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.
New/Continuing Activity: New Activity
Continuing Activity:
Emphasis Areas
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.06:
Program Budget Code: 09 - HTXS Treatment: Adult Treatment
Total Planned Funding for Program Budget Code: $0
Program Budget Code: 10 - PDCS Care: Pediatric Care and Support
Program Area Narrative:
n/a
Program Budget Code: 11 - PDTX Treatment: Pediatric Treatment
Program Budget Code: 12 - HVTB Care: TB/HIV
Program Area: Care and Support - TB/HIV Co-Infection
Given reduced PEPFAR funding and the progress made under Russia's TB control program, no USG PEPFAR funding for TB/HIV
co-infection will be provided in FY09. USAID support through Freedom Support Act funds for TB will serve as the wrap around
program through which the USG will address key TB/HIV co-infection programs.
Russia is one of 22 countries with the highest burden of Tuberculosis (TB) in the world, and growing rates of multi- and
extensively drug resistant strains of TB are of particular concern. Recent data show that TB/HIV co-infection is increasing rapidly
as many Russians infected with HIV in the peak of the HIV epidemic in 2000/2001 are now experiencing advanced stages of
immune suppression. Nationally, 5,985 new cases of TB/HIV co-infection were reported in 2007, a 23% increase in civilian cases
over 2006. In 2007, there were over 14,000 cases of TB/HIV co-infection, representing 5.2% of all registered active TB cases,
and TB was associated with 66.5% of AIDS-related deaths.
To address the challenge of TB/HIV co-infection in Russia, the Government of Russia (GOR) has strengthened its commitment to
both TB control and HIV/AIDS treatment and care programs. The GOR has markedly increased the national budget for TB
control, exceeding $488M in 07, and they have implemented a World Bank loan totaling $100M (from '04-08), Global Fund (GF)
grants under Rounds 3 and 4 totaling $99M (from '04-10). USAID support in FY08 totaled $7.2M. International assistance for TB
control and TB/HIV co-infection has encouraged adoption of international guidelines in Russia, although actual implementation
nationwide remains a significant challenge.
With previous year funding, PEPFAR partners will facilitate the hand-over of current efforts to enhance effective coordination of
the highly vertical HIV and TB systems, to build capacity of health personnel, to improve detection and diagnosis of cases, and to
provide effective preventive and treatment regimes. USG-supported PEPFAR programs on TB/HIV have been successful in
introducing new and effective screening and referral systems for TB and HIV patients. USG partners will continue to participate in
national discussions and technical working groups for TB/HIV however without PEPFAR funding.
TB/HIV co-infection control will be an integral part of the USAID-supported (Freedom Support Act funds) TB control technical
assistance program which is implemented by a number of partners in coordination with the USG-supported World Health
Organization. Targeted technical assistance will support promoting GOR commitment to scale-up improved TB services
nationwide with special emphasis on TB/HIV co-infection. USAID support will include an emphasis on strengthening outreach
efforts that can naturally link messages and support systems to improve patient adherence to both TB and HIV treatment.
Program Budget Code: 13 - HKID Care: OVC
Program Budget Code: 14 - HVCT Prevention: Counseling and Testing
Program Budget Code: 15 - HTXD ARV Drugs
Program Budget Code: 16 - HLAB Laboratory Infrastructure
Program Budget Code: 17 - HVSI Strategic Information
Total Planned Funding for Program Budget Code: $910,000
Program Area: Strategic Information
The major strategic information (SI) challenges in FY 2009 include incomplete integration of available data to characterize the
epidemic; incomplete institutionalization of MARP surveillance, and improving but still inconsistent M&E capacity and coordination.
While more strategic information is available than several years ago, incomplete characterization of the scale and direction of the
HIV epidemic in Russia remains a major problem for directing an increasingly well-resourced national response to the epidemic.
For example, increased funding for prevention measures for most at-risk populations (MARPs) in Russia is imperiled by
impressions among national authorities that generalization of the HIV epidemic has already occurred. The available data are
complex and show an increased percentage of female cases overall (44%) and an increased number of female HIV cases who
report only sexual risk factors. Yet, the data also show that many HIV-infected women who deny injecting drug abuse are co-
infected with hepatitis C, suggesting past injecting drug abuse, and in some regions, many HIV-infected women report being
sexual partners of an IDU. Additionally, recent surveys of commercial sex workers (CSWs) found HIV rates are <5% among those
that deny injecting drug abuse and are hepatitis C negative, suggesting limited sexual transmission despite high exposure among
this risk group.
Targeted USG support in FY 2009 will bring together approaches and tools introduced jointly with the World Health Organization
(WHO), UNAIDS and the Government of Russia (GOR) to improve monitoring and evaluation (M&E) and establish improved
surveillance in Russia. Building on MARP surveillance studies and activities to improve routine surveillance completed with
funding from FY 2008, the major focus for final-year FY 2009 resources will be 1) activities to improve the capacity for integration
of data from available sources and 2) targeted activities to use this integrated data to influence key policy issues such as funding
levels needed for prevention.
An optimal HIV surveillance system in Russia would include several components: a system of HIV case reporting with behavioral
data and incidence testing, a system of integrated biologic and behavioral surveillance studies among MARPS, capacity to
conduct special studies to address additional issues, and a process to adequately analyze and integrate the data. Russia's
existing national HIV/AIDS surveillance system collects HIV case data from widespread serologic screening at medical facilities
(with very high HIV testing coverage in antenatal, tuberculosis, drug treatment, and sexually transmitted disease clinics), prisons,
and some workplaces, with more than 20 million HIV tests done annually. The system collects useful data; however, it misses a
proportion of high-risk groups, collects very limited behavioral data, lacks incidence testing, suffers from methodological
weaknesses, including selection bias, and has limited analysis, communication and strategic use. Formal mapping of the
surveillance data is not routinely conducted, although case rates are calculated down to the county/district level. This surveillance
system has been evaluated by UNAIDS at the national level (2005) and at the sub-national level (2006) as part of M&E
evaluations.
The availability of data from, and the capacity to conduct integrated biologic and behavioral surveillance studies among MARPS
has significantly improved over the past five years due to support from the USG, Global Fund, and other international
organizations. Russian authorities have an increased appreciation of data from these studies and have included such data in the
2008 UNGASS report; however, support for these studies has not yet been incorporated into the governmental surveillance
system. Similarly, numerous special studies and evaluations have been conducted with (mostly) international support; however,
the data has largely not been effectively integrated with data from other sources. The integration of data from routine and sentinel
surveillance, special studies, and M&E systems to more fully describe the epidemic is needed to guide HIV-surveillance,
prevention, and care and treatment programs for all participants and stakeholders.
With FY 2008 funds, the USG will finalize support for an improved surveillance system in two pilot oblasts, including integrated
biologic and behavioral studies among MARPs (IDUs, commercial sex workers (CSWs), and men having sex with men (MSM)),
training of a regional reference laboratory in HIV incidence testing, and improved analysis of existing routine HIV surveillance
data. The surveys among CSW and IDU are planned to begin in Q1 and Q2 2009 and will include HIV, syphilis, and hepatitis C
testing in both St. Petersburg and Orenburg, and pilot BED testing in St. Petersburg. As part of survey preparations in both
regions, personnel from local AIDS Centers and NGOs will be trained to increase local capacity for future studies. FY 2008 funds
will also support data integration exercises with stakeholders in the two oblasts to integrate the results of the PEPFAR surveys
with routine surveillance and special study data for the most complete picture of the epidemic including documentation of best
practices for this process.
FY 2009 PEPFAR funding will support a survey for a locally important risk group in St. Petersburg (street youth), additional
training for selected regional AIDS Center and NGO MARP HIV surveillance specialists in data triangulation (integration), and a
series of national exercises/forums for national stakeholders to integrate data for each of the major risk groups, to better estimate
prevalence among MARPS, and to develop an improved estimate of epidemic size and anti-retroviral treatment (ART) needs. The
leading Russian national level SI institution will be integrally involved in planning and conducting the data integration activities in
order to facilitate similar future exercises. These forums will also be used to influence key policy makers on pressing issues, such
as the need for increased funding for prevention activities among MARPS. An inventory of surveys and studies that will provide
required data for UNGASS and Universal Access indicators will be developed.
As exemplified in the 2008 UNGASS report, increased collection of M&E data from different government and some NGO sources
and its increased use at the national level has been achieved through the M&E Analytical Group operating under the Federal
Service on Surveillance in the Sphere of Consumers Rights Protection and Human Well-being. In FY 2009, USG implementing
partners will finalize their activities to improve capacity in HIV M&E. At the national level, an M&E training of trainers will be
conducted. Technical support to the M&E Analytical Group will be reduced with a gradual transfer to national funding. The
methodology for the National AIDS Spending Assessment, a systematic monitoring of HIV/AIDS financial flows at national and
sub-national levels, will be refined and a training curriculum will be finalized to allow for institutionalization and roll-out to the
regional level.
The USG/Russia Country Team contains one LES SI/M&E specialist (responsible for M&E from implementing partners,
COP/APR) who functions as the SI Liaison, and a US FTE surveillance specialist (surveillance studies) who also provides
technical input to M&E. The M&E data is provided directly to the Country Team members at any time needed and for the APR;
the surveillance specialist also routinely provides updates of surveillance and study data at planning and review meetings. Data is
collected from the 15 USG partners in standardized email forms that are transmitted to USAID; partner data is stored in Excel
spreadsheets and maintained on the USAID data network. USG partners also provide data to the GOR national M&E network.
Data provided by the SI team are used in the target setting process and in decisions on allocation of resources
In FY 2009, the PEPFAR/Russia SI Reporting Guide that focuses on reporting program-level indicators will be updated to reflect
changes in OGAC reporting requirements and describe procedures for periodic data quality assessments according to the
Mission's Data Quality Improvement Plan. In end-October 2008, the USG/Russia SI Team held an Annual SI Partners meeting to
address target-setting and results reporting issues.
USG SI efforts continue to leverage resources from other sources. Some USG-supported activities described in the Care and
Treatment also provide information useful for SI purposes (clinical chart audits, CAREWare HMIS software). In the PEPFAR
regions, GLOBUS conducts monitoring studies among IDUs and CSWs, and PSI leverages Global Fund monies through its
agreement to use data from the GLOBUS studies to monitor and evaluate its USAID-funded interventions with CSWs and IDUs.
Also, the USG will leverage resources from UNODC by using the data from a UNODC-funded surveillance survey of IDUs in St.
Petersburg in 2009.
Products/Outputs:
•Improved description of the HIV epidemic in focus oblasts with 1) documentation of best practices for integration of data from
available sources in the Russian context and 2) increased capacity for HIV surveillance data integration.
•Improved national consensus on the implications of available data and improved policy based on this consensus.
•GOR and USG implementing partners' reporting, analytic capacities, and data quality activities increased.
Table 3.3.17:
