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.
This PHE activity, Evaluating adherence to antiretroviral therapy among HIV care and treatment patients in
Rwanda: A retrospective cohort study, was approved for inclusion in the COP. The PHE tracking ID
associated with this activity is RW.07.0198.
Note: This PHE is funded by carry over funds from 2007. There does not appear to be a narrative in 2008,
therefore we could not mark this activity as continuing. -NComella
New/Continuing Activity: New Activity
Continuing Activity:
Emphasis Areas
Human Capacity Development
Public Health Evaluation
Estimated amount of funding that is planned for Public Health Evaluation $0
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.09:
ACTIVITY UNCHANGED FROM FY 2008:
The USG, in collaboration with the GOR and Columbia University, has provided funding for the
development of two pediatric HIV care and treatment Centers of Excellence (COE) located at the Kigali
Hospital Center (Centre Hospitalier de Kigali or CHK) and the Butare University Hospital Center (Centre
Hospitalier Universitaire de Butare or CHUB). CHK and CHUB are the two largest referral centers in the
country; the only medical school in the country is located at CHUB. Renovations at the CHK pediatric HIV
center of excellence were completed earlier in 2008 and it is now fully operational; 5 physicians, 5 trained
pediatric HIV nurses, one data manager and one administrator staff this out-patient clinic that provides
services to 163 HIV-infected children of which 119 are currently receiving ART. Approximately, 192 HIV-
exposed infants are also followed at this site. Approximately, 293 children are in care at CHUB (161 on
ART). Personnel from both CHK and CHUB COEs provide PITC services for children at various pediatric
entry points and work to link these children and their families to care and treatment services at the COEs, or
at ART facilities closer to their homes. In FY08, both COEs will be fully operational and will be instrumental
in providing clinical services for complicated pediatric HIV cases referred from District Hospitals, in providing
long-distance patient management advice and on-sites staff mentoring, and so will constitute a major
training resource for the national pediatric HIV program.
In FY 2009, the COE will be supported to greatly expand its role in supporting the national pediatric HIV
program in Rwanda in coordination with the MOH, the CIDC, and other implementing partners. The COEs
in Kigali and Butare will be used to support training of physicians in pediatric HIV management. The cadre
of pediatric nurses will be used to train staff from clinical sites on issues related to testing children in various
clinical settings as well as on counseling children's parents' and on HIV diagnosis disclosure for older
children. A group of physicians from the COEs will provide long-distance mentoring support,, discuss
management of difficult cases with district hospitals staff, and and serve as on-site training resources for
health care providers from the various districts hospitals and health centers, in order to improve their
pediatric HIV clinical skills. ICAP will also work with CIDC and CHUK to train and supervise a cadre of
highly trained CIDC mentors who will be critical in harmonizing the approach of pediatric HIV care best
practices for all the sites, and continuously improve overall pediatric care quality throughout the country.
Health-related Wraparound Programs
* Child Survival Activities
* TB
Estimated amount of funding that is planned for Human Capacity Development $125,000
Table 3.3.10:
This is a continuing activity from FY 2008. No narrative required.
Estimated amount of funding that is planned for Human Capacity Development $175,000
Table 3.3.11:
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
The overall goal of this activity is to build capacity at central level for to support TB/HIV integration at all
levels. TB/HIV capacity building includes development, revision or updating of TB/HIV guidelines for adults
and children, creating training materials and job-aids, sharing best practices, improving TB diagnosis, and
enhancing supervision and monitoring evaluation of TB/HIV integration activities.
In FY 2009, Columbia University will continue to support TB/HIV collaborative activities at central level
through continuation of support for a long-term advisor and four national supervisors seconded to the
national TB program to oversee collaborative activities. These include providing support to the national
TB/HIV working group for revising and updating guidelines, curriculums, and tools. It also includes providing
support for supervision of quality TB and HIV service delivery to co-infected patients - particularly to
strengthen the implementation of routine HIV counseling and testing, prevention education, and referral for
HIV care (if needed) for all patients with TB at the TB/DOT clinics. Additionally, it includes implementation of
standardized symptom-based TB screening and intensified TB case-finding for patients living with HIV at
the ART clinics. In addition, Columbia is supporting the PNILT with the implementation of an electronic TB
register at selected sites. Support for two model centers established in FY 2005 will continue, Columbia
(through its agreement with PNILT and NRL) is strengthening TB capacity throughout the Rwandan
laboratory network. Lower-tier laboratories will use basic Ziel-Nielsen staining of specimens, and three
reference laboratories located in NRL, Kigali University Teaching Hospital (KUTH), and Butare University
Teaching Hospital will perform more complex assays such as TB culture, TB molecular diagnostics (PCR),
TB drug susceptibility testing, diagnostics for Mycobacterium Avium Complex (MAC) and other atypical
mycobacterium. In addition, the three reference laboratories will oversee the training and supervision of TB-
related activities in the lower tier labs to improve the quality of microscopy-based diagnostic tests. A strong
referral system will be developed to transport specimens from the lower tier labs to the reference
laboratories for TB culture and other specialized tests.
Quality assurance systems were strengthened by providing TA to the NRL for the development of an
external quality assurance (EQA) program for TB-related diagnostics. The CHK pathology lab will be up-
graded to accommodate the increasing volume of TB-related anatomical pathology and clinical pathology
specimens. Finally, these funds supported the drafting of a national strategic plan for TB lab diagnostics and
lab network strengthening in coordination with the overall national plan for integrated TB and HIV activities.
In addition to the TB laboratory activities, ICAP will strengthen TB/HIV integration in three prisons currently
providing ART services in Rwanda (ICAP-supported sites). Priority will be placed on assuring that systems
are in place for effective data collection and tracing as prisoners with HIV and prisoners with TB and HIV
are released into the community. ICAP will hire staff to work with the prisons on these aspects of TB/HIV
integration and assist with the coordination of these activities with KUTH, BUTH, NRL and PNILT. ICAP will
procure all equipment and contract with a local company to renovate laboratories in the Butare University
Hospital.
In addition, Columbia University will support additional staff positions and training at NRL, for TB culture
molecular diagnostics (PCR), TB resistance testing, MAC and other atypical mycobacterium diagnostics as
the demand is expected to grow in FY 2009 with scale-up active TB case findings among PLWA , smear
negative suspect TB clients and their families. Columbia will continue to support the network of TB labs with
transportation of specimens from low tier lab to the main three labs NRL, CHK and Butare University lab. In
FY 2009 Columbia will support the decentralization of TB quality assurance to decrease the workload on
NRL. These activities will reinforce timely diagnosis of extra pulmonary and smear negative TB thus
decreasing the high mortality currently associated with delayed diagnosis of these types of TB disease.
Columbia University was awarded the UTAP follow-on in August 2008, thus there will be continuity in the
activities outlined above.
Estimated amount of funding that is planned for Human Capacity Development $150,000
Table 3.3.12:
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS
1. Elaboration of activities
In FY 2009, Columbia will continue its TA and capacity building activities at NRL by supporting technical
activities as well as strengthening the institutional infrastructure and management capacity critical to sustain
the national network of laboratories for the Rwandan HIV care and treatment program. Direct TA will
continue to be provided through long-term advisors and periodic short-term consultants as needed. Two
long-term technical advisor positions will be continued in FY 2009. The first provides support for HIV-
related quality laboratory services, including evaluations of new technologies, technician trainings and
guidance on technical and policy issues. The second advisor, a local hire senior lab technician will remain
responsible for development and implementation of national standards, QA systems and training. These
two technical advisors will continue to transfer skills, knowledge and capacity, ensuring a sustained impact.
Columbia will continue to support laboratory TA to the NRL and CHUB TB laboratories to ensure reliable
AFB and high quality smear microscopy, liquid culture and drug sensitivity testing capability at the health
facility level. These TB diagnostic and treatment capabilities are essential in order to provide PLWHA
adequate access to comprehensive quality TB-related services. These capabilities are also essential for
the support of patients with MDR TB. Extrapulmonary TB diagnostics will be available through continued
support to CHUB and CHUK anatomical pathology laboratories.
Atelier Central de Maintenance (ACM) and NRL maintenance units for laboratory equipment will be
strengthened through training and staffing to guarantee the quality of results within the national laboratory
network. Also, small laboratory renovations will be performed to assure building sustainability inside the
national laboratory network.
Columbia will also continue to strengthen and integrate QA/QC/QI at the NRL into all HIV-related laboratory
areas serology, biochemistry, hematology, CD4, TB and malaria. New QA/QC approaches will continue to
be explored in those HIV specific areas. National specimen transportation systems will continue to be
strengthened. Specific laboratory target evaluations on new technical alternatives and new technologies
will be supported to improve the accessibility and reliability of care and treatment programs. For example,
new alternative technologies will focus on specific HIV areas like, CD4 or TB infant diagnostics. Protocols
and/or indicators should be designed to evaluate laboratory performance impacts on care and treatment
programs.
In collaboration, CDC, APHL and Columbia will support NRL to develop a highly functional national
laboratory information system for NRL, and will work, utilizing existing funds, to extend this system to district
hospitals. The laboratory information system will manage financial record keeping, as well as specimen
tracking, inventory control and programmatic indicators.
All of these activities are consistent with Rwanda's five-year strategic goals of strengthening NRL's capacity
to manage a national network of laboratories, standardize technical approaches and support QA of HIV-
related services throughout the national laboratory network.
Estimated amount of funding that is planned for Human Capacity Development $100,000
Table 3.3.16:
