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
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
SUMMARY:
USAID, through RTI, will provide support to strengthen the community response that mitigates the impact of
HIV/AIDS and TB, provides education on the importance of reporting sexual assault within 72 hours to
obtain the full benefit of post-exposure prophylaxix (PEP), and increase awareness about new Thuthuzela
Care Centers (TCCs) in order to maximize the demand for and utilization of services, thus preventing HIV
through other behavior changes related to sexual and gender-based violence.
BACKGROUND:
This is the third year of support to the TCCs. Thuthuzela means "to comfort" in isiXhosa; TCCs are multi-
disciplinary centers that provide comprehensive care for rape survivors with an emphasis on women and
children.
ACTIVITIES AND EXPECTED RESULTS:
RTI will carry out four separate activities in this program area.
ACTIVITY 1:
RTI will help NPA/SOCA to establish eight new TCCs in FY 2009, eight in 2010 and seven in 2011, for a
total of 23 TCCs. It will also fund three core staff in each TCC.
ACTIVITY 2:
USAID, through RTI, will provide grants to non-governmental organizations (NGOs) and/or subcontracts to
build awareness about: the relationship between sexual and gender-based violence and risk of contracting
HIV, the importance of reporting within 72 hours after a sexual assault to obtain PEP, and to build
awareness about the new facilities to maximize demand and utilization of services.
ACTIVITY 3:
RTI will implement a communications strategy which focuses on generating public awareness through the
media, journalism, billboards, posters and special events in collaboration with NPA/SOCA.
ACTIVITY 4:
With additional funding from the PEPFAR Special Initiative on Sexual and Gender-Based Violence, RTI will
explore strategies for explicitly raising community awareness of TCC services and for strengthening TCC
linkages with community networks to help facilitate victims' access to services.
-----------------
SUMMARY:The goal of this project is to improve care provided to victims of rape and sexual violence
through the establishment and operations of nine new Thuthuzela Care Centers (TCCs). These multi-
disciplinary centers provide comprehensive care services to women and children rape or assault survivors,
including post-exposure prophylaxis (PEP), HIV and AIDS counseling and testing, and referral to HIV care
and treatment services. These centers will also assist men, girls and boys who are increasingly becoming
victims of rape. The major emphasis area will be on training and technical assistance with minor emphasis
on commodity procurement. Target population will include infants, girls, boys, men, women, doctors, nurses
and pharmacist as well as the TCC core team. Commodities to be procured include rape kits, medical
equipment, comfort kits, and PEP medication. BACKGROUND:This project is a continuation of work
supported through PEPFAR funds in FYs 2006 and 2007 that were used to evaulate and upgrade existing
TCCs in keeping with the National Department of Health's (NDOH) National Management Guidelines for the
Care of Rape Victims. In FY 2009, this project will focus on maintaining established TCCs (20 total) in
provinces where they do not currently exist and in other locations where need is identified. Ten TCCs
currently exist. This activity is linked to the USAID Governing Justly and Democratically office's longstanding
program to support the Sexual Offenses and Community Affairs (SOCA) Unit of the National Prosecuting
Authority of South Africa in its endeavor to eradicate all forms of gender-based and sexual violence against
women and children, especially the crime of rape. The SOCA Unit has responded to the ongoing problem of
sexual offences and specifically rape in the country by seeking to expand the TCC newtork from 10 to 80
TCCs nationwide. The TCCs are a bold approach to rape care management. Under the Women's Justice
and Empowerment Presidential Initiative (WJEI, a total of 30 TCCs will be established to assist the SOCA
Unit to increase protection and advance women's legal rights. Very aptly SOCA's slogan is "Putting the
rights of women and children first." For victims of rape, the benefit of being assisted through a TCC is that
the rape survivor can obtain comprehensive, integrated rape services at a single location, including
receiving medical assistance, reporting the case to the law enforcement authorities (the police and
prosecutors), and accessing counselors and emergency support services on a 24-hour basis. To allow for
easy access to health services, most TCCs are located within hospitals or near health care facilities. The
TCCs are an initiative of the SOCA Unit of the National Prosecuting Authority and are in compliance with
the standards of the NDOH.The past few years have witnessed a growing recognition of the links between
violence against women and HIV and AIDS. The risk of HIV infection is a very real possibility with rape.
Perpetrators seldom use condoms, placing the vast majority of women and children who are victims of this
crime immediately at risk. For example, of every 100 survivors that report rape at the Manenberg (Cape
Town) TCC, an average of five are HIV-infected. This means that 95% of survivors are HIV-negative at the
time of rape at this particular TCC and can benefit from PEP and ongoing counseling. On average, 80% of
rape victims in South Africa are HIV-negative at the time of rape. According to the TCC model, when rape
victims arrive at the police station to report a rape, they are removed from the crowds to a quiet room to
Activity Narrative: take a statement. They are then transported to the nearest TCC where they are welcomed by a site
coordinator. Once the nurse or doctor is summoned to conduct the forensic medical exam, the Victim
Assistance Officer (VAO) and the doctor or nurse explains to the victim what procedures need to be
performed and help her understand why she must sign consent forms. The police detective on call to the
center is summoned and assigned to the case. Case managers are responsible for coordinating sexual
offenses cases and assist the victim in understanding what information the police investigator needs to
investigate the crime. If the victim decides to pursue charges, the case manager opens a file where copies
of all the relevant documents will be kept and the status of the victim's case will be tracked. However, the
audit conducted by RTI using FY 2006 PEPFAR funds found that exising TCCs were not 100% compliant
with this model (the highest score was 87.5% compliance. Upgrading current TCCs as well as
operationalizing new ones became an integral part of the program. ACTIVITIES AND EXPECTED
RESULTS:ACTIVITY 1: With FY 2008 PEPFAR funds, a partner TBD will continue to support SOCA's
efforts to upgrade and expand the TCC model targeting 9 additional TCCs. Part of this funding will continue
to go towards the training of the medical officers (doctors, nurses and pharmacists) on how to provide PEP
as well as to site coordinators and VAOs on how to educate victims on compliance with PEP. Site
coordinators manage the multidisciplinary team and administer each TCC. When the victim arrives, she is
comforted by a VAO, who is also responsible for building a relationship with the victim until she has been
able to report the rape, receive a medical examination, and obtain voluntary counseling and testing (VCT).
In addition, the victim is linked to any other critical service that she may require such as a place of safety
and follow up medical assistance. Promotion and education activities will also be conducted to educate
communities in which TCCs are located about the services they provide.At the TCCs, each rape victim is
encouraged to test for HIV. If the rape is reported within 72 hours, the rape survivors who test negative are
immediately provided with PEP. They are placed on PEP for 28 days and are tested again for sero-
conversion at 3 months and again at 6 months. In these 28 days, the survivor is intensively supported to
ensure compliance with medication as well her overall well-being. Rape victims who test positive for HIV
will be given appropriate counseling and will be referred to the nearest government treatment site for further
counseling, care and Antiretroviral Treatment (ART) when necessary. U.S. legislative interests being
addressed by this project include increasing gender equity in HIV and AIDS programs and women's legal
rights. This activity is also closely linked to USAID's programs in Democracy and Governance. The National
Prosecuting Authority is committed to addressing rape and the resulting problems such as HIV and AIDS,
especially the support and development of TCCs. The National Prosecuting Authority is particularly
committed to empowering women, protecting children and ensuring that the crime of rape is reduced
throughout South Africa. As such, this project will be sustainable beyond the provision of PEPFAR funds, as
the government will continue to support it.This project will assist PEPFAR to meet its goal of averting 7
million new infections by playing a critical role in increasing access to and improving quality of vital post-
rape services, including the provision of PEP.
New/Continuing Activity: Continuing Activity
Continuing Activity: 13946
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
13946 6545.08 U.S. Agency for Research Triangle 6664 4094.08 $388,000
International Institute
Development
7539 6545.07 U.S. Agency for Research Triangle 4457 4094.07 Government $400,000
International Institute Projects
6545 6545.06 U.S. Agency for Research Triangle 4094 4094.06 Government $280,000
Emphasis Areas
Construction/Renovation
Gender
* Increasing gender equity in HIV/AIDS programs
* Increasing women's legal rights
* Reducing violence and coercion
Health-related Wraparound Programs
* TB
Human Capacity Development
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.03:
SUMMARY: USAID, through Research Triangle Institute (RTI), will provide support to strengthen the HIV-
related clinical, psychological and social care services for the Thuthuzela Care Centers (TCCs) for rape
victims in all provinces.
ACTIVITIES AND EXPECTED RESULTS: RTI will help the Sexual Offenses and Community Affairs Unit of
the National Prosecuting Authority (NPA/SOCA) to establish eight new TCCs in FY 2009, eight in FY 2010
and seven more in FY 2011, for a total of 23 TCCs, and fund three core staff in each TCC. The program
focuses on refurbishment of TCCs in order to meet health and TCC blueprint standards. RTI will orient and
train TCC staff, doctors and forensic nurses; provide both core multi-disciplinary training and on-site
training; and support all TCC staff by conducting training focusing on: delivery of post-exposure prophylaxis
(PEP), HIV counseling and testing (CT), protocols for care and treatment of victims and follow-on
psychosocial counseling for TB, PEP, antiretroviral (ARV) and secondary prevention adherence. Through
the grants component, RTI will support referral systems for treatment and care and follow-on psychosocial
counseling for children who tested positive by providing assistance to non-governmental organizations
(NGOs) and working closely with them. With additional funding from the PEPFAR Special Initiative on
Sexual Gender Based violence, RTI will pilot improved models of care at selected TCCs to inform SOCA's
national "blueprint" for TCC care services and future Women's Justice and Empowerment Initiative (WJEI)
program implementation. RTI will also develop pilot models based on existing best practices in rape care
currently offered through the South African Government's Department of Health and non-governmental
organization-supported services. RTI will strengthen health care services at TCCs, with special attention to
improving PEP adherence and health care follow-up and referrals and explore strategies for explicitly
raising community awareness of TCC services and for strengthening TCC linkages with community
networks to help facilitate victims' access to services.
Activity narrative components in the FY 2008 COP related to the Department of Provincial and Local
Government (DPLG) HIV and AIDS in the Municipal Workplace activity will no longer be part of this FY 2009
Plan.
----------------------------------
SUMMARY:The first RTI component includes support to strengthen the HIV-related clinical, psychological
and social care services for the Thuthuzela Care Centers (TCCs) for rape victims in all provinces with the
exception of Limpopo, Free State and Mpumalanga. The second component encompasses strengthening
the Department of provincial and Local Government (DPLG) HIV and AIDS care program in workplace
programs in 4 districts and 15 local municipalities located in Gauteng, Mpumalanga, Western Cape, and
Limpopo provinces. The third component includes training of community health care workers in the same
municipality catchment areas on quality HIV palliative care. Populations served are adults and children,
PLHIV, health care workers and caregivers. The major emphasis area is training with minor emphasis areas
in IEC, commodity procurement, network/linkages/referral; linkages with other sectors and initiatives and
local organization capacity development.
BACKGROUND:This is the third year of support to the TCCs and DPLG. The community care component
is a new activity in FY 2007. Thuthuzela means "to comfort" in isiXhosa; TCCs are multi-disciplinary centers
that provide comprehensive care for rape survivors with an emphasis on women and children. Funding to
the DPLG in FY 2007 provides for the ongoing implementation of HIV and AIDS workplace activities
initiated in FY 2006 with an emphasis on integrating elements of the preventive care package, psychosocial
support and stigma reduction strategies for PLHIV. Caregiver training in DPLG catchment areas varies; as a
result quality of care for PLHIV suffers. Select municipalities and districts will partner with the provincial
Departments of Health and Social Development for standardized national HBC training.
ACTIVITY 1: Strengthening HIV care in the TCCs PEPFAR funding will enable the TCCs to improve the
quality of basic HIV-related clinical, psychological and social care services offered by the TCCs for rape
victims with an emphasis on women and children rape victims (key legislative area). The TCCs offer a
place of refuge and comfort for raped women and children, with an aim to reduce secondary victimization
suffered by rape victims by ensuring that the reporting process, medical examination, initial counseling,
quality of HIV-related care services are all done in one place on a 24-hour basis. Care services that will be
provided include counseling and testing, disclosure support, PEP, gender-based violence screening, quality
and supportive medical examination, psychological care and counseling by trained providers, personal
hygiene, screening for pain and symptoms and HIV-related conditions such as opportunistic infections and
provision of shelter and comfort measures. Qualified health care workers will also provide messaging on
HIV prevention and counsel and refer for the provision of CD4 testing, ART, OI prevention and treatment
(including cotrimoxazole prophylaxis, TB care), nutritional care and appropriate child survival and child care
interventions (growth monitoring, child-specific nutritional care, immunizations). The program will provide
legal counseling, program linkages for the legal protection of women and children and follow-up legal
advice. A particular program emphasis is ensuring that women's legal rights and child protection is
promoted and protected.
ACTIVITY 2: Strengthening HIV Care in Municipality Workplace Settings This component assists 4 districts
and 15 local municipalities located in Gauteng, Mpumalanga, Western Cape, and Limpopo provinces to
initiate and/or strengthen care delivery via HIV and AIDS workplace programs. Activities will be developed
and strengthened that encourage employees to obtain access to HIV prevention and care services including
emphasis on integrating elements of the preventive care package, psychosocial support and stigma
reduction strategies for PLHIV. This includes counseling and referring for HIV testing services, disclosure
support, basic screening for pain and symptoms and HIV-related conditions such as opportunistic infections,
HIV prevention messaging and access to condoms, referrals for the clinical monitoring and care that
includes ART, OI prevention and treatment (including cotrimoxazole prophylaxis, TB care), nutritional care
Activity Narrative: and appropriate child survival and child care interventions. On-site psychosocial care will be provided.
Mandatory employee participation in HIV and AIDS education programs is a key element of the program.
Strategies to reduce stigma directed towards PLHIV will be integrated in partnership with municipality
leaders and participation with labor unions is included. Outcomes include improved access to HIV and
AIDS care, stigma reduction and strategies to prevent the further spread of the disease
ACTIVITY 3: Expanding the Community Response to HIV and AIDS in Municipality Catchment AreasAll the
targeted 4 districts and 15 local municipalities (mentioned in Activity 2) have CBOs who carry out HIV-
related community and home-based care activities for PLHIV and OVC in their vicinity. It has been noted
that community providers who receive the 59-day South African Government accredited home-based care
training from the NDOH provide exemplary services. However, many CBOs do not have access to the
standardized training program. This activity will expand NDOH standardized training in the targeted
municipalities depending on the unique needs and ongoing training programs supported by the provincial
Departments of Health and Social Development. The training will include but not be limited to the following
topics: elements of the preventive care package for adults and children; basic HIV terminology and facts;
psychosocial aspects of HIV and AIDS; basic pain and symptom management; bereavement care and
communication skills; legal issues; care considerations for OVC; infection control; health education;
culturally appropriate care; end of life care; ART adherence; how to provide referrals; supportive
supervision; program design; and project management. Community caregivers working in drop-in centers
(catering to orphans and vulnerable children) will be trained in ways to mitigate the burden of women and
girls in their care of family members who are ill and of young children who have lost their parents to HIV and
AIDS. Sites will be selected in partnership with municipalities and the provincial Departments of Health and
Social Development. Follow up from the training and technical support will be provided to the community
organizations by the designated training support team. Training provided through this activity serves to
build and sustain linkages between the district municipalities, the provincial Departments of Health and
Social Development, and community-based organizations (CBOs) and non-governmental organizations
(NGOs) thereby reinforcing the coordination role of the DPLG. These activities will contribute to PEPFAR
goals of providing palliative care to 10 million HIV-infected individuals and their families, including OVC.
Continuing Activity: 13947
13947 6547.08 U.S. Agency for Research Triangle 6664 4094.08 $1,455,000
7541 6547.07 U.S. Agency for Research Triangle 4457 4094.07 Government $1,500,000
6547 6547.06 U.S. Agency for Research Triangle 4094 4094.06 Government $125,000
Refugees/Internally Displaced Persons
Estimated amount of funding that is planned for Human Capacity Development $11,250
Table 3.3.08:
FY 2008 COP activities will be expanded to include:
-Piloting improved models of care at selected Thuthuzela Care Centers (TCCs) to inform SOCA's national
"blueprint" for TCC care services and future Women's Justice and Empowerment Initiative (WJEI) program
implementation.
USAID, through RTI, will provide support to strengthen the HIV-related clinical, psychological and social
care services for the TCCs for child rape victims in all provinces.
RTI will help the Sexual Offences and Community Affairs (SOCA) Unit of the National Prosecuting Authority
(NPA) to establish 8 new TCCs in FY 2009, 8 in 2010 and 7 in 2011, for a total of 23 TCCs, and fund three
core staff in each TCC. The program focuses on refurbishment of TCCs in order to meet health and TCC
blueprint standards. RTI understands that the funds cannot be used for new construction without special
waivers.
RTI will orient and train TCC staff, doctors and forensic nurses; provide both core multi-disciplinary training
and on-site training; and support all TCC staff by conducting training focusing on: delivery of post-exposure
prophylaxis (PEP), HIV counseling and testing (CT), protocols for care and treatment of victims and follow-
on psycho-social counseling for TB, PEP, ARV and secondary prevention adherence.
Through the grants component, RTI will support referral systems for treatment and care and follow-on
psycho-social counseling for children who tested positive by providing assistance to non-governmental
organizations (NGOs) and working closely with them.
With additional funding from the PEPFAR Special Initiative on Sexual Gender-based Violence, RTI will pilot
improved models of care at selected TCCs to inform SOCA's national "blueprint" for TCC care services and
future WJEI program implementation. RTI will also develop pilot models based on existing best practices in
rape care currently offered through the SAG's Department of Health and NGO-supported services.
ACTIVITY 5:
RTI will strengthen health care services at TCCs, with special attention to improving PEP adherence and
health care follow-up and referrals and explore strategies for explicitly raising community awareness of TCC
services and for strengthening TCC linkages with community networks to help facilitate child victims' access
to services.
New/Continuing Activity: New Activity
Continuing Activity:
Estimated amount of funding that is planned for Human Capacity Development $7,500
Table 3.3.10:
USAID, through Research Triangle Institute (RTI), will provide support to strengthen the HIV-related clinical,
psychological and social care services for the Thuthuzela Care Centers (TCCs) for rape victims in all
provinces.
RTI will help the South Africa National Prosecuting Authority's (NPA) Sexual Offenses and Communtiy
Affairs (SOCA) Unit to establish eight new TCCs in FY 2009, eight in 2010 and seven in 2011, making a
total of 23 TCCs. It will fund three core staff in each TCC. The program focuses on refurbishment of TCCs
in order to meet health and TCC blueprint standards. RTI understands that it cannot use the funds for new
construction without special waivers. RTI will orient and train TCC staff, doctors and forensic nurses;
provide both core multi-disciplinary training and on-site training; and support all TCC staff by conducting
training focusing on the delivery of post-exposure prophylaxis (PEP), HIV counseling and testing (CT),
protocols for care and treatment of victims and follow-on psycho-social counseling for TB, PEP, ARV and
secondary prevention adherence.
organizations (NGOs) and working closely with them. With additional funding from the PEPFAR Special
Initiative on Sexual and Gender-based violence, RTI will pilot improved models of care at selected TCCs to
inform SOCA's national "blueprint" for TCC care services and future Women's Justice and Empowerment
Initiative (WJEI) program implementation.
RTI will also develop pilot models based on existing best practices in rape care currently offered through the
SAG's Department of Health and NGO-supported services. RTI will strengthen health care services at
TCCs, with special attention to improving PEP adherence, health care follow-up and referrals and will
Continuing Activity: 21158
21158 21158.08 U.S. Agency for Research Triangle 6664 4094.08 $242,500
Estimated amount of funding that is planned for Human Capacity Development $6,250
Table 3.3.14:
