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.
OVERVIEW AND BACKGROUND
The South-to-South Partnership for Comprehensive Family HIV Care and Treatment Program (S2S) is a partnership between The International Center for AIDS Care and Treatment Programs at Columbia University and Tygerberg Children Hospital at Stellenbosch University, which began in May 2006 with a focus on building pediatric care and treatment capacity throughout sub-Saharan Africa. In March 2008, S2S re-launched to focus exclusively on the needs of South Africa.
S2S PROGRAM GOALS & OBJECTIVES S2S's goal is to work closely with USAID implementing partners supporting Adult HIV Care and Treatment to implement a family-focused approach to service delivery that includes integration of PMTCT and pediatric care and treatment programs that that will advance the SA National DOH's HIV & AIDS and STI Strategic Plan (2007-2011) to reduce the number of HIV infections and reduce the impact of HIV/AIDS on individuals and families. This includes ensuring quality, timely and comprehensive HIV care and treatment to all HIV-infected pregnant and postnatal women, their children and family members.
The primary aim of the S2S program is to collaborate with the Department of Health other USAID implementing partners to improve the ability of health workers, the multidisciplinary team and health service to meet the objective of providing quality family-focused approach to HIV care and treatment.
S2S AREAS OF FOCUS (BUDGET CODES) • Support provision of comprehensive PMTCT services • Care and treatment for HIV-infected pregnant women, women in the postpartum period, and woman of childbearing age • Prevention, care and treatment for HIV-exposed infant and HIV-infected infants and children • Identifying and engaging HIV-infected infants and children with unknown HIV status • TB/HIV co-infection management and integration
S2S APPROACH S2S provides technical, programmatic, capacity building and systems support using a multidisciplinary care model to initiate, expand, link and/or deepen relevant family-focused services to rapidly increase the uptake of HIV prevention, care and treatment services for pregnant women and young children.
The cornerstone of S2S efforts target clinical and management site staff and includes continuing and phased-in skills building, knowledge transfer, supportive supervision, clinical mentoring and modeling to improve quality of care, strengthening clinical critical thinking/reasoning skills, supporting job-realignment and instituting a multidisciplinary approach to service provision. The S2S technical team is a multidisciplinary team, targeting all cadres of health workers involved in the provision of HIV prevention, care and treatment services.
S2S supports these efforts through the following activities in all four areas of focus (PMTCT, Pediatric Care and Support, Pediatric Treatment and TB/HIV): 1. Direct Site Support: Working in collaboration with USAID implementing partners at site level to support government and non-government staff working to implement family-focused HIV services o Clinical systems mentorship: Clinical and systems 2. Offsite Training: Conducting offsite skills building and performance improvement interventions for site staff at the Tygerberg Children's Hospital o One week Pediatric HIV management course o Conducting one-week (CPD accredited) Performance and Capacity Enhancement trainings (PACE), focusing on developing and supporting health workers and fostering the skills that enhance their capacity to work effectively and to remain engaged in their work, motivated and healthy while working in an environment that is often physically and emotionally demanding. 3. Onsite Training: Conducting onsite skills building and performance improvement interventions for site staff at the S2S supported sites o Two-day PMTCT District Cluster Implementation Workshop, focusing on the implementation aspects of increasing the uptake of and improving the quality of pediatric HIV care, treatment and support services o One-day Pediatric District Cluster Implementation Workshop, focusing on the implementation aspects of increasing the uptake of and improving the quality of PMTCT services 4. Development of HIV specific performance and training tools and resources.
Program outcomes will be measured using a Standards of Care (SOC) tool, which speaks to the DOH and PEPFAR indicators for quality and comprehensive HIV prevention, care and treatment for women, children and their families. This tool aims to quickly and simply assess the key service delivery areas outlined in the Budget Code sections of this document. While it is multifaceted in function, it can serve to monitor the programs longitudinal progression and growth over any period of time. S2S will utilize the SOC in the initial assessment of the program, and after support has been provided, to assess program progress and also to identify other areas in need of support. Sites will be encouraged to use the SOCs after formal support ends to continue to monitor important program quality and measures.
It is anticipated that by closely monitoring and evaluating the inputs, activities, outputs and outcomes of the S2S program that a comprehensive summary of the achievements of the program will be highlighted. This information will not only be critical for program improvement, but also to communicate to the partners the progress and achievements that have occurred as a result of these site level collaborations.
Although not providing direct prevention, care and treatment services, S2S supports USAID implementing partners to increase the capacity of health facilities to manage and strengthen HIV/AIDS
prevention, care and treatment services, including, training and mentoring health workers, improving information systems and ensuring integration of ART programs within TB, STI and PMTCT services.
S2S will work with DoH and USAID implementing partners to provide family-focused treatment and care services for HIV-infected children. S2S equips health workers with the necessary skills to address the special needs of HIV-infected children, and their families.
Areas for support will be prioritized based on challenges and needs of district and sites supported by S2S and will be contextualized according to the specific setting, site attributes and available (and future) resources. S2S supports the following Pediatric Care and Support activities:
• Identification of infection status: ensure timely identification of HIV exposure and infection status of infants and children, initiate HIV care and treatment services for children, provider support to provider- initiated counseling and testing. • Routine testing (provider initiated testing) of symptomatic children in pediatric medical settings: rapidly identify large numbers of HIV-positive children, and provide direct links to treatment and care.
• Linkages to HIV services: improve linkage, referral and retention of HIV-exposed and infected children in care, linkage to child survival interventions. • Opportunistic infections: support the prevention, diagnosis and treatment of opportunistic infections in HIV-infected children. • Monitoring of HIV-infected children: regular clinical and CD4 monitoring, monitoring of growth and development, monitoring of nutritional status. • Early Infant Diagnosis: Develop services to offer EID, reporting tools and counseling for HIV-exposed infants. • Improve quality of life: provide appropriate pain assessment and management, provide psychological, social and spiritual support to HIV-exposed and HIV-infected children. • Linkage, referral and coordination with care and treatment programs for caregivers and family members: Community HIV care for HIV-exposed and infected children. • Comprehensive pediatric HIV care support services: basic and quality pediatric care, neurodevelopmental screening and capacity building, psychiatric and psychological issues and support, HAART initiation and management in children, toxicity, treatment failure, adherence, adolescents, malaria, pediatric pain/symptom relief assessment and management, sexual abuse.
As part of the larger package of support, S2S offers offsite Comprehensive Pediatric HIV Care and Treatment Trainings and onsite Paediatric HIV/AIDS Cluster Implementation Workshop.
1. One week CPD accredited pediatric HIV training events will be hosted at the University of Stellenbosch Faculty of Health Science, Tygerberg Children's Hospital, for 10 participants per training event. At the end of the pediatric training events, participants will have received comprehensive exposure to pediatric HIV/AIDS care and treatment services and issues through a variety of training platforms, including a targeted didactic program that emphasizes case management and service implementation. Four participants are selected from S2S-supported facilities for the training. In addition, partners such as FPD, BroadReach, ECHO and Right to Care are allocated six slots for participants they choose to nominate. The pediatric care and support content of the pediatric training focuses on: an overview of pediatric HIV, early infant diagnosis and care of the exposed infant, management of the HIV-infected child, growth and neurodevelopmental monitoring, pediatric ART , ART Follow-Up: toxicities and second line regimens, pediatric tuberculosis, opportunistic infections (respiratory, oral, gastrointestinal, neurological, dermatology), adherence, psychosocial support and counseling, pediatric disclosure, adherence and care.
2. The Paediatric HIV/AIDS Cluster Implementation Workshop is a one-day workshop offered to staff at primary level (and ART staff at S2S supported sites on the management of HIV infected children (care and treatment). The aim of the workshop is to address identified knowledge and skills gaps related to
paediatric HIV/AIDS care with the goal of increasing the uptake of children into HIV care and treatment services. To reinforce skills and guidelines and help staff implement the skills transferred at the Paediatric Cluster Implementation workshop, S2S provides onsite technical and systems support, including mentoring, shadowing and one-on-one skills and knowledge transfer to reinforce concepts and guidelines discussed in the workshop.
Areas for support will be prioritized based on challenges and needs of district and sites supported by S2S and will be contextualized according to the specific setting, site attributes and available (and future) resources. S2S supports the following Pediatric Treatment activities:
• Provision of and adherence to treatment: provide ART for all HIV-infected infants and eligible children, appropriate pediatric formulations, CTX prophylaxis, ongoing treatment adherence support. • Comprehensive pediatric treatment services: basic and quality pediatric care, neurodevelopmental screening, psychological support and adherence, HAART initiation and management in children, including: toxicity, treatment failure.
1. One week pediatric HIV training events will be hosted at the University of Stellenbosch Faculty of Health Science, Tygerberg Children's Hospital, for 10 participants per training event. At the end of the pediatric training events, participants will have received comprehensive exposure to pediatric HIV/AIDS care and treatment services and issues through a variety of training platforms, including a targeted didactic program that emphasizes case management and service implementation. Four participants are selected from S2S-supported facilities for the training. In addition, partners such as FPD, BroadReach, ECHO and Right to Care are allocated six slots for participants they choose to nominate. The pediatric care and support content of the pediatric training focuses on: an overview of pediatric HIV, early infant diagnosis and care of the exposed infant, management of the HIV-infected child, growth and neurodevelopmental monitoring, pediatric ART , ART Follow-Up: toxicities and second line regimens, pediatric tuberculosis, opportunistic infections (respiratory, oral, gastrointestinal, neurological, dermatology), adherence, psychosocial support and counseling, pediatric disclosure, adherence and care.
2. The Paediatric HIV/AIDS Cluster Implementation Workshop is a one-day workshop offered to staff at under-five clinic and ART staff at S2S supported sites on the management of HIV infected children (care and treatment). The aim of the workshop is to address identified knowledge and skills gaps related to paediatric HIV/AIDS care with the goal of increasing the uptake of children into HIV care and treatment services. To reinforce skills and guidelines and help staff implement the skills transferred at the Paediatric Cluster Implementation workshop, S2S provides onsite technical and systems support, including mentoring, shadowing and one-on-one skills and knowledge transfer to reinforce concepts and guidelines discussed in the workshop.
The PMTCT activities conducted by S2S are aligned to South Africa's 2009 National Accelerated PMTCT Plan (A-Plan). The Standards of Care (SOC) utilized to assess progress made by sites supported by S2S following capacity building activities are directly correlated to the priority PMTCT indicators detailed in the A-Plan.
Areas for support will be prioritized in collaboration with the leadership of the DoH and USAID implementing partners based on challenges, needs and set targets of district and sites supported by S2S. These areas of support will be contextualized according to the specific setting, site attributes and available (and future) resources. S2S supports the following PMTCT activities.
MCH services: integrate PMTCT with MCH services to serve as an entry point to other HIV services for women, children and male partners, ensure mothers and infants with HIV are appropriately referred to HIV services for continued treatment, care and support. • Family planning services: improve access to available family planning through active and effective wrap around and linking to PMTCT, MCH and ARV services. • Transition PMTCT program: transition short-course PMTCT programs to full, family-based care and treatment programs, support effective interventions based on current WHO antiretroviral PMTCT and national guidelines, prepare for the rapid implementation of new guidelines. • Quality/performance improvement: support the implementation of quality and performance improvement measures, ongoing evaluation of the quality of PMTCT services and program impact. • Routine HIV testing and counseling services for PMTCT: target all women of reproductive age at every entry point, group pre-test information session, disclosure support, family testing. • Partner testing: integration of partner testing in PMTCT, gender issue awareness/sensitization, supportive services for partners at every entry point.
• Comprehensive MCH service: enhance basic MCH package to meet needs of HIV-positive pregnant women including safer sex, nutrition, malaria prevention, family planning, immunizations, TB screening, treatment and isoniazid prophylaxis. • ARV for PMTCT: Routine clinical/immunological evaluation of HIV-positive women, prophylaxis for all women not HAART eligible, fast tracking of HAART for all eligible women. • Provision of safe labor and delivery and post-partum services: Improve/enhance quality of labor and delivery services, biosafety, safer obstetric practices, postpartum follow-up. • Infant feeding counseling: ongoing and routine comprehensive infant feeding support during pregnancy, labor and delivery and post-delivery, quality infant feeding counseling and assessment of AFASS of feeding choice. • Enhance existing on-site PMTCT client tracking systems: enhance/implement MCH appointments and client tracking/tracing system, criteria for use system to improve client management. • Linking PMTCT programs with pediatric follow-up: systems strengthening for HIV-exposed infant follow- up, early infant diagnosis and routine testing of children, and strengthen linkages to adult and pediatric care and treatment.
As part of the larger package of PMTCT support, S2S will offer 2 day PMTCT District Cluster Implementation Workshops to antenatal, postnatal and labor and delivery ward staff at supported sites. The aim of the workshop is to address indentified knowledge and skills gaps related to PMTCT services. These training courses focus on implementing newly acquired skills to improve the quality of the care package for HIV-infected pregnant women and HIV exposed infants, and are in addition to the onsite mentoring, precepting and informal training sessions S2S offers to sites in the areas of PMTCT.
Areas for support will be prioritized based on challenges and needs of district and sites supported by S2S and will be contextualized according to the specific setting, site attributes and available (and future) resources. S2S supports the following TB/HIV activities:
• TB/HIV and the family: integration of TB screening at every entry point, improved linkages between HIV and TB programs, routine HIV testing for all clients undergoing TB treatment. • TB/HIV testing and linkages: increase provider-initiated HIV testing and counseling and linkages to HIV care and treatment among TB patients. • TB/HIV testing and linkages: increase provider-initiated HIV testing and counseling and linkages to HIV
care and treatment among TB patients. • PLHIV with TB: improve TB screening, diagnosis and treatment among people living with HIV, provide isoniazid preventive therapy for PLHIV. • Infection control: develop or enhance TB infection control activities. • Monitoring and evaluation: strengthen program monitoring and evaluation of TB.
