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
Columbia University implements a comprehensive HIV care and treatment program in South Africa that is
funded with Track 1 central funding, as well as South Africa COP funding. The activities do not differ across
the funding mechanisms, and this entry is thus a repeat of the South Africa COP entry. All targets are
reflected in the South Africa COP entry.
SUMMARY:
Activities are carried out in FY 2008 to support implementation and expansion of comprehensive HIV
treatment and care primarily through human resources and infrastructure development, technical assistance
and training and community education and support, primarily in public sector facilities in the Eastern Cape,
Free State (new geographic focus area) and KwaZulu-Natal. Columbia University will support these
activities by using funds for human capacity development, local organization capacity building, and strategic
information. The degree of activity effort will vary in each site, but all emphasis areas will be addressed in all
sites. The target population will include infants, children and youth, men and women (including pregnant
women) and people living with HIV (PLHIV). Columbia will continue to support the recruitment of doctors,
nurses, pharmacists and pharmacist assistants.
BACKGROUND:
Columbia University (Columbia), with PEPFAR funds, began supporting comprehensive HIV care and
treatment activities in FY 2004. Health facilities were initially identified in the Eastern Cape and in FY 2006,
due to new boundary demarcations and additional PEPFAR funds, Columbia started providing similar
assistance in KwaZulu-Natal. In FY 2006, in response to provincial HIV care and treatment priorities,
Columbia began strengthening the down referral of services from hospitals to primary health clinics. This
resulted in a total of 36 health facilities receiving technical and financial support from Columbia, including
public hospitals, community health centers, primary health clinics and a non-governmental wellness center.
In FY 2007 an additional two health facilities in KwaZulu-Natal (East Griqualand Usher Memorial Hospital
and the Kokstad Community Clinic) received technical and financial assistance for HIV care and treatment
services.
ACTIVITIES AND EXPECTED RESULTS:
All activities are in line with South African government (SAG) policies and protocols, and activities will be
undertaken to create sustainable comprehensive HIV care and treatment programs, and primarily include
four programmatic areas:
ACTIVITY 1: Support Recruitment and Placement of Health Staff
Since FY 2005 Columbia has been involved in the recruitment of staff to support the HIV comprehensive
program at health facilities. High staff attrition rates of Department of Health (DOH) recruited personnel
have been a challenge in guaranteeing a steady enrolment of eligible PLHIV into care and treatment.
Columbia will continue to support the recruitment of doctors, nurses, pharmacists and pharmacist assistants
through existing partnerships with University of Fort Hare, Nelson Mandela Bay Metropolitan Municipality,
Ikhwezi Lokusa Wellness Center, University of KwaZulu-Natal Cato Manor, and the Foundation for
Professional Development. Columbia supported the recruitment and placement of approximately 15
doctors, 30 nurses (registered and enrolled nurses), 4 pharmacists and 7 pharmacist assistants and 15
trainee pharmacist assistants. These health personnel provide direct patient care in the hospitals and clinics
including: clinical assessment, screening for tuberculosis (TB) and antiretroviral treatment (ART) eligibility,
opportunistic infections (OI) diagnosis and management, and offering OI prophylaxis and treatment, and
ART. The health providers also develop patient treatment plans as part of the multidisciplinary team in the
health facility; and assist patients to access relevant SAG social grants.
ACTIVITY 2: Training and Clinical Mentoring
Columbia has established a partnership with the Foundation for Professional Development to provide ARV
didactic training in all supported health facilities. A second partnership with Stellenbosch University assists
the rural health facility staff (St. Patrick's, Holy Cross and Rietvlei hospitals and their referral clinics), with
the management of patients on ART by conducting case discussions on a monthly basis. Columbia has
clinical advisors as part of its South African team consisting of nurse mentors, and medical officers who
provide day-to-day clinical guidance on the management of patients on ART.
ACTIVITY 3: Strengthen ART Down and Up Referral Linkages Between Hospitals and Primary Healthcare
Clinics
In the early phases of the ART program, all patients are evaluated and initiated on therapy at hospital level.
Within three to six months of providing support to the hospital-based ART program, designated referral
clinics are integrated into the services. In the rural health facilities, a small team of health providers, usually
comprising of a medical officer, professional nurse and peer educator, travel to the primary healthcare
clinics (PHC) to screen patients for OIs and to determine suitability for ART. This approach has enabled
expansion of ART services at PHC level and has resulted in improving and increasing access to treatment.
The team of health providers has also developed capacity of the onsite health providers and the goal is to
have the onsite DOH health staff eventually provide the full package of HIV care and treatment services. In
FY 2008, Columbia will continue to support linkages with the public clinics and the development of a more
sustainable system of service provision.
ACTIVITY 4: HIV Care and Treatment Information System
Columbia will continue to support the implementation of a provincial information system that captures
information regarding HIV palliative care and ART. Activities in FY 2008 will include:
a. Continued implementation of facility paper-based ART registers that capture both adult and pediatric ART
indicators.
b. In collaboration with the Eastern Cape Department of Health (ECDOH) and other partners in the Eastern
Cape, support the development and implementation of standardized individualized patient records for use at
health facilities that incorporates information on client ART use.
c. Implement an ART software system. In FY 2007, Columbia in partnership with Africare (a PEPFAR
partner) and Health Information System Program (HISP) customized and developed ART software that
captures and collates HIV and AIDS program data. This ART database is being adapted for data entry, and
installation is expected before end of FY 2007. The system is being piloted at three health facilities in East
Activity Narrative: London: Frere, Cecilia Makiwane and Duncan Day Village hospitals. In FY 2008, after assessing results
from the pilot sites, Columbia will engage the ECDOH in discussion on how the module could be added into
the existing District Health Information System to efficiently generate reports on the HIV program, and
thereafter implemented at more ART services outlets.
In addition, in 2007 Columbia begun a new partnership with Disease Management system (DMS) - a patient
-centered health management information system (HMIS) that operates at the patient level of care to assist
health care professionals initially at 4 identified Columbia supported health facilities in Port Elizabeth
(Livingstone, KwaZakhele Day Hospital, Motherwell clinic and Chatty clinic) to provide comprehensive care
management of people living with HIV, as well as providing management information for relevant
stakeholders. In FY 2008, with lessons learned from the implementation of this system, Columbia in
partnership with ECDOH proposes to extend the use of this information system in all HIV and ART service
delivery points, where feasible. In addition, by FY 2008, Columbia will support the implementation of similar
program activities (as specified above) in newly identified health facilities in the Free State (to be
determined).
By providing support for ARV services in the public sector and two NGO sites, Columbia's activities will
contribute to the realization of the PEPFAR goal of providing care to 2 million people. These activities will
also support efforts to meet HIV and AIDS care and support objectives outlined in the USG Five-Year
Strategy for South Africa.
