to infants from six weeks of age until definitive HIV status can be ascertained.
In COP09, the awardee will initiate its program for Continuous Quality Improvement (CQI) in order to
strengthen and institutionalize quality interventions. Monitoring and evaluation of the activity's PMTCT
program will be consistent with the national plan for patient monitoring. Identified and trained activity-
supported PMTCT specialists will work in conjunction with CQI specialists, program managers, clinical
associates as well as counterparts at other IPs. PMTCT specialists will join the CQI-led team in conducting
site visits at least quarterly, during which they will evaluate PMTCT clinical services, HCT done in the
PMTCT setting, the utilization of national PMM tools and guidelines/SOPs, proper medical record keeping,
referral coordination, and use of standard operating procedures in PMTCT. On-site TA with more frequent
follow-up monitoring visits will be provided to address weaknesses when identified during routine monitoring
visits. State agency representatives and the USG will be included in quarterly monitoring and supportive
supervision visits and submit reports of visits accordingly.
The activity will collaborate with UNICEF-supported PMTCT sites to provide training on PMTCT service
delivery to 36 healthcare workers according to the national curriculum. Trained staff will be used as
Activity Narrative: facilitators to step down trainings to other health care workers in their facilities and in nearby government
health facilities as a human capacity development activity.
CONTRIBUTIONS TO OVERALL PROGRAM AREA: This activity will provide counseling and testing
services to 3000 pregnant women, and provide ARV prophylaxis to 132 clients. This will contribute to the
PEPFAR goal of preventing 1,145,545 new HIV infections in Nigeria by 2009.
LINKS TO OTHER ACTIVITIES: The PMTCT services will be linked to HCT, basic care and support, ARV
services, ARV drugs, OVC, TB/HIV, laboratory services, and SI. All identified pregnant women who present
at every point of service will be provided with information about the PMTCT program and referred
accordingly. ARV treatment services for infants and mothers will be provided through ART services. Basic
pediatric care, including TB care, is provided for infants and children through OVC activities. All HIV-positive
women will be registered for adult care and support services.
POPULATIONS BEING TARGETED: This activity targets women of reproductive age and their partners,
infants and PLWHAs. This activity also targets training of health care providers, TBAs and mothers who will
work as peer educators and referral persons.
EMPHASIS AREAS: This activity includes major emphasis on training, supportive supervision, quality
assurance/improvement and commodity procurement. Emphasis is also placed on development of
networks/linkages/referral systems. In addition, integrating PMTCT with ANC and other family-centered
services while ensuring linkages to Mother-Child-Health (MCH) and reproductive health services will ensure
gender equity in access to HIV/AIDS services.
New/Continuing Activity: New Activity
Continuing Activity:
Emphasis Areas
Gender
* Increasing gender equity in HIV/AIDS programs
* Reducing violence and coercion
Health-related Wraparound Programs
* Child Survival Activities
* Family Planning
* Safe Motherhood
* TB
Human Capacity Development
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
USAID Nigeria is negotiating a new award which will provide integrated OVC programming. As is the
practice when making new awards, OGAC will be informed when the award is ready, and the partner(s) and
targets will be uploaded into COPRS. The targets developed for this activity are notional, as they may be
subject to change during the course of the award negotiation, but the program as proposed is on a scale to
potentially reach about 1,400 OVC and to provide support and training to 1,000 caregivers.
This element of the new activity will focus on providing AB prevention messages for OVCs and their
caregivers in four states (Kaduna, Kano, Bauchi and Niger) to expand services of care and support and
referral to treatment for children affected or infected by HIV and AIDS. This activity will collaborate with
community OVC programs and FBOs to adapt and pilot an HIV prevention program for young adolescents
prior to sexual debut (estimated 12 to 16 years). The proposed model program is abstinence-based and
with condom and other prevention services as appropriate for age given to older OVCs and their care
givers.
Through its support to OVCs, the activity will, facilitate organizational capacity building in prevention
programs for a core local partner who will gradually transit to be the prime partner. It will work with already
developed and successful child protection committees, train peer educators among them to reach their
peers with abstinence message as well as facilitate adults/ child communication between care givers and
OVCs. Community Protection Committees (CPC) will also be used to reach children of HIV-affected
families and will expand outreach to improve access to prevention of mother to child transmission services
(PMTCT), economic strengthening and OVC services.
The activity will strengthen the capacity of indigenous organizations to respond to HIV/AIDS in their
communities; provide quality comprehensive prevention services for AIDS OVCs. The minimum package
intervention approach as defined in the national prevention plan will be utilized for reaching these OVCs and
their caregivers.
This prevention intervention will also include educational activities that relate to 1) Trust Building and Group
Cohesion; 2) Risks and Values; 3) Educate Yourself: Obtaining Information; 4) Educate Yourself: Examining
Consequences; 5) Build Skills: Communication; 6) Information about Sexual Health; 7) Attitudes and Skills
for Sexual Health; 8) Review and Community Project. Overall the program will help youth assess the short-
and long-term impact of their decisions on themselves, their families, and their communities, help develop
decision-making skills, develop communication skills, learn basic facts about HIV/AIDS, sexual health,
condoms and other contraceptives, and learn refusal skills. The educational methods include in-school
curricular activities and extra curricular activities including the PEP model. While the focus of the program
is on HIV/AIDS, it is also involves a comprehensive education program that covers many topics including
knowledge about risks associated with other sexually transmitted infections, teen pregnancy, violence,
alcohol, and other drug use.
The partner will work with community groups that are trained and experienced in identifying vulnerable
children and families, provide a strategic starting point for a project that will work with community-based
systems to effectively reach OVC. The activity will complement the services of local agencies by reaching
children and families that may not have access to HIV prevention services or lack opportunities to access
information on HIV prevention. Issues of stigma through awareness activities, peer advocates, and support
groups will be addressed. Linkages will be sought for nutritional and educational support with USG
supported wrap-around activities.
CONTRIBUTION TO OVERALL PROGRAM AREA: This activity program area focus is on strengthening
the capacity of families and communities to provide prevention services to OVCs and their care givers.
These activities contribute to the USG's PEPFAR strategy of preventing HIV for an identified vulnerable
group and are also consistent with the National HIV Prevention plan.
LINKS TO OTHER ACTIVITIES: Linkages will be established with HIV/AIDS treatment centers and
community care and support program to ensure that OVC and caregivers stay alive and in good health, to
counseling and testing centers to enable family members to receive necessary support and to reduce the
increase in numbers of HIV+ children.
POPULATION BEING TARGETED: This activity will target girl and boy OVC and families affected by
HIV/AIDS. It will provide services to OVC, caregivers of OVC and other children/siblings living in OVC
households in community settings using existing established and accepted organizations as service
providers. In addition, religious and community leaders, leaders of women's organizations will be trained to
combat stigma in their work.
EMPHASIS AREAS: The activity includes an emphasis on local organization capacity development and
community mobilization, education and training. The program will aim to support equal numbers of males
and female OVC and address economic and education factors that limit access to services of either gender.
* Increasing women's access to income and productive resources
Table 3.3.02:
Table 3.3.03:
The activity will focus on scaling up support to OVC and caregivers in four states (Kaduna, Kano, Bauchi
and Niger) to expand access to care and support and referral to treatment for children affected or infected
by HIV and AIDS. The activity will provide care and support for OVC, through building organizational
capacity building for a core local partner who will gradually transit to be the prime partner, community based
system of assessment, action planning, home visits, referrals, and specific support in psychosocial,
education and economic strengthening. It will work with already developed and successful child protection
committees that are trained and experienced in assessing the needs of the most vulnerable children and
families. Community Protection Committees (CPC) will be used to reach children of HIV-affected families
and will expand outreach to improve access to pediatric treatment, prevention of mother to child
transmission services (PMTCT), economic strengthening, education enrollment and psychosocial support.
communities; provide quality comprehensive and compassionate care for AIDS affected OVC; and
strengthen the legal policy and institutional framework for OVC and protection at national and sub-national
levels. The project will provide direct support and services through scholarships, psychosocial support to
families, referrals and support for transportation costs as needed, testing and treatment services, nutrition
and basic health education, and economic strengthening.
children and families, providing a strategic starting point for a project that will work with community-based
systems to effectively reach OVC. Diverse members of communities, representing a range of levels of
education and income, religious and ethnic diversity, disabled, etc., will be invited to create a forum to
reflect on issues of power, privilege, access and vulnerability specific to the community.
The activity will complement the services of local agencies by reaching children and families who may not
have yet accessed treatment, or who may be reluctant to seek treatment because of confidentiality and
stigma. Issues of stigma will be addressed through awareness activities, peer advocates, and support
groups. The program will work with service providers to help provide support for transport costs when
needed to access treatment, and will link with other organizations and agencies providing services to OVC
and caregivers to maximize support and avoid overlapping services. Linkages will be sought for nutritional
and educational support with USG supported wrap-around activities.
Education will be supported through working with the CPC, school management Committees and Parent
Teachers Association to determine the specific problems preventing families from sending their children to
school and collectively generate lasting solutions. Direct support to children would include scholarships for
school-aged children as well as linking to vocational training for out-of-school children. Education activities
will leverage existing partnerships between the prime partner and the educational systems of two of the
states (Kano and Kaduna) to address systemic issues in the education setting that do not support a more
conducive environment for learning for all students, including OVC, as well as the provision of teaching
materials. OVC completing vocational training will be linked to economic strengthening opportunities.
Economic strengthening activities for caregivers will focus on promoting village savings and loan groups.
These groups are self forming and after initial external support for facilitation and operational guidelines,
they will begin to self-function.
Healthcare will be provided through partnerships with USG IPs, GON, FBOs and healthcare centers for
monitoring and treatment of OI and through health education at support group meetings and home visits.
Other services will include immunization, provision of preventive care packages comprising insecticide
treated nets and water guard/containers, and the treatment of other minor ailments. Health and nutritional
activities will be provided through educational activities. Peer education will be initiated in schools for and
communities to for HIV prevention and also create demand for HCT among OVC, caregivers and the
general population. Psychosocial support will be provided through group counseling, for formation of
HIV/AIDS prevention clubs, the reinforcement of established youth-friendly centers, home visitations, and
through the integration of OVC into community recreational facilities.
the capacity of families and communities to provide care and support for OVC. These activities contribute
to the USG's PEPFAR five year strategy of providing care and support to OVC and are also consistent with
the Strategic Framework on OVC.
increase in numbers of HIV+ children. This activity will also be linked to prevention activities targeting out of
school OVC, in-school children and the community protection structures
community mobilization, nutrition and training. The program will aim to support equal numbers of male and
Activity Narrative: female OVC and to address economic factors that limit access to services of either gender.
Table 3.3.13:
