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: 2005 2008 2009
This is a continuing activity from FY 2008. No narrative required.
New/Continuing Activity: Continuing Activity
Continuing Activity: 12822
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
12822 8122.08 Department of Drew University 6309 100.08 HIV Support to $138,457
Defense RDF
8122 8122.07 Department of Drew University 4331 100.07 HIV Support to $75,246
Emphasis Areas
Gender
* Increasing gender equity in HIV/AIDS programs
Health-related Wraparound Programs
* Child Survival Activities
* Family Planning
* Malaria (PMI)
* Safe Motherhood
* TB
Military Populations
Human Capacity Development
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Estimated amount of funding that is planned for Education $103,962
Water
Table 3.3.01:
ACTIVITY IS NEW IN FY 2009.
The overall goal of this activity is to decrease new HIV infections in the Rwanda Defense Forces (RDF)
through the expansion of male circumcision (MC) services with emphasis that MC be offered as part of an
expanded approach to reduce HIV infections in conjunction with other prevention programs, including HIV
testing and counseling, treatment for other sexually transmitted infections, promotion of safer-sex practices
and condom distribution. MC will not replace other known methods of HIV prevention and will be considered
as part of a comprehensive HIV prevention package.
In FY 2008, PEPFAR worked closely with the Rwanda Ministry of Health (MOH) and other donors in a
national task force to develop policy that recognizes the MC as an effective HIV prevention method
alongside the ABC strategy. The MOH has also requested donor support for the expansion of MC services
beginning with the Rwanda military (one of Rwanda's most at-risk populations). Conducting MC in the
Rwanda military is considered vital since the military is predominately male, typically young, highly mobile
and is considered a high risk group. The RDF provides an ideal institutional setting to begin the roll out of
MC as an HIV prevention intervention as it has taken the lead in controlling HIV transmission among
Rwandan troops.
In FY 2009, Drew University will ensure that male circumcision efforts are rolled out in the RDF as an
additional method for HIV prevention. With the help of Drew University, through PEPFAR support, the RDF
has expanded HIV care and treatment to three military-operated hospitals and five brigade clinics. Drew
University will build capacity for MC in the RDF through the development of treatment protocols, training of
providers, sensitization of soldiers and their partners for circumcision, and the enhancement of physical
infrastructure of clinical sites so that proper circumcision may be conducted. MC will be conducted on a
voluntary basis on HIV-negative soldiers and services will be attentive to socio-cultural context, human
rights and ethical principles, health services strengthening, training, gender implications, service delivery,
and program evaluation.
These activities address the key legislative issues on gender, particularly with respect to male norms and
stigma reduction. Additionally, prioritizing prevention efforts on the military is a key strategy of both PEPFAR
and the Government of Rwanda as reflected in the Rwanda PEPFAR Five-Year Strategy.
New/Continuing Activity: New Activity
Continuing Activity:
* Addressing male norms and behaviors
Estimated amount of funding that is planned for Human Capacity Development $150,000
Table 3.3.07:
ACTIVITY UNCHANGED FROM FY 2008:
Under the Rwanda Defense Force (RDF), there are a total of three military hospitals and five brigade clinics
throughout the country. Drew University began working in two military hospitals and three brigade clinics in
FY 2005 with PEPFAR support. The support modalities include TA and training on ARV and basic care and
support (BCS), M&E, and lab infrastructure. Drew is considered a full PEPFAR clinical partner working in
ARV, TB/HIV, PMTCT, Basic Care and Support, and Prevention for Positives. It collaborates with CHAMP
for services in military communities such as OVC, and receives drug procurement from PFSCM. In line with
national policies, the hospitals started performance-based financing as incentives for facilities.
Drew University improves the capacity of the RDF to provide quality HIV treatment and care for military
personnel, their partners and families of military personnel, and community members who live in the
surrounding areas. The package includes clinical staging and baseline CD4 count for all patients, control
CD4 count every six months, prevention of opportunistic infections through prophylaxis with cotrimaxazole
to eligible patients based on national guidelines and their diagnosis and treatment, psychosocial counseling
including counseling and referrals for positive female victims of domestic violence and referrals of PLWHA
in care to community-based BCS services based on their individual need.
In FY 2008, Drew University provided the same package of palliative care to 2,500 PLWHA enrolled at three
military hospitals and five brigade clinics. Drew University developed and distributed HIV care package to all
HIV+ individuals receiving care in RDF sites and also paid for "mutuelles" health insurance for all individuals
receiving HIV care in RDF sites. Through PEPFAR support, Drew University ensured the provision of
improved quality of HIV treatment and care services, trained 40 RDF providers at the facility level in
diagnosis and treatment of STI/OIs/mental health disorders diagnosis by integrating these services into the
5 brigade clinics. To improve the health of HIV+ patients, Drew University implemented a mobile treatment
and care unit (MTCU) affiliated to the health facility, which conducted outreach HIV staging, clinical
evaluation and treatment initiation and follow-up to hard-to-reach HIV+ patients. The MTCU ensured the
provision of a continuum of care and treatment services, which includes but not limited to: basic HIV
laboratory tests, STIs/OIs screening and treatment, provision of CTX prophylaxis, ART, ART adherence
support, psychosocial support, family planning, nutrition counseling, prevention for positives, HIV status
disclosure, spiritual care, bereavement care as well as hygiene and malaria education. BCS activities were
implemented in conjunction with other services such as VCT, FP, ART, TB/HIV, OIs, and/or STIs delivery
settings in RDF.
In addition, peer educators were trained to provide social support to members and periodic inter-
brigade/community interactive, experience-sharing discussion group workshops were organized to increase
treatment adherence and share success stories witnessed during the course of HIV care therapy. In
collaboration with CHAMP project, Global Fund project and PMI, Drew University referred the 2,500 PLWA
and their families for malaria prevention services including bed nets provision. For clinically stable healthier
PLWHA, Drew University assisted the RDF to strengthen referral to community-based support groups for
improved treatment adherence and increased access to non-clinical HIV care services. Through PFSCM,
Drew provided OI-related drugs, CD4 testing, and OI diagnostics for the clinical management of PLWHA
enrolled in care. Drew worked with SCMS to ensure appropriate stock management, inventory control, and
storage for all USG-procured commodities at Drew-supported sites.
In FY2009, these activities will continue at three military hospitals and five brigade clinics. Drew University
will also provide technical assistance to RDF to strengthen linkages between community-based and clinic-
based HIV care services. At brigade and/or community levels, Drew will support: 1) the formation of civil-
military allied associations of PLWHA and train members in provision of home-based care services, 2)
access to locally available and/or self-initiated nutritional support and 3) HIV prevention for positives which
includes training of caregivers on adequate management, distribution and use of care package and 4) HIV
clinical cases detection and referral.
Continuing Activity: 12826
12826 2752.08 Department of Drew University 6309 100.08 HIV Support to $306,686
7191 2752.07 Department of Drew University 4331 100.07 HIV Support to $357,123
2752 2752.06 Department of Drew University 2554 100.06 HIV Support to $265,125
Estimated amount of funding that is planned for Human Capacity Development $50,000
Table 3.3.08:
THIS IS A CONTINUING ACTIVITY FROM FY 2008, ALREADY APPROVED.
Continuing Activity: 12829
12829 2751.08 Department of Drew University 6309 100.08 HIV Support to $1,226,325
7190 2751.07 Department of Drew University 4331 100.07 HIV Support to $642,460
2751 2751.06 Department of Drew University 2554 100.06 HIV Support to $120,375
Table 3.3.09:
The Rwandan Defense Force (RDF) has a total of three military hospitals and five brigade clinics throughout
the country. Drew University began working with the RDF in 2005 and currently is providing support to two
military hospitals and three brigade clinics with PEPFAR funding. Drew University works closely with the
RDF to improve the capacity to provide quality HIV prevention care and treatment services for military
personnel their families, as well as for community members who live in areas close to military health care
facilities. Drew University provides technical assistance (TA) and training on HIV care and support, palliative
care, treatment, M&E, and lab infrastructure. As a PEPFAR implementing partner, Drew University
provides a full complement of HIV-related services at military facilities, including: VDT, PMTCT, HIV care
(including palliative care) and treatment services, TB/HIV specific interventions, as well as, prevention for
positives services. All needed drugs for HIV treatment and care are purchased through SCMS.
Approximately 2,000 HIV-infected adults are enrolled in care, of these 1,650 are receiving ART at RDF
facilities. While the numbers of children currently enrolled in care and treatment at these facilities is small,
in FY08 and FY09, Drew University will provide support to significantly increase services for the pediatric
population reached through military health care facilities. In FY 2008, Drew University will extend its
support to all 8 RDF facilities in Rwanda and PMTCT services will be added to 2 new sites (5 of 8 facilities
will provide this service). During FY 2008, and in line with national policies and sustainability strategies, the
Kanombe Military Hospital, the largest military facility, located in Kigali, will begin HIV service provision
using a performance-based financing (PBF) model, similar to the approach used in many civilian facilities in
Rwanda. In FY 2009, Drew University hopes to further increase PMTCT to all RDF hospitals and brigade
clinics.
In FY 2008, Drew University will provide an integrated package of care and support services for HIV-
exposed infants and HIV-infected children at all 8 Drew University sites. In FY 2009, the activities
established in FY 2008 at the three military hospitals and five brigade clinics will continue. Care and support
for HIV-exposed infants identified in PMTCT will include access to early infant diagnosis using DBS;
provision of co-trimoxazole prophylaxis until their HIV status is known, infant feeding support and tracking of
mothers and infants lost-to-follow-up for re-engagement in care.
Drew University's care and support model for HIV-infected children includes provision of regular clinical
assessments (monthly for HIV-exposed infants and every six months for older, stable children) and staging
and baseline CD4 count or percentages for all HIV-infected children, follow-up CD4 every six months or less
as needed, management of other HIV-related illnesses, including OI diagnosis and treatment, and routine
provision of co-trimoxazole prophylaxis for eligible children and for all HIV-exposed infants. All pediatric
patients will be screened for TB at least once every six months. Children suspected of having TB will be
investigated to establish a diagnosis and begin treatment as per national guidelines. Children without active
TB disease but who were exposed to an active case will be provided with INH prophylaxis.
In addition, sites will provide nutritional counseling and complementary food support, pain and symptom
management, end-of-life care, integrated management of childhood management (IMCI) at its MCH clinics.
Sites will also distribute long-lasting insecticide treated nets (LLITN), safe water interventions, and provide
basic hygiene education and community outreach services. In collaboration with CIDC, Drew University
trained 30 health care providers in psycho-social care for children living with HIV/AIDS and launched
psycho-social care services at all its ART sites, thus increasing the complement of services to support
children and their families.
Strengthened nutritional services at Drew University-supported sites will include training, counseling to HIV-
positive mothers during pregnancy and after delivery to provide women with the opportunity to make the
best informed infant-feeding choice. Nutritional assessments using anthropometric indicators, the provision
of food support to HIV-exposed infants and management of malnutrition through provision of micronutrient
and multivitamin supplements is also part of the nutritional support package for children. Drew University
will ensure programmatic linkages to the Title II food support for clinically eligible PLHIV and children
(implemented by PEPFAR and World Food Program (WFP)) in selected health districts and to the
USAID/Ibyringiro project which provides complementary food support for HIV-exposed infants at USG-
supported sites throughout Rwanda. Drew University will also reinforce vegetable gardening initiated at
health facilities that received PMTCT food support though the WFP.
Drew University supported sites will establish HIV community outreach services by working with trained
community health care workers with key HIV messages emphasizing pediatric HIV, care, nutrition during
monthly meetings at the health facilities. By providing HIV messages on a regular basis, Drew University's
sites aim to ensure a continuous flow of information to and from the community in order to increase
awareness and increase service utilization. The facility-based military focal points, community health
workers in the military neighborhood, constitute an effective system to ensure continuity of care, promote
retention into care, and improve coverage and quality of pediatric HIV services. Drew University will also
support the development of systems for referral of HIV-infected children to access malaria prevention
services, including the provision of LLITN and home-based management of malaria. These services will be
provided through a collaborative approach between Drew University, CHAMP, the Global Funds program
and the PMI. Other services to be provided through this collaborative effort includes the distribution of
water purification kits and basic hygiene and health education, psycho-social support, and improve access
to education, and legal support services for vulnerable children and their families.
Table 3.3.10:
Table 3.3.11:
ACTIVITY UNCHANGED FROM FY 2008.
throughout the country that provided health care services to military personnel and their families. Drew
University began working in two military hospitals and three brigade clinics in FY 2005 with PEPFAR
support. The support modalities include TA and training on ARV and palliative care, M&E, and laboratory
infrastructure. Drew is a USG funded clinical partner working in ARV, TB/HIV, PMTCT, Palliative Care and
Prevention for Positive. It collaborates with CHAMP for services in military communities such as OVC, and
receives drug procurement from SCMS. In line with national policies, the hospitals start performance-based
financing as incentives for facilities.
In FY 2008, Drew University supports 40 HIV and TB services providers at facilities for continuous TB/HIV
integration using the TRAC/PNILT TB/HIV training module, counseled all 2,000 TB patients registered at
three military hospitals and five brigade clinics for HIV test and provided testing services to 90% of those
who accepted to take the test. Drew University supported facilities to strengthen referral mechanisms within
the same facility and between facilities which enabled patients diagnosed with TB and HIV to better adhere
to TB treatment via DOTS, and access co-trimoxazole prophylaxis, CD4 counts or percentages and receive
ART if eligible.
PBF is a major component of the Rwanda PEPFAR strategy for ensuring long-term sustainability and
maximizing performance and quality of services. In coordination with the HIV PBF project, Drew University
shifted some of their support from input to output financing based on sites' performance in improving key
national HIV performance and quality indicators. Examples of quality indicators included correctly filling
stock control cards in X-ray departments, the percentage of TB labarotory exams that were corroborated
during quarterly controls, the number of X-rays of good quality that had correct diagnosis and reported in
patient file, and the number of complete series of AFBs correctly done. Payment of indicators was linked to
the quality of general health services through adjustments of payments based on the score obtained using
the standardized national Quality Supervision tool and a performance incentive for the production of more
than agreed upon quantities of each indicator. Drew University in partnership with MSH paid incentives to
community health workers based on number of TB suspected case and focused on TB control at site level.
In addition, Drew University through regular supervision to supported sites ensured that TB/HIV data were
recorded and reported following national guidelines and staff conducted quarterly M&E meeting with PLHIV
associations, community health workers with the aim analyzing data and use them for program quality
improvement.
In FY 2009, these activities will continue at three military hospitals and five brigade sites. Drew University
will provide 2,000 HIV-infected clients with TB preventive therapy and eligible patients for ART. Drew
University will ensure that TB clinical care continues to be part of a package of a comprehensive HIV/AIDS
care strategy by improving the infrastructure at RDF hospitals and brigade clinics and train RDF health
providers to diagnose, treat, and through an established information system, monitor and report TB
progression trends. Drew University will ensure that the provision of preventive co-trimoxazole prophylaxis
continues to be integrated into a HIV care package for adults and children, to encourage TB prevention and
reduce clinical disease. With PEPFAR support, Drew University will ensure that 100% of HIV positive adults
and children enrolled into care in RDF sites receive TB screening and treatment (if TB infection is
confirmed) and in the same manner, 100% of TB patients will be tested for HIV through PIT. In addition, all
HIV positive, TB co-infected adults and children eligible for ART will be automatically enrolled and followed-
up through in-facility referrals and linkages. TB preventive co-trimoxazole prophylaxis will also be provided
to HIV-infected adults and children enrolled on care whether on and/or pending starting ART. To ensure
successful TB prevention, Drew will support TB awareness-raising activities, mainstreamed at
brigade/community-level through existing associations of HIV-positive individuals. Efforts to track family
members exposed to TB and potentially at risk for HIV will be pursued. TB exposed children of TB/HIV co-
infected adults will be identified, evaluated and provided with appropriate prophylaxis or treatment as
indicated by the national guidelines for TB management in children. HIV testing for children of HIV positive
adults with TB identified at TB clinics or enrolled in ART clinics will be offered at Drew supported sites. HIV
positive children identified through this approach will be enrolled in ART services as part of a family
approach to TB/HIV service provision and as part of efforts to improve the quality of services offered to
military personnel and their families.
These activities support Rwandan national plan for TB/HIV and PEPFAR to prevent, diagnose and treat
patients with both TB and HIV patients.
Continuing Activity: 12827
12827 8146.08 Department of Drew University 6309 100.08 HIV Support to $65,404
8146 8146.07 Department of Drew University 4331 100.07 HIV Support to $24,896
Table 3.3.12:
Continuing Activity: 12828
12828 8165.08 Department of Drew University 6309 100.08 HIV Support to $57,229
8165 8165.07 Department of Drew University 4331 100.07 HIV Support to $36,641
* Reducing violence and coercion
Table 3.3.14:
