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
Integrated activity flag: (HLAB #12307) This activity is part of an integrated program described elsewhere in the COP. The provision of training to healthcare workers in the implementation and rollout of ART services integrates with the development of laboratory service and with the collection of patient laboratory data to produce cumulative patient reporting of patients on ART (Laboratory Infrastructure).
Summary: Toga will train doctors in the implementation of ART (Kimera course in advanced ART), targeted at clinical support. This program area will emphasise training, with the target population being health care providers, in particular doctors (private and public). The training will follow National and PEPFAR guidelines. It is anticipated that this program area will twin (Twinning) with other PEPFAR partners.
Background: The training activities of Toga, carried out by Kimera Solutions, a sub-program within the Toga umbrella organization, is an ongoing service and has been honed on the demand for rapid scale-up of clinical capacity. The course consists of a two day workshop in conjunction with self-study material. Training activities will be aimed at doctors in the vicinity of Togatainer deployment sites. Once sites have been selected doctors will be invited to attend training courses. Continued clinical support will be provided subsequent to the training. The activities associated with training will be coordinated by Toga with interested government structures. It is anticipated that the training of doctors will enhance access to service for rural and peri-urban women and children.
Activities and Expected Results:
Activity 1: Training Training will be provided to 30 doctors in advanced ART, as well as providing clinical support through an electronic support facility, with the expected result of enhanced treatment capacity in resource poor settings. The training is targeted at healthcare professionals in the public and private/NGO sector, with the aim to provide healthcare professionals involved in the rollout of ARV treatment with a more advanced level of knowledge and insight into the treatment of HIV. The course covers the following dimensions of ART: Starting ART; Laboratory monitoring; Treatment regimens; ART-associated adverse effects; Changing treatment; Adherence; Tuberculosis; Pregnancy; Paediatrics; Operational preparation; ART-Implementation; and Treatment success.
These courses are all held as two-day workshops in small groups, generally conducted in groups of eight to ten healthcare workers. The course combines a self-study component together with the two-day workshop. Training courses are continuously updated from research findings as well as our practical experience in the field.
Activity 2: Clinical support The training of healthcare professionals is followed in programmatic sequence with clinical support. This component is of vital importance particularly at the initiation and in the early phases of an antiretroviral (ART) programme roll-out. The clinical support comprises an electronic decision support service, as well as a telephonic support line run by our clinical consultants. Clinical support is seen as an important educational reinforcement of the initial training. Activity 3: White Rabbit (WR) Toga will deploy 40 WR electronic requesting and reporting systems for use in conjunction with the laboratory service to produce cumulative patient reports on laboratory measurement. The WR system is currently being deployed at selected PEPFAR partner sites. With direct funding, deployment will extend to clinics and general practitioners in the vicinity of each Togatainer deployed (within a radius of approximately 30km to 50 km, depending on the setting). The activity will be coordinated by Toga with selected Togatainer placement sites, selected clinics and doctor's practices as well as interested local government structures.
Deployment of WR electronic requesting and reporting system will entail: (a) A detailed site assessment to understand the site and patient workflow, including user information,
training and technical requirements as well as existing patient numbering systems. Should a client not have a unique patient numbering system in place, advice and education is given to establish such; (b) Provision of computer hardware where none exists or where hardware is of inadequate capacity; (c) Implementation of WR system, which includes software and logistics support. The WR electronic requesting and reporting environment produces historically consolidated laboratory reports, enabling clinicians and other healthcare workers to assess the patient's laboratory measurement at a glance.
These activities support the 2-7-10 PEPFAR targets in South Africa.
New COP entry: Integrated activity flag: These activities are part of an integrated program described elsewhere in ARV Services.
Summary: Toga will deploy three Togatainer laboratories (mobile, prefab structures) to support ARV programs in resource-poor settings - ideally proximal to ARV clinics. Each Togatainer will in turn serve a sub-network of referral work through the deployment of White Rabbit (WR) electronic requesting and reporting systems. The emphasis areas are Infrastructure, Linkages with Other Sectors and Initiatives, Logistics, Local Organization Capacity Development, Quality Assurance and Supportive Supervision, and Strategic Information. The target populations of this program area are patients on ARV in peri-urban, peripheral settings.
Background: Laboratory services in the public sector is provided through regional centralized laboratories, with limited peripheral capacity for specialized testing (e.g. CD4 and viral load). In the private sector there are centralized laboratories in Johannesburg, Cape Town and Pretoria with Stat-labs proximal to high patient volume settings, mostly in urban settings. The Togatainer addresses the need for peripheral deployment of laboratory services, specifically HIV treatment monitoring, utilizing a unique set of robust assays.
The Togatainer concept is based on the MeTRo (Measure To Roll Out) principle as a means of rolling out treatment capacity. In monitoring HIV-infected patients on treatment the generation of viral load tests at specific sites empowers other cadres of healthcare personnel to make management decisions. In patients who are well controlled on ARV therapy down referral to peripheral clinic are facilitated, thus decreasing the load on a central clinic or doctor. Should laboratory results of peripheral patients suggest up-referral this decision can be made by a nurse, based on a laboratory result. This fulfils an objective of the WHO down-referral strategy.
The activities described has been tested and developed in current PEPFAR-funded settings. Prior to implementation of each Togatainer interested local government and provincial structures will be engaged. Toga will be responsible for the implementation of all Togatainers, though local contractors may be used to assist with infrastructure services. The creation of employment, including professionally qualified medical technologists, will provide a unique opportunity for people from local communities and help to retain them in the community. Medical technology as the chosen profession of many females is likely to enhance female opportunities as most laboratories are served by a preponderance of female technologists. It is anticipated that the provision of laboratory service will enhance the standard of care to for rural and peri-urban women and children.
Activity 1: Togatainers Deployment of three Togatainers capable of performing the following tests: HIV tests; CD4 tests and/or lymphocyte tests; TB diagnostics; Syphilis testing; and HIV disease monitoring. Deployment entails site preparation, laboratory infrastructure (either shipping container or bricks and mortar at site) preparation, equipment sourcing, testing, calibration and implementation. Ongoing activities will include continuous training and supervision, as well as structured Quality Control, including internal and external quality assurance programs.
Activity 2: Training Training of three medical technologists in the operation of an HIV monitoring laboratory. The recruitment of technologists should ideally be from communities in which Togatainers are to be deployed (e.g. through advertising in local media). Prior to implementation Toga will embark on a broad assessment to determine the availability of technologists in target areas, to be sure of technologist availability upon implementation.
The duration of training ranges from 4 to 6 weeks at the central laboratory in Johannesburg. The new employee will receive training on all the relevant instrumentation as well as the administrative procedures.
Togatainer technologists report weekly in writing to the Peripheral Lab Manager on issues such as the general running of the lab, equipment, quality etc. Further monitoring occurs by having computer access from the central lab to the site's database in order to monitor turn-around times, workload, output and quality. The peripheral manager aims to carry out quarterly visits to the various sites and also deals with the performance management of the staff members at these sites.
Staff retention may be a challenge. Staff members are deployed in remote rural areas and often will be the only person in the laboratory. In addition to the regular monitoring, the program aims to rotate Togatainer technologists through Toga central lab for ongoing development and training, and this may be expanded to other sites outside of Johannesburg. Telephonic contact will be made on a regular basis.
The training component will also include the training of 5 administrative staff in the support of HIV monitoring laboratories.
Activity 3: Lab Monitoring Conducting HIV monitoring tests for 2000 individuals at peripheral settings, expecting an additional 1000 patients (non PEPFAR funded), totaling 3000 by the end of year one. These tests include viral load, CD4 count, Full blood count, AST, ALT and U&E. Provision has also been made for hand-held Lactate testing devices.
Toga will continue its discussions with the South African Government to address long-term sustainability. Toga will also engage with other funders, specifically in the private sector, to support Togatainers. Toga will remain involved in the training and technical support of laboratories, as well as the provision of support systems. Toga will also pursue the involvement with other NGO structures and funder organizations to ensure the sustainability of peripheralised laboratories. Toga is currently supporting a broad range of organizations in the private sector (Anglo Platinum, Anglo Gold, Anglo Coal, GoldFields, etc.) and NGOs (Southern African Catholic Bishops' Conference, Right to Care, Ndlovu Medical Centre, PHRU etc.) with laboratory and programmatic support services.
These activities support the PEPFAR 2-7-10 goals in South Africa.
