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:
ACTS (Advise, Consent, Test, Support) is an innovative system for implementing routine HIV testing. It was
developed by the is the Adolescent AIDS Program at the Children's Hospital at Montefiore Medical Center
in New York and has been proven in both the US and South Africa to help providers more routinely offer
HIV counseling and testing to their patients.
BACKGROUND:
This is a new activity funded in last quarter FY 2008. Montefiore Hospital implements youth-focused
prevention programs that seek to educate and empower youth to delay the onset of sexual activity, abstain
from sex and/or reduce the number of concurrent sex partners in line with the goals of the HIV & AIDS and
STI Strategic Plan for South Africa, 2007-2011. Prevention programming will foster female youth
empowerment with a goal of improving self-esteem and reducing high-risk behaviors, and programming will
also emphasize being faithful to young men in an effort to reduce the practice of multiple concurrent
partners.
ACTIVITIES AND EXPECTED RESULTS:
In late FY 2008, Montefiore's Youth Program looked to provincial youth peer education programs to open
doors to implementing ACTS (Advise, Consent, Test, Support) in other provinces. In addition, Montefiore
was asked to assist these youth programs by providing training on routinely offered voluntary counseling
and testing and by providing sexual prevention messages.
In FY 2009, $122,000 will go toward abstinence and being faithful (AB) programs. South Africa in general
has a high teenage pregnancy rate with every one in three girls having had a baby by the age of 20
(LoveLife Report). In many instances, the first sexual experience of girls is through coercion. Other reported
factors that contribute to teenage pregnancy include health-care professionals' attitudes about youth and
sex (presenting barriers to accessing contraception), social pressures and self affirmation (pregnancy
proves fertility and, therefore, womanhood; multiple concurrent partners proves virility and, therefore,
manhood) and low socio-economic conditions (lack of education and employment opportunities). To
address these issues in the context of HIV prevention, the ACTS Project proposes partnering on a new
program that engages small youth-serving non-governmental organizations to offer peer-delivered
prevention programs in three new provinces: Limpopo, Mpumalanga and KwaZulu-Natal.
Strong linkages will be sought with youth peer education programs that can engage in-school and out-of-
school youth to delay sexual debut (especially youth in high transmission and rural areas) and reduce risk
among sexually active youth by promoting the idea of being faithful and reducing the practice of having
multiple concurrent partners. The ACTS program leadership will work with the appropriate provincial and
district department of health offices to coordinate these new sub-partner efforts with sexual prevention as
well as counseling and testing activities in their service areas. Successful applicants will receive small to
medium sized grants to educate and empower youth to delay the onset of sexual activity, abstain from sex
and/or reduce the number of concurrent sex partners.
Due to the high risk nature of their sexual relationships, it is of utmost importance that both young men and
women are equipped with the necessary knowledge to make informed decisions about their sexual and
reproductive health, and services to address their sexual and reproductive health needs are accessible and
efficient. The programs will also educate youth about HIV and AIDS, provide HIV counseling and testing
and emphasize other key prevention messages in line with the goals set forth by the South African
government. The new sub-partners will be provided with an evidence-based prevention curriculum such as
"Family Matters" that they can adapt for their local youth populations. Grantees will also receive ACTS
collateral materials including HIV prevention and education videos; standard operating procedures for HIV
testing and prevention programmes, work plans with measurable objectives and timelines within which they
must meet their targets. The evaluation of these sub-partners will take place as continuing quality
improvement activities recorded on a quarterly basis.
--------------------
The Montefiore Medical Center aims to eliminate missed opportunities to test youth by building the capacity
of youth-serving clinics and STI clinics to more routinely provide CT using the ACTS model. ACTS ( Assess,
Consent, Test and Support) is a program of rapid, simplified counseling and testing (CT) that effectively
scales up provider-initiated counseling and testing (PICT). In addition, will implementing a youth-based
PICT, Montefiore Medical Center will work with rural districts to target non-government organizations
(NGOs) working with youth to provide HIV prevention activities.
Engaging young people in HIV counseling and testing, prevention and care is one of the most important
strategies for reducing the burden of HIV and AIDS in South Africa. Unfortunately, thousands of
opportunities to achieve these goals are missed every day when vulnerable South African youth seek a
variety of health care services but are not offered HIV counseling and testing (CT) or provided with HIV
prevention information. By reducing pre-test counseling sessions to five minutes or less, ACTS allows
nurses to incorporate CT into the other clinical services they provide, such as sexually transmitted infection
(STI) care and family planning and promotes immediate follow-up and linkage to care. In addition, youth can
then be linked with NGO proving HIV prevention services to ensure behavior change. The target population
for this activity is youth between the ages of 10-25 in hard to reach parts of the country. The major
emphasis area for these activities includes building local capacity and creating linkages, networks and
referrals between youth-based prevention services
Activity Narrative: and the ACTS CT model.
ACTIVITES AND EXPECTED RESULTS:
Using ACTS, this program will focus initially on maximizing the linkages between youth based NGOs
working in the area of HIVE and AIDS prevention and CT services in high-prevalence youth clinics, starting
with STI clients and expanding to family planning clients. The linkage with the NGOs will ensure that ACTS
services can be implemented in conjunction with AB targeted messaging and with other NGO activities.
ACTS will link with youth-based NGOs in and around the clinics where services are being implemented.
This will ensure that youth get both CT services and AB prevention messages. Simalarily to its approach
with working with health facilities, the ACTS team will engage each new NGO, develop an implementation
and monitoring plan and train all relevant providers HIV and AIDS prevention, in the importance of CT,
collection PEPFAR indicators, provide quality assurance monitoring and initial HIV care. During the five
year cooperative agreement, this model will be continuously refined and successively implemented in high
prevalence communities and sites throughout South Africa starting in the Western Cape and Mpumalanga.
The yout-based NGO project will expand services to Waterberg district in Limpopo province and the North
West Province.
In FY 2008, the team will continue to refine the ACTS services in two youth clinics in Khayelitsha. A
monitoring and evaluation plan will be developed that includes PEPFAR indicators. A quality assurance
plan will evaluate linkage to prevention among HIV negative youth as well as ensure that newly diagnosed
HI-infected youth also receive information on positive prevention. A Project Director will be hired and trained
and locations in Mpumalanga or other Province will be chosen as well as additional clinical and community
sites in the Western Cape. The goal is for this partner to test 20,000 youth for HIV and link them to
prevention.
These activities will contribute towards meeting PEPFAR's 2-7-10 goals by targeting youth between the
ages of 15-25 and ensuring that they receive AB messages. In linking prevention services with CT
services, this activity will ensure that youth understand how to stay negative after undergoing a HIV test.
New/Continuing Activity: New Activity
Continuing Activity:
Emphasis Areas
Gender
* Addressing male norms and behaviors
* Increasing gender equity in HIV/AIDS programs
Human Capacity Development
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.02:
In late FY 2008, Montefiore Hospital's youth program looked to provincial youth peer education programmes
to open doors to implementing the Advise, Consent, Test, Support (ACTS) program in other provinces. In
addition, Montefiore Hospital was asked to assist these youth programmes by providing training on routinely
offered voluntary counseling and testing (VCT) and providing sexual prevention messages.
$388,000 will go toward other prevention activities due to the high risk nature of youth sexual relationships.
It is of utmost importance that both young men and women are equipped with the necessary knowledge to
make informed decisions about their sexual and reproductive health, and that services to address their
sexual and reproductive health needs are accessible and efficient. In this vein, the ACTS program proposes
implementing a new initiative to engage small youth-serving non-governmental organizations (NGOs) to
deliver prevention programs in three new provinces: Limpopo, Mpumalanga and KwaZulu-Natal. We will
work with the appropriate provincial and district department of health offices to coordinate these new sub-
partner efforts with existing prevention as well as counseling and testing activities in their service areas.
Recruitment for these new community partners will take place via advertisements in provincial or district
media to ensure fair and open competition. Successful applicants will receive small- to medium-sized grants
to develop and deliver prevention programs directed at higher risk youth including those living in townships
and transit corridors as well as young women in their 20s. Prevention programs that focus on reducing
multiple concurrent partners, cross generational and transactional sex; increasing awareness of youth risk
for HIV via social marketing, peer education programs and the active involvement of youth living with HIV;
promoting abstinence, being faithful and condom (ABC) messages with novel approaches to ensuring
correct and consistent condom use will also be encouraged to apply. The programs will also educate youth
about HIV/AIDS, provide HIV counseling and testing and emphasize other key prevention messages in line
with the goals set forth by the South African Government. The new sub-partners will be provided with ACTS
collateral materials including HIV education video content; standard operating procedure and work plans
with measurable objectives and timelines within which they must meet their targets. The evaluation of these
sub-partners will take place as continuing quality improvement activities recorded on a quarterly basis.
and the ACTS CT model.
working in the area of HIV and AIDS prevention and CT services in high-prevalence youth clinics, starting
services can be implemented in conjunction with HIV prevention activities that targeted messaging and with
other NGO activities. ACTS will link with youth-based NGOs in and around the clinics where services are
being implemented. This will ensure that youth get both CT services and HIV prevention messages.
Similarly to its approach with working with health facilities, the ACTS team will engage each new NGO,
develop an implementation and monitoring plan and train all relevant providers HIV and AIDS prevention, in
the importance of CT, collection PEPFAR indicators, provide quality assurance monitoring and initial HIV
care. During the five year cooperative agreement, this model will be continuously refined and successively
implemented in high prevalence communities and sites throughout South Africa starting in the Western
Cape and Mpumalanga. The youth-based NGO project will expand services to Waterberg district in
Limpopo province and the North West Province.
In FY2008, the team will continue to refine the ACTS services in two youth clinics in Khayelitsha . A
ages of 15-25 and ensuring that they receive HIV prevention messages. In linking prevention services with
CT services, this activity will ensure that youth understand how to stay negative after undergoing a HIV test.
New/Continuing Activity: Continuing Activity
Continuing Activity: 22498
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
22498 22498.08 HHS/Centers for Montefiore 8709 8709.08 $388,000
Disease Control & Hospital
Prevention
Table 3.3.03:
Growth and Expansion of Testing Venues:
The primary goal of the Assess, Consent, Test and Support (ACTS) initiative is to increase by 20,000 each
year the numbers of youth who learn their HIV status through youth-serving health clinics and community
and faith-based organizations in the Western Cape and at least one other province. The strategy for
reaching this number of youth is to first routinize provider-delivered HIV testing in clinical settings-
particularly among young sexually transmitted infection (STI) and family planning clients, and then engage,
train and support other youth-serving clinics and community organizations/non-governmental organizations
(NGOs) in efforts to institute or improve existing HIV testing services.
In year two, the ACTS team will expand by at least 15 sites the number of testing venues offering provider-
delivered, streamlined counseling and testing (CT). We will also strengthen our relationships with the
existing 14 ACTS clinics in the Western Cape to ensure that opportunities to test youth are maximized. As a
third arm of our expansion strategy, outreach will be made to community-based organizations (CBOs) and
faith-based organizations (FBOs) in the communities where we are working to offer HIV testing to youth
who do not access health care at our partner clinics.
A major focus of work in year two will be to continue working with the South African National Department of
Health (NDOH) and other partners to select ACTS implementation clinics in a minimal of an additional
province (P2). Once sites in P2 are located, we will complete site-specific needs assessments,
implementation plans and staff training sessions, with a goal of officially launching routine testing at P2 sites
in year two. This effort will be aided by working with high risk youth-serving NGOs as mentioned in our other
sexual prevention sections.
Improving Linkages to Care:
In addition to the scale-up of routine HIV testing at additional sites, the program will continue to focus efforts
on linking newly diagnosed HIV-infected youth to reorganized care and prevention services. In year two, we
propose to implement a support group curriculum concentrating on newly diagnosed HIV-infected youth
derived from evidence-based cognitive behavioral interventions for HIV-infected adolescents and families
that were demonstrated as efficacious in the United States and adapted for prevention of mother-to-child
transmission (PMTCT) programs in South Africa. The adapted curriculum will address common issues that
challenge the health of HIV-infected youth in South Africa including engaging in appropriate care
consistently; understanding the personal significance of HIV disease staging and progression; improving
adherence to HIV medications; coping with an HIV diagnosis; disclosing HIV status to family, friends and
partners; choosing and negotiating abstinence, being faithful and condom use (ABC) prevention; and
preparing for the future.
Prevention for Uninfected Youth:
For youth who are HIV-negative, the ACTS program will provide culturally appropriate information,
education and communications materials based on ABC. Additionally, a video loop comprising culturally
appropriate HIV prevention and care content will be developed with social marketing partners in Cape
Town. This video content will be utilized in the waiting rooms of the youth clinics in Khayelitsha to improve
HIV testing uptake, HIV knowledge and prevention/risk reduction behavior.
Monitoring and Evaluation:
The ACTS program will be monitored to collect requested PEPFAR indicators (numbers of newly
established testing venues, numbers of youth tested, numbers of HIV youth identified, numbers of providers
trained in ACTS). We will also measure progress toward several public health and quality improvement
goals with a particular focus on linkage to care for HIV youth and linkage to antiretrovirals (ARVs) for youth
with CD4 counts <200.
-------------------------
scales up provider-initiated counseling and testing (PICT).
variety of health care services but are not offered HIV counseling and testing (CT). By reducing pre-test
counseling sessions to five minutes or less, ACTS allows nurses to incorporate CT into the other clinical
services they provide, such as sexually transmitted infection (STI) care and family planning and promotes
immediate follow-up and linkage to care. This frees up lay counselors via task shifting to provide more
intensive counseling and support services to HIV-infected youth.
Activity Narrative: Using ACTS, this program will focus initially on maximizing CT services in high-prevalence youth clinics,
starting with STI clients and expanding to family planning clients. TB screening will also be introduced. The
ACTS program will then broaden its activities to other health care facilities and community organizations.
The ACTS team will engage each new site, develop an implementation and monitoring plan and train all
relevant health care providers in CT, collect PEPFAR indicators, provide quality assurance monitoring and
initial HIV care. During the five year cooperative agreement, this model will be continuously refined and
successively implemented in high prevalence communities and sites throughout South Africa starting in the
Western Cape and Mpumalanga.
In FY20 08, the team will continue to refine the ACTS services in two youth clinics in Khayelitsha . A
plan will evaluate linkage to care among newly diagnosed HI-infected youth. A Project Director will be hired
and trained and locations in Mpumalanga or other Province will be chosen as well as additional clinical and
community sites in the Western Cape. The goal is for this partner to test 20,000 youth for HIV and link them
to prevention, link 2000-4000 HIV-infected youth to improved care, screen at least 100 youth for TB,
train 180 nurses, lay counselors and peer educators to implement the ACTS CT protocol, and establish 15
new CT outlets. The integration of local staff and partners in the operation and monitoring of this program to
scale-up routine testing will ensure local ownership and sustainability.
These activities will contribute towards meeting PEPFAR's 2-7-10 goals.
Continuing Activity: 19512
19512 19512.08 HHS/Centers for Montefiore 8709 8709.08 $522,000
Health-related Wraparound Programs
* TB
Table 3.3.14:
