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: 16746
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
16746 15219.08 U.S. Agency for IntraHealth 7529 7090.08 IntraHealth $525,549
International International, Inc Bilateral
Development
15219 15219.07 U.S. Agency for IntraHealth 7090 7090.07 IntraHealth New $530,856
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 $370,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
ACTIVITY UNCHANGED FROM FY 2008:
IntraHealth has been providing basic care and support (BCS) HIV services to 11,103 PLHIV at 39 sites in
FY 2008. In FY 2009, BCS services will continue, including 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. From FY 2007 through FY 2008, IntraHealth, with support from Mildmay International and
the Association for Palliative Care in Africa (APCA), has been and will be supporting MOH to develop a
palliative care policy that will facilitate effective pain management for HIV infected persons at a national
level, according to WHO guidelines. In addition, IntraHealth will continue to provide psychosocial counseling
including gender based violence related counseling. IntraHealth with strengthen referrals for HIV-infected
female victims of domestic violence, and strengthen linkages to legal service providers and the national
police. To ensure comprehensive services across a continuum, IntraHealth, through partnerships with
community service providers, will ensure functional referrals of patients enrolled in care to community-based
care services based on individual needs and strengthen existing linkages between facility and community
based services. Such services will include, adherence counseling, spiritual support, stigma reducing
activities, OVC support, IGA activities, and HBC services for end-of-life care. IntraHealth will continue to
collaborate with SCMS to ensure adequate quantification of HIV diagnostic kits, CD4 tests, and other
laboratory investigations that are necessary for clinical management of HIV infected patients. Additionally,
IntraHealth will also continue to work with SCMS to ensure appropriate storage, stock management, and
reporting of all OI-related commodities.
In FY 2009, IntraHealth will continue to provide BCS services for a total of 13,952patients, whic includes
11,103 existing and an additonal 2,849 new patients at at 39 existing sites, including 24 ART sites and 39
TC/PMTCT sites. Services will emphasize quality of care through mentoring, a continuum of care through
operational partnerships, and sustainability of services through PBF. IntraHealth 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, and will strengthened nutritional services through relevant
training for site staff, nutritional counseling according to established guideline and using existing materials,
and will multiply existing job aids like the nutritional counseling cards for providers and counselors.
Nutritional assessments using anthropometric measurements will be done to determine eligibility for food
support according to national and PEPFAR nutrition guidelines. Management of adult malnutrition will
include provision of micronutrient and multivitamin supplements.
IntraHealth 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-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 hygiene health education. In addition family planning education, counseling
and methods will be provided to PLHIV and their spouses. Family Planning services will be located within
the counseling, ART and PMTCT services of the site to reduce need for referrals. The partners will continue
to strengthen psychological and spiritual support services for PLHIV at clinic and community levels through
TRAC -Plus coordinated training in and supportive supervision of psychological support for all IntraHealth-
supported health facilities and community-based providers, including GBV counseling, positive living, and
counseling on Prevention for Positives.
In line with the MOH policy on community health and use of community health workers (CHWs), the partner
will continue to support 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.
In order to ensure a continuum of HIV care, IntraHealth 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 preART services. IntraHealth-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. IntraHealth 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.
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 08, IntraHealth 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, IntraHealth will continue to build the capacity of four DHTs to coordinate an effective network of
quality Basic care and other HIV/AIDS services. The basic package of financial and technical support
Activity Narrative: 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.
Continuing Activity: 16749
16749 15227.08 U.S. Agency for IntraHealth 7529 7090.08 IntraHealth $668,324
15227 15227.07 U.S. Agency for IntraHealth 7090 7090.07 IntraHealth New $289,534
Estimated amount of funding that is planned for Human Capacity Development $125,000
Table 3.3.08:
THIS IS A CONTINUING ACTIVITY FROM FY 2008. NO NARRATIVE REQUIRED.
Continuing Activity: 16752
16752 15445.08 U.S. Agency for IntraHealth 7529 7090.08 IntraHealth $3,488,025
15445 15445.07 U.S. Agency for IntraHealth 7090 7090.07 IntraHealth New $2,591,184
Table 3.3.09:
ACTIVITY UNCHANGED FROM FY2008 .
IntraHealth 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 39 sites in 4 districts. Of these facilities 39 provide
PMTCT, 24 provide ART for adults and for children, and have the comprehensive package of VCT, PMTCT,
OI and ART co-located in the same premises. These facilities are located in 4 districts of the northern region
of Rwanda and City of Kigali. In FY2008, IntraHealth HIV Clinical Services Project (HCSP) provided a
comprehensive package of basic care and support services to 1,110 HIV-infected children and treatment to
113, at 24 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, HCSP 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, IntraHealth HCSP will continue to provide the same package to 1,110 HIV-infected children
and HIV-exposed infants at its 24 existing sites. IntraHealth will also increase treatment services for 285
new children at 24 existing sites.
To address the need to expand diagnosis of HIV in the pediatric population IntraHealth 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 HCSP-supported sites, as an index case, IntraHealth HCSP will
offer HIV-testing for their partners and children and enroll the infected family member/s into care and
treatment services. HCSP-supported sites will link with OVC service providers operating in northern
Rwanda 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, HCSP-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.
HCSP 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 group sessions HCSP will provide ITNs, nutrition counseling, food support
through home gardening and animal breading, and provide food supplementation to mother infant pairs.
This last activity is conducted in collaboration with a prime Community partner, WFP, and the
CRS/ACDIVOCA/World Vision consortium. In districts with no PEPFAR funded Community Service
Provider, the HCSP-supported sites will use funds from its private donor, the MAC/AIDS Foundation (Make-
up Art Cosmetics AIDS Foundation), to provide a food and nutrition package for some of its patients. In
addition, HCSP-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 IntraHealth supported sites. Mother and infant information will be
transferred from PMTCT to other MCH programs through the use of the "carte de liaison" currently in use in
Rwanda. Early infant diagnosis services, now available at 29 of IntraHealth supported sites, will be
expanded to increase full coverage of sites by end of FY09. EID will be offered at six weeks of age.
IntraHealth will also work with the district health teams to ensure that samples collected at the sites are
transferred efficiently to the processing lab in Kigali and work with the MoH to increase reliability of result
turn-around times.
At HCSP-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.
IntraHealth 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 IntraHealth will work to implement a system to assess
vulnerability, based on a model implemented at the Mildmay pediatric HIV clinic in Uganda, and provide, at
selected sites, daycare services for children at risk of dying due to extreme poverty, parental illness or other
factors. The package of daycare services will include home visits for families with HIV-infected children,
nursing, and medication adherence in a child-friendly environment.
Pediatric HIV care and treatment programs in Rwanda face many challenges, including the need for
increased numbers of qualified trained pediatric health care providers. The HCSP 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.
Activity Narrative: In collaboration with AIDSRelief, FHI and TRAC-plus, HCSP clinical staff will be trained to become clinical
mentors. Mentor staff will, in turn, train hospital and health center service providers in pediatric clinical HIV
care, palliative care, patient record-keeping, data recording and use, and quality performance measurement
and improvement. HCSP will promote staff retention and motivation at supported sites through improvement
of work space 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, the HCSP 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. HCSP 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.
HCSP has recently deployed the IQchart software to improve data recording, analysis and use at supported
clinical sites. HCSP will train data managers and health service providers in the use of this 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, HCSP, 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. HCSP 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.
HCSP 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 IntraHealth, Inc. began implementing the national TB/HIV policy using national guidelines at
their 31 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 cotrimoxazole 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 those who are co-
infected receive cotrimoxazole and 100% of those who are eligible receive ART.
However, in FY 2008, at the national level, lower than expected numbers of PLHIV receiving basic care
services are diagnosed and treated for TB. The priority in FY 2009 will be to increase support to DHT to
provide supervision to non PEPFAR funded sites within IntraHealth supported districts of the Northern
Zone, to increase the diagnostic capacity of district hospitals and other TB treatment and diagnostic Centers
(CDTs) within the IntraHealth supported districts. Services for TB/HIV management will also include a
strong focus on infection control standards through use of national guidelines and protocols developed at
national level with PEPFAR funding. Increased diagnostic capacity for both pulmonary and extra pulmonary
TB and expand implementation of regular TB screening and for all PLHIV is planned for those with
suspected TB disease, ensuring complete treatment with DOTS, and monitoring treatment failure in order to
facilitate early detection of MDR.
In FY 2009, this partner will continue to support individual sites to collect and analyze quality data on site
and improve the quality of TH/HIV services. IntraHealth will ensure that TB registers are updated as
relevant and that screening of HIV positive individuals is done at every visit. Additionally, in FY 2009 the
partner will provide refresher training to two staff from each district that underwent respiratory infection
control training and will continue to build their capacity through TRACPLUS coordinated mentoring so they
can continue to provide supportive supervision to facilities within their supported districts.
In order to ensure effective integration of TB and HIV, IntraHealth, will continue to support integrated
planning and TB/HIV training to both HIV services providers and TB services providers. The partner will
continue to work towards improved diagnostic services for TB, including coordinating specimen transport
and patient transport for appropriate diagnostic services (such as chest radiography and FNA specimen for
extrapulmonary TB) and treatment services to relevant referral centers and provide appropriate follow-up for
quick results and prompt patient care.
In FY 2009, IntraHealth, Inc. will focus on continuous quality improvement in their 39 existing sites and
building the capacity of the District health teams to plan and implement an HIV program within the existing
health delivery system. The goal is to offer one stop services where an HIV positive individual is screened
for TB, family planning, and is appropriately served or referred.
Integrating TB and HIV is one step towards integrating HIV into primary healthcare.
Continuing Activity: 16750
16750 15230.08 U.S. Agency for IntraHealth 7529 7090.08 IntraHealth $186,028
15230 15230.07 U.S. Agency for IntraHealth 7090 7090.07 IntraHealth New $133,224
Estimated amount of funding that is planned for Human Capacity Development $40,000
Table 3.3.12:
Continuing Activity: 16751
16751 15443.08 U.S. Agency for IntraHealth 7529 7090.08 IntraHealth $162,774
15443 15443.07 U.S. Agency for IntraHealth 7090 7090.07 IntraHealth New $150,495
* Addressing male norms and behaviors
Table 3.3.14:
