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: 16732
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
16732 15215.08 U.S. Agency for Elizabeth Glaser 7527 7089.08 EGPAF Bilateral $539,020
International Pediatric AIDS
Development Foundation
15215 15215.07 U.S. Agency for Elizabeth Glaser 7089 7089.07 EGPAF New $427,453
International Pediatric AIDS 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 $67,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
This PHE activity, Evaluation of complementary foods program, was approved for inclusion in the COP.
The PHE tracking ID associated with this activity is RW.08.0110.
Title: Evaluation of the Impact of Maternal and Infant Nutritions on PMTCT Programs
This is a continuing activity spanning 24 months.
In FY08 COP:
01-MTCT
OGAC TBD (EGPAF)
Mech: 8882.08
Activity #: 17059.08
Prime Partner: TBD (soon to be EGPAF)
State/OGAC
GHCS (State)
$200,000
Continuing Activity: 17059
17059 17059.08 Department of To Be Determined 8882 8882.08 OGAC TBD
State / Office of (EGPAF)
the U.S. Global
AIDS Coordinator
Estimated amount of funding that is planned for Public Health Evaluation
Program Budget Code: 02 - HVAB Sexual Prevention: AB
Total Planned Funding for Program Budget Code: $5,706,700
Total Planned Funding for Program Budget Code: $0
Program Area Narrative:
PEPFAR will continue to implement a range of behavioral and biomedical prevention interventions that address the sources of
new infections at the scale and quality necessary to reduce incidence. According to the Rwanda 2005 DHS, national HIV
prevalence is 3%, and is higher in women than in men (3.6% versus 2.3%). Women are infected at younger ages than men,
possibly resulting from cross-generational sex. HIV prevalence in youth aged 15-24 years is 1.5% for females compared to 0.4%
in males (DHS 2005).
There are an estimated 150,000 infected individuals in Rwanda according to the EPP Spectrum 2008. Prevalence is significantly
higher in urban areas than in rural areas (7.3% versus 2.2%), (DHS 2005). HIV in Rwanda is primarily transmitted through
heterosexual contact (75%) and mother-to-child transmission (20%) (GFATM, Round 7 GOR application, 2007).
Modeling of DHS data suggests that over 90% of new heterosexually acquired HIV infections in Rwanda occurred within couples
in cohabitation (Dunkle et al, Lancet 2008). Approximately 2% of heterosexual couples are serodiscordant. Condom use in the
general population is very low. Among young people between the ages of 15-24 years who are sexually active, only 25% of
women and 39% of men used a condom during their last sexual encounter (DHS 2005.)
Conservative estimates suggest that approximately 1,264,000 vulnerable children live in Rwanda, of whom 820,000 are orphans
of all causes (DHS 2005 and 2002 GOR Census). Youth comprise 14.7% of PLHIV (Presentation from the Triangulation Training
Workshop for Analysis and Use of Strategic Information; September 2008) indicating the pressing need to further support and
enhance prevention activities for youth.
Multiple sexual prevention strategies are being used in Rwanda. These include: promotion of abstinence and delayed sexual
debut among youth; enhanced condom distribution and promotion; targeted behavior change communication (BCC); male
circumcision in the military; prevention activities for HIV-positive individuals; improved integration with family planning services;
increasing male involvement in prevention and HIV/AIDS services; and, scaling up VCT, including couples CT.
Abstinence and fidelity (AB) activities focus on youth 10-24 and reach young people in a range of community settings (churches,
drop-in centers, rehabilitation centers, schools and universities). The activities include: provision of information on HIV risk and the
importance of abstinence as an HIV prevention strategy. They also promote fidelity among married couples. Life skills including
communication, negotiation, self-esteem and tools to address the social norms which affect sexual behavior are also part of AB
programming. By the end of FY 2008, PEPFAR had reached over 1,086,387 individuals with AB messages; 701,510 youth with
abstinence only messages and trained over 12,299 individuals in promoting the use of AB. The interventions used include: a
range of mass media activities (radio dramas, public service announcements etc); interpersonal peer communication and
education; working through churches to increase the capacity of religious leaders and parents to support young people to make
and keep abstinence pledges; improving the capacity of youth clubs and cluster groups to implement BCC activities; programs in
school; and working with the military through both AIDS support clubs and counseling and testing services.
A recent evaluation of abstinence and be faithful activities shows evidence that AB activities serve an important role in promoting
social discourse about sexual practices that put young people at risk for HIV. AB was found to be consistent with traditional and
religious beliefs and AB programs were found to be strong contributors to boosting confidence and skills among young people as
well as a foundation for future healthy behaviors.
Other sexual prevention activities focus on targeting most at risk populations including sex workers and their clients, military and
uniformed officers, married couples, people living with HIV/AIDS (PLHIV), discordant couples, mobile populations including
refugees, OVC, young women in transactional and cross generational relationships, married men, and out of school youth. The
activities include: partner reduction; provision of quality condoms and information on their use; promotion of counseling and
testing- including couples counseling and testing; strengthening youth friendly health centers for high risk youth; male circumcision
in the military; key messages for prevention with positives; and, integration of family planning, alcohol and gender issues into
routine prevention activities. Emphasis will be placed on women's empowerment, male involvement and male norms. Alcohol
screening has been added to VCT, incorporated into messaging with prevention with positives, and also incorporated into
activities within the military. Clinical and community gender-based violence (GBV) activities create awareness and focus on
changing societal norms related to GBV; they also promote the availability and uptake of prophylaxis for victims of sexual
violence.
By the end of FY 2008, PEPFAR had reached over 830,068 individuals with HIV prevention messages beyond abstinence and
being faithful and trained over 9,872 individuals in promoting condoms and other prevention. Over 3,399 outlets had been
established to increase access to condoms, including drop in centers, peer educators and retail outlets. The interventions used
include: a range of mass media radio dramas; interpersonal communication and peer education; working through community
groups including out-of-school youth cluster groups, networks of commercial sex workers (CSWs) and trucker associations to
increase their capacity to promote, demonstrate and use condoms. PEPFAR also supports commodity and logistics systems to
ensure that condoms are available where they are needed the most. Counseling and testing also was used to impart valuable HIV
prevention information.
Condom programming in Rwanda is entering a new, and important, phase. The GOR is placing emphasis and strong support
behind integrated and structured condom programming, and has recently revived the condom steering committee to guide policy
and ensure efficient programs. A recent condom assessment undertaken by the National AIDS Commission (CNLS) revealed
major gaps in condom programming - from long term and secure funding to logistics and communication campaigns about
condom use. PEPFAR is structuring its support to address some these gaps including increasing the funding available for
condom procurement to ensure that there is adequate supply for MARPS, members of the military and the public sector. PEPFAR
is also supporting Population Services International (PSI) and DELIVER to address supply, accessibility, visibility and consistent
and correct use of condoms. Major communication campaigns will be rolled out with FY 2009 funds to promote condoms as dual
protection; to help minimize stigma and lack of knowledge about condom use and to ensure that people know how to use them.
Other activities reaching most at-risk populations (MARPs) will include rolling out a comprehensive package of prevention
services for commercial sex workers- ensuring that they have access to STI screening and treatment, condom availability through
community-based outreach, and referral to other HIV services. This package of services will be made available to other MARPS,
including high-risk youth.
The Ministry of Health (MOH) recently rolled out a new community health policy and is developing a cadre of approximately
27,000 community health workers (CHWs) who require training in various health areas. These CHWs will serve as the entry point
into the health system and will relieve much of the burden at health facilities by offering basic preventive and curative services at
the community level. PEPFAR will support the community health roll out with training and capacity development for the CHWs.
Through Peace Corps volunteers, PEPFAR will also support capacity building in rural communities by developing comprehensive
HIV/AIDS prevention strategies.
Limited male circumcision activities began in FY 2008. In FY 2009, PEPFAR will support the roll out of male circumcision (MC)
activities within the military, including training, minor infrastructure improvements to military operating theaters, provision of
services, monitoring and evaluation of services, and communication campaigns to reinforce other prevention practices. Emphasis
will be placed on communication to ensure that soldiers do not assume unsafe behavior following circumcision. These services
are linked to other BCC and VCT activities in the military. MC services will be provided to approximately 3,000 men in FY 2009.
In FY 2009, PEPFAR will continue to support integrated prevention activities with key target groups, using emerging evidence and
best practices. Operational research and evaluations will be undertaken to assure that current evidence continues forms that
basis for prevention activities. This will include an understanding of the dynamics of HIV transmission in Rwanda. Data
triangulation of different data sets - (2005 RDHS-III, the 2006 BSS and other behavioral data) was conducted yielding valuable
information on risk groups and drivers of the epidemic. Surveillance (including behavioral) and population estimates of female sex
workers and other at risk groups is currently underway, as is ongoing technical assistance to determine best practices for reaching
sex workers (MARPS).
PEPFAR will reach 605,380 individuals with prevention messages and services promoting the use of abstinence and fidelity in FY
2009.
PEPFAR will reach 556,201 individuals with prevention messages and services, which go beyond AB in FY 2009.
This strategy fully supports and complements the GOR National HIV/AIDS Strategy.
Table 3.3.02:
ACTIVITY UNCHANGED FROM FY 2008:
Elizabeth Glazer Pediatric AIDS Foundation (EGPAF) has been providing basic care and support (BCS)
HIV services to 12,913 PLHIV at 37 sites in FY 2008. BCS services will continue in FY 2009, and they
include clinical staging and baseline CD4 count for all patients; follow-up CD4 counts 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. In FY 2009 EGPAF include pain
management in BCS services both at the facility and community levels in line with the national Palliative
Care Policy and guidelines. In addition, EGPAF will continue to provide psychosocial counseling including
gender based violence related counseling. EGPAF with strengthen referrals for HIV-infected female victims
of domestic violence, and strengthen linkages to legal service providers and the national police. EGPAF will
continue to collaborate with SCMS to ensure adequate quantification of HIV diagnostic kits, CD4 tests, and
other laboratory reagents and equipments that are necessary for clinical management of HIV infected
patients. Additionally, EGPAF will also continue to work with SCMS to ensure appropriate storage, stock
management, and reporting of all OI-related commodities.
In FY 2009, EGPAF will continue to provide BCS for 20,728 patients, which include 12,913 existing and an
additional 7,815 new patients at 40 existing sites, including 27 ART sites and 35 TC/PMTCT sites.
Expanded services will emphasize quality of care through mentoring, a continuum of care through
operational partnerships, and sustainability of services through PBF. EGFPAF will continue to collaborate
with Title11 Food Partners and sub partners implanting the food assistance for People Living with HIV,
under Project "IBYIRINGIRO", and with the WFP. Additionally the partner will continue to strengthen
nutritional services through relevant training for site staff, nutritional counseling according to established
guidelines and using existing materials, and will multiply existing job aids like the nutritional counseling
cards for providers and counselors. Within EGPAF supported sites nutritional assessments using
anthropometric measurements will be done to determine eligibility for food support according to national and
PEPFAR nutritional guidelines. Management of adult malnutrition will include provision of micronutrient and
multivitamin supplements.
EGPAF will at site level also ensure referrals for all PLHIV and their families for malaria prevention services,
including access to LLITNs, in collaboration with Community Service Providers, GFATM and PMI; and
referral of PLHIV and their families to CBOs and other community-service providers for distribution of water
purification kits and hygiene health education. In addition the partners will continue to strengthen
psychological and spiritual support services for PLHIV at clinic and community levels through CIDC (MOH)
coordinated training in and supportive supervision of psychological support for all EGPAF-supported health
facilities, GBV counseling, positive living, and counseling on Prevention for Positives.
In order to ensure a continuum of HIV care, EGPAF in collaboration with community- based organizations,
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 efficient referrals to care services for
patients identified through PMTCT programs, PLHIV associations, and in/out patient 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. EGPAF-supported sites will continue to assess individual PLHIV needs,
organize monthly clinic-wide case management meetings to minimize loss to follow-up 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. EGPAF will continue to work with Community providers to maintain 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 ensure the linkage with community-
based HBC services, adherence counseling, spiritual support through church-based programs, stigma
reducing activities for PLHIVs. At the 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.
In line with the MOH policy on community health and use of community health workers, the partner will
continue to support all facilities to train, equip, and supervise 20 community health leads per health facility,
in addition to other health care workers, totaling up to 996 lead health workers within the supported districts
the 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 facilities. The
facility-based case managers, community health leads and community-based services providers constitute
an effective system that ensures continuum, coverage and quality of BCS services.
PBF has been a successful model of the PEPFAR Rwanda strategy to ensure long-term sustainability and
maximize performance and quality of services. In FY 2008, EGPAF assumed management of PBF
contracts for the supported sites and this will continue through FY 2009, with intensive training for site staff
to perfect PBF management. In FY 2009, there will be a focus on quality indicators in all program areas as a
strategy for the overall improvement of quality outcomes in health.
In FY 2009 EGPAF will continue to build the capacity of four DHTs to coordinate an effective network of
quality BCS 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.
This activity addresses the key legislative areas of gender, wrap around for food, family planning, income
generating activities and reduction of stigma and discrimination through increased community participation
in care and support of PLHIV.
Activity Narrative:
Continuing Activity: 16735
16735 15226.08 U.S. Agency for Elizabeth Glaser 7527 7089.08 EGPAF Bilateral $886,030
15226 15226.07 U.S. Agency for Elizabeth Glaser 7089 7089.07 EGPAF New $182,000
* Reducing violence and coercion
Estimated amount of funding that is planned for Human Capacity Development $150,000
Program Budget Code: 09 - HTXS Treatment: Adult Treatment
Total Planned Funding for Program Budget Code: $24,733,267
Table 3.3.09:
THIS IS A CONTINUING ACTIVITY FROM FY 2008, ALREADY APPROVED.
Continuing Activity: 16738
16738 15446.08 U.S. Agency for Elizabeth Glaser 7527 7089.08 EGPAF Bilateral $4,114,500
15446 15446.07 U.S. Agency for Elizabeth Glaser 7089 7089.07 EGPAF New $2,012,958
The Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) has a well established program in Rwanda and is
one of the principal implementing partners for PMTCT and HIV care and treatment programs supported by
PEPFAR in the country. In FY 2008, EGPAF provided an integrated package of care and support services
for HIV-exposed and HIV-infected children at all 33 EGPAF sites. EGPAF's care and support model
includes providing regular clinical assessments ( monthly for HIV-exposed infants and older HIV positive
children unitl the age of 14, after which they reviewed and every 3 months) and staging and baseline CD4
counts 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 treated as per national guidelines. Children without active TB disease, who were
exposed to an active case, will also be provided with INH prophylaxis.
Care and support for HIV-exposed infants starts with PMTCT service provision, and EGPAF will work with
sites to ensure that all sites implement DBS testing; that HIV-exposed infants are retained in care and on co
-trimoxazole prophylaxis until their HIV status is known and that mothers and infants lost-to-follow-up are
being recuperated in the communities.
HIV-exposed infants and exposed children also receive nutritional counseling and complementary food
support; pain and symptom management and end-of-life care services if needed. Parents are provided with
long-lasting insecticide treated nets (LLITN), safe water, interventions, basic hygiene education and
community outreach services. EGPAF sites are also working with the MCH unit of the MoH to scale-up
IMCI at maternal-child health clinics at their sites. In FY08, in collaboration with TRAC-Plus, EGPAF trained
80 health care providers in pediatric psycho-social care for children living with HIV/AIDS and launched
psycho-social care services at 14 of the 24 EGPAF supported ART sites.
In FY 2009, EGPAFs expanded services will emphasize integration of pediatric HIV care in MCH settings,
reinforce a family-centered approach, monitor quality of services, ensure continuity of care and
sustainability of services through performance-based financing (PBF).
EGPAF will ensure HIV-testing for partners and children of HIV-positive clients and have clear, functional
referral mechanisms for newly diagnosed adults and children. EGPAF will strengthen links with
associations of people living with HIV (PLHIV) and community health workers (CHW) to foster interactions
between the community and the health facility and to convey key HIV messages to the communities. In
order to ensure continuity of HIV care for children, EGPAF recruited two new staff positions at each of its
sites (a community liaison agent and a case manager that will serve as the focal point for service
integration). Case managers work to ensure referrals to care for HIV-exposed infants identified through
PMTCT programs, children identified in PLHIV associations, malnutrition centers, immunization programs,
TB clinics and OVC programs. Case managers will hold sessions with facility and community-based service
providers for more efficient referrals and to ensure timely enrollment in care and treatment for children
diagnosed with HIV/AIDS. EGPAF sites will assess individual PLHIV needs, organize monthly clinic-wide
case management meetings to minimize loses-to-follow-up, and provide direct oversight for community
health workers.
EGPAF sites will support HIV community outreach services by training CHW to delivery key HIV messages
emphasizing pediatric HIV, care, nutrition during their monthly meetings at the health facilities. By providing
HIV messages on a regular basis, EGPAF's sites will ensure a continuous flow of information to the
community. The facility-based community focal points, community health workers and community-based
service providers constitute an effective system to ensure continuity of care, extend coverage and improve
quality of pediatric HIV care.
EGPAF will also support referrals for all HIV-infected children to malaria prevention services, including
referral for provision of LLITN and integration of home-based management of malaria, in collaboration with
CHAMP, GFAT and the PMI. EGPAF will also refer children and their families to CHAMP community-based
organizations, linkages committees and other community-service providers to received water purification
kits and basic hygiene and health education; psycho-social, educational, and legal support services.
Strengthened nutritional services at EGPAF supported sites will include training, counseling to HIV-positive
mothers during pregnancy and after child birth to provide women with the opportunity to make informed
decisions regarding the choice for infant-feeding. Nutritional assessments using anthropometric indicators,
the provision of food support to HIV-exposed infants and infected children and management of malnutrition
through provision of micronutrient and multivitamin supplements is also part of the nutritional support
package for children. EGPAF will ensure programmatic links 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 to HIV-exposed infants at
USG-supported sites throughout Rwanda. EGPAF will also support vegetable gardening activities at health
facilities receiving food support from the WFP.
EGPAF-supported ART sites will continue to provide psycho-social care for children living with HIV/AIDS.
The support includes "disclosure, counseling and adherence sessions" through children support clubs.
These clubs are organized per age group and meet once a month at health facilities. During group
sessions, health care providers reinforce key psycho-social and HIV messages and discuss problems and
possible solutions adapted to the ages of the children. Children also participate in recreational and
educational activities. EGPAF will work with sites to retraining and mentor health care providers in provision
of psycho-social care for HIV-infected children as needed, and provide appropriate educational and
recreational materials to support these activities.. Health care providers will be trained by actively
participating in group and orientation sessions on how to engage children in discussions and in creative
activities and participating in the organization of a camp for HIV-infected children from various children's
Activity Narrative: clubs. The week-long camp will include a variety of activities ranging from walks, environment lessons,
games, music, as well as, age appropriate educational sessions on a variety of health and psycho-social
topics.
In collaboration with CIDC, EGPAF clinical staff will be trained as clinical mentors and they will train hospital
and health centers services providers in pediatric HIV care, palliative care, data recording and use, quality
performance measurement and improvement.
Through partnership with the districts, sites, SCMS and in close collaboration with CAMERWA, EGPAF will
provide diagnostic kits, CD4 reagents, and other laboratory commodities for clinical monitoring of children in
care and on treatment. In addition, EGPAF will work with SCMS and Pharmacy Task Force (PTF) to ensure
appropriate storage, stock management, and reporting of all pediatric OI-related commodities.
Performance-based financing (PBF) is a major component of the Rwanda USG strategy for ensuring long-
term sustainability and maximizing performance and quality of services. EGPAF will continue to shift some
support from input to output financing based on each sites' performance in improving key national HIV
performance and quality indicators. Through its PBF system, and the provision of continuous technical
assistance to sites via regular formative and evaluative supervisory visits, and with improved data on
pediatric HIV care EGPAF in collaboration with TRAC-plus, the National Commission on AIDS (CNLS) and
the national PBF program will support health facilities to maintain a system of quality improvement. By using
pediatric HIV basic care and support data EGPAF's supported health facilities will be able to regularly
review program performance. EGPAF has initiated the IQ chart database at ART sites in order to improve
data recording, analysis and use. EGPAF will strengthen data managers and health services providers' use
of the software and collected data to better inform practices for pediatric care and treatment
Finally, EGPAF will work with districts, health facilities and energy partners the Belgian Cooperation (BTC,
Global Fund, Access), to ascertain the each sites' power needs to support HIV services (laboratories, cold
chain, IT and other critical services). Together with the GoR and other partners, EGPAF will establish a
contributions framework for its sites and will, in function of available funds provide health facilities with the
best cost effective energy option (solar panels, electric generators).
Table 3.3.10:
Table 3.3.11:
ACTIVITY UNCHANGED FROM FY 2008.
In FY 2007, EGPAF began implementing the national TB/HIV policy using national guidelines at their 24
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 24 EGPAF-supported
PMTCT and HIV Care and Treatment sites, 100% of 10,130 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 EGPAF supported districts,
to increase the diagnostic capacity of district hospitals and other TB treatment and diagnostic centers
(DTHs) within EGPAF-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 EGPAF 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, EGPAF 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, EGPAF will focus on continuous quality improvement in their 42 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. EGPAF 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, EGPAF 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 2009, 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 EGPAF office will also continue to ensure quality and coordination of the roll-out of
quality services and infection control services within EGPAF 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: 16736
16736 15229.08 U.S. Agency for Elizabeth Glaser 7527 7089.08 EGPAF Bilateral $219,440
15229 15229.07 U.S. Agency for Elizabeth Glaser 7089 7089.07 EGPAF New $73,140
Estimated amount of funding that is planned for Human Capacity Development $40,000
Table 3.3.12:
Continuing Activity: 16737
16737 15442.08 U.S. Agency for Elizabeth Glaser 7527 7089.08 EGPAF Bilateral $192,010
15442 15442.07 U.S. Agency for Elizabeth Glaser 7089 7089.07 EGPAF New $30,811
* Addressing male norms and behaviors
Table 3.3.14:
