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: 2008 2009
NO FY 2009 FUNDING IS REQUESTED FOR THIS ACTIVITY:
This activity was approved in the FY 2008 COP, is funded with FY 2008 PEPFAR funds, and is included
here to provide complete information for reviewers. No FY 2009 funding is requested for this activity. This
program area was discontinued in FY 2009 as the costs for this activity were transferred to another donor
who was keen to assist with Care services. Therefore there is no need to continue funding this activity with
FY 2009 COP funds.
New/Continuing Activity: New Activity
Continuing Activity:
Table 3.3.08:
This PHE activity, Costs and Cost-Effectiveness of Treatment Delivery in South Africa, was approved for
inclusion in the COP. The PHE tracking ID associated with this activity is ZA.07.0121.
New/Continuing Activity: Continuing Activity
Continuing Activity: 16505
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
16505 16505.08 U.S. Agency for Boston University 6575 192.08 AIDS Economic $300,000
International Impact Surveys
Development
Emphasis Areas
Human Capacity Development
Public Health Evaluation
Estimated amount of funding that is planned for Public Health Evaluation $300,000
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.09:
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
Please note that the activities and reference numbers have been changed. Activity 1 in FY 2008 COP is no
longer included as a Basic Public Evaluation (BPE). Activity 2 in FY 2008 COP is now BPE 1 in FY 2009
COP. BPE 2 in FY 2009 COP was previously included under the Palliative Care section of FY 2008 COP.
BPE 1: Evaluation of patient-level non-clinical outcomes
This evaluation will not be modified in any major way from the FY 2008 COP. It is taking place at three
PEPFAR-supported treatment facilities that are sub-partners of PEPFAR partner Right to Care and relies on
data collected during routine clinic visits. Approximately 800 adult patients will continue to be assessed for
non-clinical outcomes of treatment. In FY 2009, the patients being followed will have been on antiretroviral
therapy (ART) for 3-5 years, allowing long-term impacts of treatment to be assessed. It is expected that at
least three additional publications of international journal quality will be produced by the evaluation team by
the end of FY 2009, as well as several site- and issue-specific reports that will assist in developing
operational improvements to programs. This BPE serves as an evaluation system to track patient progress
and outcomes in terms of non-clinical indicators such as quality of life and economic well-being.
Understanding these impacts and improving the non-clinical outcomes of long-term patients is essential to
the sustainability of treatment programs. This BPE is expected to continue to serve as a valuable tool for
routine monitoring and evaluating of treatment service quality. It will continue to generate information to
improve the treatment services being provided by Right to Care and to maximize the economic and other
non-clinical benefits of treatment to adult patients and their households.
BPE 2: Improvements in linkages to care
In FY 2009, this evaluation will move from observational data collection to evaluation of programmatic
improvements implemented by PEPFAR partners. As noted in the FY 2009 COP Technical Considerations,
patients not yet ready for ART require a more active follow-up strategy than is currently in place at most
facilities, to reduce loss to care and promote early presentation for treatment. Once the rates of and
reasons for loss to care are identified through FY FY 2008 COP activities, potential improvements in
procedures and services will be identified through discussion with the treatment sites and other
stakeholders. With FY 2009 funding, two or more such improvements will be implemented and evaluated
through this BPE. Depending on the results of these intervention-specific evaluations and availability of
funding, ongoing evaluation responsibilities will then be transferred either to the implementers of the
interventions (other PEPFAR implementation partners) or to the Health Economics Research Office of the
Wits Health Consortium. This BPE is expected to produce at least two publications of international journal
quality and to generate a set of recommendations to service providers for improving linkages to care.
-----------------------------------
SUMMARY:Boston University (BU) will use FY 2008 funds to 1) expand and extend an ongoing analysis of
cost and cost-effectiveness of models of treatment delivery in South Africa; and 2) extend an ongoing
analysis of the outcomes and sustainability of treatment for adult patients. Results will be used to inform
future planning by the USG PEPFAR Task Force and South African Government and improve treatment
delivery. All of the activities are public health evaluations, and the target populations for the activities are
adults, people living with HIV, policy makers, program managers, clinicians (public and private),
organizations (all types), and USG staff.BACKGROUND: ACTIVITY 1: BU was requested in FY 2005-2007
to examine cost and cost-effectiveness of alternative models of treatment delivery in use in South Africa.
The original methodology considered only the first 12 months following treatment eligibility and included
relatively small sample sizes. Initial results have raised new questions requiring larger samples and longer
periods of follow-up. In FY 2007, BU amended the methodology to cover up to the first 24 months on
treatment, expand the sample of patients from each site, and analyze new models of treatment delivery
initiated after the original sites were selected. In FY 2008, the number of sites will be increased further and
the methodology will be refined to generate more detailed information about the relationships between
resource utilization (costs) and patient outcomes. In addition, the methodology will be adapted to analysis
of pediatric treatment delivery models and an initial set of pediatric sites will be analyzed. ACTIVITY 2:
With USG support, BU began an evaluation in 2005 of the impact of treatment on South African patients'
social and economic welfare, including quality of life, labor productivity, family stability, and other outcomes.
In FY 2008, this evaluation will be continued for a fourth year, allowing examination of longer term outcomes
essential to treatment sustainability. Both activities address specific areas of interest of the South African
Government and are being undertaken with the approval of relevant local and provincial authorities. Both
activities will be conducted in partnership with the Health Economics Research Office (HERO) of the Wits
Health Consortium. BU's finding from all phases of the targeted evaluations are being utilized by the USG
PEPFAR Task Force and other PEPFAR partners to improve efficiencies within current treatment service
delivery models.ACTIVITIES AND EXPECTED RESULTS:ACTIVITY 1: Analysis of treatment models and
costsThe USG supports a wide range of treatment delivery models in South Africa, including public sector,
private sector, and NGO-based programs. In FY 2005-2007, PEPFAR provided support to BU and HERO
for a targeted evaluation of the cost-effectiveness of approximately 10 treatment sites representing various
models of delivery, including urban and rural public hospitals, a rural NGO clinic and a rural faith-based
clinic, and a private physician-based program. The models and sites have been chosen to represent the
most promising or most common approaches to large-scale treatment delivery in urban and rural areas and
in the public and private sectors. The analysis relies mainly on retrospective data routinely collected by
treatment programs to generate information about which models of treatment delivery are successfully
treating the largest number of patients at the lowest cost, which characteristics of delivery systems are most
important, and whether patient medical outcomes are affected by the model and cost of treatment delivery.
The specific measure of cost-effectiveness being used is cost to retain a patient in care and responding to
therapy, with responding defined as an undetectable viral load, incremental increase in CD4 count, and/or
absence of serious clinical conditions. Both costs and outcomes are estimated at the 12-month and 24-
month points following medical eligibility for treatment under South African national guidelines.Initial results
of the evaluation have raised a number of additional questions that can only be answered by expanding and
extending the activity for a fourth year (FY 2008). These include the cost per successful outcome in years 3
and 4 following treatment eligibility; costs for subsets of patients, such as those who initiate treatment with
very low CD4 counts or who switch to second-line regimens during the first year; and cost-effectiveness of
Activity Narrative: treatment delivery models launched after the original study sites were chosen. In FY 2008, BU will revise its
methodology to estimate costs and effectiveness up to 48 months following eligibility, incorporate the larger
sample sizes needed to examine subsets of patients, and add additional study sites to the evaluation. In
addition, the methodology will be adapted to pediatric treatment, which will require different definitions of
outcomes and different time frames for evaluation. The pediatric methodology will be applied to an initial
set of treatment sites. The expected results of this activity are accurate and detailed estimates of the costs
of delivering treatment and achieving successful outcomes across a wide range of settings and types of
patients. This information will assist the South African Government, PEPFAR, and other funding agencies to
estimate future resource needs, increase efficiency among existing providers, and target future investments
toward the most cost-effective models of delivery.ACTIVITY 2: Impact of treatment on patients' welfare.
While the medical effectiveness of antiretroviral therapy (ART) in suppressing viral replication and restoring
immune function is well established, little is known about the impact of treatment of HIV and AIDS on the
economic and social welfare of African patients. In particular, it is not known if treatment will offset the
impact of untreated AIDS on labor productivity, family stability, quality of life, and other indicators of social
and economic development and treatment sustainability. In FY 2005, BU and HERO launched an evaluation
of the economic and social outcomes of treatment for adult South Africans receiving care from three
PEPFAR-supported treatment sites. The sites include a large urban public hospital, an informal settlement
non-governmental clinic, and a rural faith-based non-governmental clinic. At each site, a random sample of
pre-ART patients and patients who had been on ART less than 6 months were enrolled in the study and
completed a baseline questionnaire focusing on family stability, ability to work and/or perform other normal
activities, quality of life, adherence, costs of obtaining treatment, and sources of income. Follow-up
interviews are conducted during regularly scheduled clinic visits at intervals of 3-6 months, depending on
the patient's status. Over the course of FY 2005 and FY 2006, 672 ART patients and 446 pre-ART patients
were enrolled in the study and completed baseline and follow-up questionnaires. By the end of the FY 2007
funding period, all of these patients will have been followed for a minimum of 2 years, and some for more
than 3 years.In FY 2008 no new patients will be added, but because the impact of treatment on patients'
welfare will change over time, following the current patients for an additional year will generate valuable
information about the sustainability of treatment beyond the initial two years. Almost all of the pre-ART
patients will have initiated ART by FY 2008, allowing a pre- and post-treatment comparison for this
group.The expected result of this activity is rigorous empirical information available about the non-clinical
outcomes of treatment for South African patients treated through PEPFAR and South African Government
treatment initiatives. If patients are shown to be able to resume their normal activities, find and retain jobs,
maintain family stability, and improve quality of life, support for long-term provision of treatment and
expansion of current programs will be strengthened. Analysis of the characteristics of patients for whom
outcomes are less successful will also help improve treatment program design and patient support
efforts.Information coming out of both of these targeted evaluations will be definitive in designing more
efficient and effective programs, contributing to the US Mission's ability to reach its PEPFAR targets.
Continuing Activity: 13692
29169 29169.06 HHS/Health Catholic Relief 11901 11901.06 $126,026
Resources Services
Services
Administration
29168 29168.06 HHS/Health Catholic Relief 11901 11901.06 $2,502
29167 29167.06 U.S. Agency for Children's AIDS 11900 11900.06 $338,880
International Fund
29166 29166.06 HHS/Health Catholic Relief 11899 11899.06 $1,615,895
29165 29165.06 HHS/Health Catholic Relief 11899 11899.06 $2,582,819
29164 29164.06 HHS/Centers for Elizabeth Glaser 11898 11898.06 $7,579,660
Disease Control & Pediatric AIDS
Prevention Foundation
29163 29163.06 HHS/Centers for Elizabeth Glaser 11898 11898.06 $8,184,849
29162 29162.06 HHS/Centers for Sanquin 11897 11897.06 $676,440
Disease Control & Consulting
Prevention Services
29161 29161.06 HHS/Centers for Sanquin 11896 11896.06 $676,440
29160 29160.06 HHS/Health Catholic Relief 11895 11895.06 $3,132,337
13692 2916.08 U.S. Agency for Boston University 6575 192.08 AIDS Economic $350,000
7509 2916.07 U.S. Agency for Boston University 4448 192.07 AIDS Economic $300,000
2916 2916.06 U.S. Agency for Boston University 2627 192.06 AIDS Economic $160,000
Gender
* Increasing gender equity in HIV/AIDS programs
