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
This is a continuing activity from FY 2008. No narrative required.
New/Continuing Activity: Continuing Activity
Continuing Activity: 16739
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
16739 15208.08 U.S. Agency for Family Health 7528 7088.08 FHI Bilateral $502,175
International International
Development
15208 15208.07 U.S. Agency for Family Health 7088 7088.07 FHI New $371,734
International International Bilateral
Emphasis Areas
Gender
* Increasing gender equity in HIV/AIDS programs
Health-related Wraparound Programs
* Child Survival Activities
* Family Planning
* Malaria (PMI)
* Safe Motherhood
* TB
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $300,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Estimated amount of funding that is planned for Economic Strengthening $88,000
Education
Water
Table 3.3.01:
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
FHI has been providing STI services for sex workers at two clinical sites in Kigali (Biryogo and Busanza).
These locations were selected based on the sex worker populations in that area. In FY 2008, FHI worked
closely with the OGAC prevention technical working group to define, implement and evaluate programming
for prevention of HIV in MARPS. Specifically, a package of services for sex workers was defined and
implemented. This package of services included: community-based outreach, condom programming, STI
screening and treatment, referral to PMTCT and HIV treatment and care for those who are HIV-infected. In
addition, the TWG and FHI are working together to help determine policy, training, procurement and data
needs to facilitate comprehensive HIV prevention programs for Rwanda, and prepare tools that could assist
all partners in implementing and expanding such programs.
In FY 2009, FHI will continue to provide the preventative package of care to 3,000 MARPS and extend the
lessons learned from its experience to other partners that are providing services to sex workers. FHI will
support national institutions to update existing guidelines on STI management using an enhanced
syndromic approach. This approach will be targeted at most-at-risk populations, especially sex workers.
Continuing Activity: 16741
16741 16741.08 U.S. Agency for Family Health 7528 7088.08 FHI Bilateral $150,000
* Addressing male norms and behaviors
* Increasing women's access to income and productive resources
* Increasing women's legal rights
* Reducing violence and coercion
Workplace Programs
Estimated amount of funding that is planned for Human Capacity Development $50,000
Estimated amount of funding that is planned for Education $50,000
Table 3.3.03:
ACTIVITY UNCHANGED FROM FY 2008:
FHI has been providing basic care and support to 24,180 at 64 sites in FY 2008. Basic Care services in FY
2009 will continue, and they include clinical staging and baseline CD4 count for all patients; follow-up CD4
every six months, management of HIV-related illnesses, including OI diagnosis and treatment, and routine
provision of CTX prophylaxis for eligible adults, basic nutritional counseling and support, positive living and
risk reduction counseling, pain and symptom management, and end-of-life care. FHI will continue to provide
psychosocial counseling including counseling and referrals for HIV-infected female victims of domestic
violence. To ensure comprehensive services across a continuum, FHI, through the partnership with EP
community partners and other community services providers, will continue to refer patients enrolled in care
to community-based HIV services based on their individual need. Such community services include
adherence counseling, spiritual support, stigma reducing activities, OVC support, IGA activities, and HBC
services for end-of-life care. FHI will continue to work with SCMS to ensure adequate quantification of HIV
diagnostic kits, CD4 tests, and other laboratory reagents and equipments necessary for clinical
management of HIV infected patients. Additionally FHI will also continue to work with SCMS for the
appropriate storage, stock management, and reporting of all OI-related commodities.
In FY 2009, FHI will continue to provide basic care services to a total of 30,934 patients, whic include
24,180 existing patients in care and an additional 6,754 new patients at 64 existing sites, including 35 ART
sites and 52 TC/PMTCT sites. Services will emphasize on quality of care, a continuum of care through
operational partnerships, and sustainability of services through PBF. FHI will continue to collaborate with
Title 11 Food Partners and sub-partners implementing the food assistance for people Living with HIV, under
the project "IBYIRINGIRO", and with the WFP; and will continue to strengthen nutritional services through
relevant training for site staff. Provision of nutritional care will include counseling according to established
national guidelines and using existing materials, and will multiply existing job aids like nutritional counseling
cards for providers and counselors. Nutritional assessments using anthropometric measurements will be
done to determine food support eligibility according to national and EP nutrition guidelines. Management of
adult malnutrition will include provision of micronutrient and multivitamin supplements.
FHI will at site level also ensure referrals for all PLHIV and their families for malaria prevention services,
including for the provision of LLITNs, in collaboration with PEPFAR-supported community-based
organizations, GFATM and PMI; and referral of PLHIV and their families to CBOs and other community-
service providers for distribution of water purification kits and health education on hygiene. In addition family
planning education, counseling and methods will be provided to PLHIV and their spouses. This service will
be located within the voluntary counseling, ART and PMTCT services of the site to reduce need for
referrals. FHI will continue to avail at national level, relevant documentation, based practice reports and
operational research reports and job aids to strengthen integration of FP into HIV services as an effective
HIV prevention strategy among the positives. The partner will continue to strengthen psychological and
spiritual support services for PLHIV at clinic and community levels through TRAC -Plus (MOH) coordinated
training in supportive supervision of psychological support for all FHI-supported health facilities and
community-based providers. Such support includes GBV counseling, counseling on positive living, and
counseling on PwPs.
In line with the MOH policy on community health and use of community health workers (CHWs), the
partners will continue to train, equip, and supervise 20 community health leads per health facility reaching a
total of 1,370 lead health workers within the supported districts. Health facilities will continue to support the
CHWs through well coordinated regular meetings to ensure quality and coverage of community based HIV
services, and linkages between community and facility. The facility-based case managers, community
health leads and community based services providers constitute an effective system that ensures
continuum, coverage and quality of palliative care.
In order to ensure continuum of HIV care, FHI will provide supportive supervision and monitoring of case
managers at each of the supported sites. These case managers, with training in HIV patient follow-up, will
ensure referrals to care services for pediatric patients identified through PMTCT programs, PLHIV
associations, and in/outpatient services. Case managers will continue to have planning sessions with
facilities and community-based service providers to maintain a more efficient use of patient referrals slips to
ensure timely enrollment in care and treatment and retention in pre-ART services. FHI -supported sites will
continue to assess individual PLHIV needs, organize monthly clinic-wide case management meetings to
minimize follow-up losses of patients, and provide direct oversight of community volunteers. The community
volunteers will be organized in associations motivated through community PBF based on the number of
patients they assist and quality of services provided. FHI will continue to work with Community Services
providers to develop effective referral systems between clinical care providers and psycho-social and
livelihood support services, through the use of patient routing slips for referrals and counter referrals from
community to facilities and vice versa. Depending on the needs of individuals and families, health facilities
will the linkage with community-based HBHC services, adherence counseling, spiritual support through
church-based programs, stigma reducing activities PLHIVs. At community level, the partner will be
responsible for provision of medical services particularly community-based pain management and end-of-
life care in line with national palliative care guidelines.
PBF has been a successful model of the PEPFAR Rwanda strategy to ensuring long-term sustainability and
maximizing performance and quality of services. In FY 2007 through FY 2008, FHI with support from the
HIV PBF project was able to assume management of all PBF subcontracts in its supported districts. This
will continue through FY 2009, with intensive training and oversight for site staff to perfect PBF contract
management.
In the context of decentralization, DHTs now play a critical role in the oversight and management of clinical
and community service delivery. FHI will strengthen the capacity of four DHTs to coordinate an effective
network of basic care and other HIV/AIDS services. The basic package of financial and technical support
includes staff for oversight and implementation, transportation, communication, training of providers, and
other support to carry out key responsibilities.
Activity Narrative: This activity addresses the key legislative areas of gender, wrap-around for food, microfinance and other
activities, and stigma and discrimination through increased community participation in care and support of
PLHIV.
Continuing Activity: 17108
17108 8144.08 U.S. Agency for Family Health 7528 7088.08 FHI Bilateral $973,263
8144 8144.07 U.S. Agency for To Be Determined 4692 4692.07 C-RFA
International
Estimated amount of funding that is planned for Human Capacity Development $180,000
Table 3.3.08:
THIS IS A CONTINUING ACTIVITY FROM FY 2008, ALREADY APPROVED
Continuing Activity: 16745
16745 15444.08 U.S. Agency for Family Health 7528 7088.08 FHI Bilateral $4,951,875
15444 15444.07 U.S. Agency for Family Health 7088 7088.07 FHI New $4,762,598
Table 3.3.09:
ACTVITY UNCHANGED FROM FY 2008
FHI is one of the USG partners providing HIV care and treatment services for HIV-infected adults and
children in Rwanda. At present, the program has 64 sites in 6 districts. Of these facilities 52 provide
PMTCT, 35 provide ART for adults and for children, and 26 have VCT, PMTCT and ART (for adults and
children) co-located in the same premises. These facilities are located in 5 districts of the southern region of
Rwanda and in Kigali City. In FY2008, FHI provided a comprehensive package of basic care and support
services to 2,418 HIV-infected children and treatment to 1,293 at 35 sites. This package of services, is
provided in collaboration with local community service providers and includes, co-trimoxazole prophylaxis,
nutrition counseling and food support, insecticide treated nets (ITN) and safe water interventions. In
addition, FHI provides follow-up services for HIV-exposed infants who are followed-up and maintained on co
-trimoxazole prophylaxis until confirmation of their HIV status can be obtained.
For FY2009, FHI will continue to provide the same package to 2,713 HIV-infected children and HIV-
exposed infants at its 35 existing sites. FHI will also increase treatment services for 675 new children at 35
existing sites to reach a total of 3,093 of children in care and 1,550 of children on ART by end of FY09.
To address the need to expand diagnosis of HIV in the pediatric population FHI will increase testing for
targeted pediatric populations within the catchment area of its existing sites. Using each HIV adult patient
enrolled in care and treatment at FHI-supported sites, as an index case, FHI will offer HIV-testing for their
partners and children and enroll the infected family member/s into care and treatment services. FHI-
supported sites will link with OVC service providers operating in its supported districts to offer HIV testing
services for children, according to national guidelines, and ensure enrollment of HIV-infected children into
care and treatment services. In addition, FHI-supported sites will link with malnutrition and TB centers within
their facilities or at specialized sites located in the vicinity to provide HIV testing to all pediatric in- and out-
patients and enroll the infected children into care and treatment services. FHI will also work to establish and
strengthen linkages with PLHIV associations in the local network, and the administrative district authorities
and health teams to support activities to increase awareness in communities on issues related to pediatric
HIV to increase pediatric HIV testing and enrollment into care.
At PMTCT sites, enhanced follow-up of mothers and exposed infants will be promoted through support
groups of HIV-infected women based on the mother-to-mother model. In this model, women who
demonstrate steady consultation attendance and good baby care are identified and used to coach new HIV-
positive mothers during pregnancy and after delivery to ensure that both women and their infants access
needed services. During these groups sessions FHI will provide ITNs, nutrition counseling, enhancing
family food support through training for improved home gardening and animal breading techniques, and
provide food supplementation to mother infant pairs. This last activity is conducted in collaboration with a
Prime PEPFAR funded Community Partner, the World Food Program (WFP), and the
CRS/ACDIVOCA/World Vision consortium. In addition, FHI-supported sites will provide health education on
safe water and provision of water purification products. HIV-exposed infants identified at PMTCT sites will
be followed in the context of existing MCH services offered at existing FHI sites. Mother and infant
information will be transferred from PMTCT to other MCH programs through the "carte de liaison" currently
in use in Rwanda as a means to transfer relevant HIV information between PMTCT and MCH programs.
Early infant diagnosis services, now available at 40 of FHI supported sites, will be expanded to increase full
coverage of sites by end of FY09. EID will be offered at six weeks of age and at later ages for symptomatic
infants less than 18 months of age according to the national algorithm. FHI will also work with the district
health teams to ensure that samples collected at the sites are transferred efficiently to the processing lab at
the National Reference Laboratory in Kigali and work with the MoH to increase reliability of result turn-
around times.
At FHI-supported sites HIV-infected children will be staged clinically and using CD4 (counts or percentages
as these become available) and eligible infants and children will be enrolled in ART. FHI will work with other
clinical implementing partners and the MoH to train health care providers on newly updated pediatric HIV
treatment guidelines which include changes for early treatment of HIV-infected infants and changes in CD4
thresholds for treatment initiation of children between 36 and 59 months of age. Systematic chart reviews
to identify children now eligible for treatment based on new CD4 cut-offs will be initiated in FY08.
All pediatric patients will have regular anthropometric evaluations to identify early signs of malnutrition and
ensure prompt initiation of nutrition rehabilitation interventions. Newly identified patients will be screened at
enrollment and at regular intervals for signs and symptoms of common opportunistic infections or other
infectious complications of HIV in children, including: candidiasis, pneumonia, malaria, meningitis, and PCP.
In addition, all pediatric patients will be screened for TB at least once every six months. Children suspected
of having TB will be further investigated and put on TB treatment or INH prophylaxis if infection or exposure
is confirmed based on current national guidance. Additionally, infants and children on ART will also be
assessed at each visit for issues related to adverse events, toxicity and adherence to ART. Staff will be
trained to ensure, as much as possible, the early detection of signs of immunologic and clinical failure and
initiation of second line treatment regimens based on national guidance.
Because HIV-exposed, infected and affected children do not have the same level of vulnerability and risk of
death as non-infected or affected population FHI will work to implement a system to assess vulnerability and
will conduct home visits for families with HIV-infected children in order to identify and manage accordingly
those that need special attention.
Pediatric HIV care and treatment programs in Rwanda face many challenges, including the need for
increased numbers of qualified trained pediatric health care providers. FHI will ensure that site-level
providers are trained or receive refresher training session in pediatric HIV patient management, according
to national guidelines. Providers will receive regularly planned in-service trainings and coaching sessions.
In collaboration with AIDSRelief, and TRAC-plus, FHI has dedicated staff to be part of the national
mentoring team, who will provide continued mentoring to clinical staff at FHI supported sites in addition to
national level mentoring. Mentor staff will, in turn, train hospital and health center service providers in
Activity Narrative: pediatric clinical HIV care, palliative care, patient record-keeping, data recording and use, and quality
performance measurement and improvement. FHI will continue to promote staff retention and motivation at
supported sites through innovative ways including continued training for individual staff skills development
and offering continuous technical support to successfully implement a performance-based financing model
of service delivery which provides staff bonus awards to high scoring sites.
Through work with the Supply Chain Management System (SCMS) and CAMERWA, the national
pharmaceutical warehouse, the district-level pharmacy,, the National Reference Laboratory (NRL) and the
regional laboratory network, FHI will ensure training of health service providers on HIV opportunistic
infections, drug and reagent stock management and distribution, adherence counseling, good pharmacy
record-keeping and data use. FHI will collaborate with health facilities to survey energy needs for proper
operation of laboratories, IT equipment and storage facilities. Sites in need of back-up or extended power
supplies will be equipped with solar-based energy sources.
FHI will continue to train data managers and health service providers in the use of patient data software.
Pediatric HIV care indicators will be linked to PMTCT indicators in the database for better follow-up of
infants exposed to HIV. With improved data on pediatric HIV care, FHI, in collaboration with TRAC-plus, the
national performance-based program, and the HIVQUAL project will support health facilities to build and
sustain a system of quality performance measurement, improvement. This system will use basic pediatric
HIV care and support and treatment data as a source to regularly review program performance and
design/implement appropriate interventions to improve the quality of services provided to children and their
families. FHI staff in charge of each district will ensure that meetings to review internal data take place on a
regular basis and that the improvement plan is implemented at individual sites. Yearly, district-level
meetings are planned where each facility will share their performance data and improvement strategies. FHI
will ensure that pediatric HIV care is integrated with adult HIV care and that the family approach is
reinforced.
Table 3.3.10:
Table 3.3.11:
ACTIVITY UNCHANGED FROM FY 2008.
In FY 2007, FHI began implementing the national TB/HIV policy using national guidelines at their 59
supported sites. The program's achievements include an improvement in the percentage of TB patients
tested for HIV from less than 70% to 95% and improving HIV-infected TB patient's access to HIV care and
treatment (increased proportion of patients accessing co-trimoxazole and ART). In FY 2008, the goal was
to ensure at least 95% of all TB patients were tested for HIV and that 100% of eligible patients receive co-
trimoxazole and 100% of those who are eligible receive ART. In addition, at the 59 FHI-supported PMTCT
and HIV Care and Treatment sites, 100% of 16,642 adults and children enrolled in HIV care were routinely
screened for TB.
However, in FY 2008, at the national level lower than expected numbers of PLHIV receiving basic care
services were diagnosed and treated for TB. The priority in FY 2009 will be to increase support to district
health teams (DHT) to provide supervision to non-PEPFAR funded sites within FHI supported districts of
Rwanda's Southern Zone, to increase the diagnostic capacity of district hospitals and other TB treatment
and diagnostic centers (DTHs) within FHI-supported districts. Improving services for TB/HIV management
will also include a strong focus on infection control standards through use of national guidelines and
protocols developed with PEPFAR funding; increased diagnostic capacity for both pulmonary and extra
pulmonary TB; fully expand implementation of regular TB screening and for all PLHIV (adults and children),
and for those with suspected TB disease; ensuring complete treatment with DOTS, and monitoring
treatment failure in order to facilitate early detection of MDR TB and tracking of exposed family members for
appropriate HIV and TB screening and or initiation of isoniacid prophylactic therapy as indicated in the
national guidelines.
Additionally, in FY 2009 FHI will provide refresher trainings to two staff members from each district that
underwent respiratory infection control training in FY 2007 and 2008 and will continue to build their capacity
through TRAC-coordinated mentoring so they can continue to provide quality supervision to facilities within
their assigned districts.
In order to ensure effective integration of TB and HIV, FHI will continue to support integrated planning and
TB/HIV training for HIV and TB services providers. The partner will continue to work towards improved
diagnostic services for TB, including coordinating specimen transport and/or patient transport for
appropriate diagnostic (such as chest radiography and FNA specimen for extra-pulmonary TB) and
treatment services to relevant referral centers and provide appropriate follow-up for quick result turn-around
times, and prompt patient care.
In FY 2009, FHI will focus on continuous quality improvement in their 64 existing sites and building the
capacity of the DHT to plan and implement an HIV program fully integrated into the existing health care
system. The goal is to offer "one stop" services for HIV-infected adults and children to improve retention
into care, increase access to a variety of services including co-trimoxazole prophylaxis, CD4 and clinical
staging, regular assessments for TB or ARV drug toxicity and support for adherence. In addition, other
services, such as family planning, STI diagnosis and treatment, nutritional support and other services can
also be made available in a coordinated manner to maximize resources at site-levels and in the community
and increase the chances that persons can access all the services needed for appropriate care and
treatment.
TB/HIV activities have greatly increased access to critical clinical services for adults co-infected with HIV
and TB. The pediatric population has not necessarily been targeted with some of these interventions
although they are at high risk for TB even when not HIV co-infected. HIV-testing of children being treated at
TB clinics, expedited initiation of co-trimoxazole for HIV-infected children identified at TB clinics and active
case finding of TB cases among children of adults with TB/HIV co-infection has not been implemented in
most countries. At present, most USG supported partners have begun regular clinical screening of children
enrolled in ART programs for signs, symptoms or history of TB exposure but that is generally the extent of
services offered to children. Testing for HIV in children at TB clinics has not been generally implemented at
this time. FHI and other USG partners and donors will work with the GoR to develop an agenda to
specifically address issues related to TB in children.
In addition to TB/HIV activities at their supported sites, FHI recruited and extensively trained three TB/HIV
focal persons in FY 2008 to work together with personnel from AIDSRelief, Columbia University, PNILT and
TRAC-plus and the UPDC unit of the MoH to create a TB/HIV coordination sub-group who will be charged
with bringing together a national technical working group to develop an agenda to further support TB/HIV
integration and improve the quality of services at all levels. In FY 09, this team will continue to ensure the
functioning of the national TB/HIV working group, conduct monthly regular supervision to districts and give
feedback to sites regarding weaknesses in the program, provided recommendations for program
improvement and achievements observed with respect to TB/HIV activities. The three staff based at FHI
office will also continue to ensure quality and coordination of the roll-out of quality services and infection
control services within FHI supported site in both out and in-patient settings for adult and children.
Lessons learned from integrating TB and HIV will serve to further support efforts to fully integrate HIV into
the primary healthcare delivery system for adults and children.
Continuing Activity: 16743
16743 15228.08 U.S. Agency for Family Health 7528 7088.08 FHI Bilateral $384,100
15228 15228.07 U.S. Agency for Family Health 7088 7088.07 FHI New $232,707
Estimated amount of funding that is planned for Human Capacity Development $40,000
Table 3.3.12:
Continuing Activity: 16744
16744 15441.08 U.S. Agency for Family Health 7528 7088.08 FHI Bilateral $231,088
15441 15441.07 U.S. Agency for Family Health 7088 7088.07 FHI New $312,944
Table 3.3.14:
