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: 2007 2008 2009
Track 1 and 2 funds are combined for this activity.
ACTIVITY DESCRIPTION:
In COP07 AIDSRelief (AR) is providing ART services to 28 Local Partner Treatment Facilities (LPTFs) and
10 satellite sites. In COP08 these services will be increased to cover 30 LPTFs and 20 satellites across the
16 states of Abia, Adamawa, Anambra, Benue, Ebonyi, Edo, Enugu, FCT, Imo, Kaduna, Kano, Kogi,
Nasarawa, Ondo, Plateau, and Taraba. Through primary and secondary faith-based facilities AR will extend
ART services to underserved rural communities to reach 10,200 new patients (including 1000 children) for a
total of 28,200 active patients (including 2270 children) reached in COP08. In setting and achieving COP08
targets, consideration has been given to modulating AR's rapid COP07 scale-up plans in order to
concomitantly work towards continuous quality improvement.
All LPTFs will have the capacity to provide comprehensive quality ART services through a variety of models
of care delivery. This includes quality management of OIs and ART, a safe, reliable and secure
pharmaceutical supply chain, technologically appropriate lab diagnostics, treatment preparation for patients,
their families and supporters and community based support for adherence. This technical and programmatic
assistance utilizes on-site mentoring and preceptorship. It also supports the development of site specific
work plans and ensures that systems are in place for financial accountability. AR will adhere to the Nigerian
National ART service delivery guidelines including recommended first and second line ART regimens. In
addition, AR will partner with Clinton Foundation and Global Fund as appropriate to leverage resources for
providing antiretroviral drugs to patients.
In COP07 AR trained 690 health service providers. In COP08 AR will train and retrain an additional 400
health service providers. Training topics include ART clinical care, treatment adherence and laboratory
monitoring consistent with the National ARV guidelines/training curriculum. AR will make special efforts to
increase LPTF capacities in the delivery of pediatric ART services, including counseling, using one of its
established partners in Jos for practical training. In COP08 AR will continue conducting 2-week intensive
didactic and practical trainings preceding site activation followed by continuous onsite mentoring. Training
will maximize use of all available human resources including a focus on community nursing and community
adherence. AR will work closely with the USG team to monitor quality improvement at all sites and across
the program.
AR will work with supported sites to identify HIV-infected patients, to enroll them in care and treatment, to
perform appropriate clinical and laboratory staging of adults and children, and to provide comprehensive
care and support, including the prompt initiation of ART for eligible patients. Non ART eligible individuals will
be enrolled into care for periodic follow-up, including laboratory analysis at least every 6 months, to identify
changes in ART eligibility status. All enrolled PLWHA will have access to the preventive care package
(water sanitation/treatment education, ITN), and be linked to community social services. Other care
components, discussed under the basic care and support narrative, include TB screening, OI
prophylaxis/treatment, routine laboratory analysis, and nutritional counseling. ART sites at LPTFs are co-
located in facilities with TB DOTS centers to facilitate TB/HIV service linkages. As a part of comprehensive
service delivery, activities addressing prevention for positives shall be enhanced through counseling and
provision of full and accurate information for PLWHA including discordant couples.
A key component for successful ART is adherence to therapy at the household and community levels.
PLWHA on treatment are encouraged to have a treatment support person such as a family member to
whom he/she had disclosed HIV status to improve support in the home and increase adherence. AR will
continue to build and strengthen the community components by using nurses and counselors to link health
institutions to communities. Each LPTF will appoint a specific staff member to coordinate the linkages of
patients to all services. This will also build the capacity of LPTFs for better patient tracking, referral
coordination, and linkages to appropriate services. These activities will be monitored by the AR technical
and program management regional teams.
In COP08, AR will strengthen its program for Continuous Quality Improvement (CQI) in order to improve
and institutionalize quality interventions. AR will hire an additional three CQI staff that will be supervised by
the CQI specialist. These 4 CQI specialists will be responsible for spearheading CQI activities in their
respective regions. This will include standardizing patient medical records to ensure proper record keeping
and continuity of care at all LPTFs. Monitoring and evaluation of the AIDSRelief ART program will be
consistent with the national plan for patient monitoring. The CQI specialists will conduct team site visits at
least quarterly during which there will be evaluations of infection control, the utilization of National PMM
tools and guidelines, proper medical record keeping, efficiency of clinic services, referral coordination, and
use of standard operating procedures across all disciplines. On-site TA with more frequent follow-up
monitoring visits will be provided to address weaknesses when identified during routine monitoring visits.
Some of the data will be used to generate biannual life table analyses that identify factors associated with
early discontinuation of treatment. In addition, at each LPTF an annual evaluation of program quality shall
consist of a 10% random sample of linked medical records, adherence questionnaires and viral loads to
examine treatment compliance and viral load suppression for adult patients who have been on treatment for
at least 9 months. A similar process will be undertaken for all children who have been on ART for at least 9
months. Each of these activities will highlight opportunities for improvement of clinical practices.
Sustainability lies at the heart of the AR program, and is based on durable therapeutic programs and health
systems strengthening. AIDSRelief has developed a Sustainability Plan in Year 4 focusing on technical,
organizational, funding, policy and advocacy dimensions. Through its comprehensive approach to
programming, AR will increase access to quality care and treatment while simultaneously strengthening
health facility systems. All activities will continue to be implemented in close collaboration with the
Government of Nigeria (GON) to ensure coordination and information sharing, thus promoting long term
sustainability. AR will continue to strengthen the health systems of LPTFs. This will include human resource
support and management, financial management, infrastructure improvement, and strengthening of health
management information systems. In collaboration with the CRS SUN project, AR will focus on institutional
capacity building for indigenous umbrella organizations such as the Catholic Secretariat of Nigeria (CSN).
Activity Narrative: These strategies will enable AR to transfer knowledge, skills and responsibilities to in-country service
providers.
AR will continue to participate in Government of Nigeria (GON) harmonization activities and to participate in
the USG coordinated clinical working group to address ongoing topics in ARV service delivery.
CONTRIBUTION TO THE OVERALL PROGRAM AREA:
By adhering to the Nigerian National ART service delivery guidelines and building strong community
components into the program, this activity will contribute to achieving the overall PEPFAR Nigeria target of
placing 350,000 clients on ART by 2009 and will also support the Nigerian government's universal access to
ART by 2010 initiative. By putting in place structures to strengthen LPTF health systems, AR will contribute
to the long term sustainability of the ART programs.
LINKS TO OTHER ACTIVITIES:
This activity is linked to HCT services (5425.08) to ensure that people tested for HIV are linked to ART
services; it also relates to activities in ARV drugs (9889.08), laboratory services (6680.08), care & support
activities including prevention for positives (5368.08), PMTCT (6485.08), OVC (5416.08), AB (15655.08),
TB/HIV (5399.08), and SI (5359.08).
AR will collaborate with the 7-D program of Catholic Relief Services to establish networks of community
volunteers. Networks will be created to ensure cross-referrals and sharing of best practices among AR and
other implementing partner sites. Effective synergies will be established with the Global Fund to Fight AIDS,
Tuberculosis and Malaria through harmonization of activities with GON and other stakeholders.
POPULATIONS BEING TARGETED:
This activity targets PLWHA, particularly those who qualify for the provision of ART, from rural and
underserved communities. Special focus will be placed on identification and treatment of HIV infected
children.
EMPHASIS AREAS:
This activity will include emphasis on human capacity development specifically through in-service training.
These ART services will also ensure gender and age equity in access to ART through linkages with OVC
and PMTCT services in AR sites and neighboring sites. The extension of ARV services into rural and
previously underserved communities will contribute to the equitable availability of ART services in Nigeria
and towards the goal of universal access to ARV services in the country. The provision of ART services will
improve the quality of life of PLWHA and thus reduce the stigma and discrimination against them.
New/Continuing Activity: Continuing Activity
Continuing Activity: 12992
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
12992 9895.08 HHS/Health Catholic Relief 6364 5332.08 HHS/HRSA $1,042,789
Resources Services Track 1.0 CRS
Services AIDSRelief
Administration
Emphasis Areas
Construction/Renovation
Gender
* Increasing gender equity in HIV/AIDS programs
Health-related Wraparound Programs
* Malaria (PMI)
* TB
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $90,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $25,000
and Service Delivery
Food and Nutrition: Commodities
Estimated amount of funding that is planned for Food and Nutrition: Commodities $25,000
Economic Strengthening
Education
Water
Estimated amount of funding that is planned for Water $25,000
Table 3.3.09:
