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.
TBD - ROADS 2
New/Continuing Activity: New Activity
Continuing Activity:
Table 3.3.02:
TBD with GHCS (STATE) Funds.
Table 3.3.03:
TBD expected $500,000 to ROADS 2 and $500,000 TBD.
Program Budget Code: 09 - HTXS Treatment: Adult Treatment
Total Planned Funding for Program Budget Code: $0
Program Budget Code: 10 - PDCS Care: Pediatric Care and Support
Program Area Narrative:
N/A
Program Budget Code: 11 - PDTX Treatment: Pediatric Treatment
Program Budget Code: 12 - HVTB Care: TB/HIV
Program Budget Code: 13 - HKID Care: OVC
Program Budget Code: 14 - HVCT Prevention: Counseling and Testing
Total Planned Funding for Program Budget Code: $1,463,670
OVERVIEW
Sudan has a low generalized HIV/AIDS epidemic with Southern Sudan having an estimated HIV prevalence of 2.6% (UNAIDS,
2007). The country is rebuilding from years of civil war that caused great damage to all sectors and infrastructure, including the
health infrastructure. Intensive and focused efforts in HIV prevention, care, and treatment are needed to ensure the HIV epidemic
does not become a greater problem in this fragile society. HIV Counseling and Testing (HVCT) is a key element of the PEPFAR-
Sudan HIV program, and is an opportunity for individuals, couples, and groups to not only learn about their HIV status, but to
establish personalized risk reduction plans. HVCT is important for helping HIV negative persons remain HIV negative, and for
linking HIV positive persons with care, treatment and support options.
Client-initiated counseling and testing (CICT) services have continued to expand steadily with support from US Government
(USG) through PEPFAR, the United Nations Children's Fund (UNICEF), and to lesser extent European donors. Most CICT occurs
at fixed sites that are located at health facilities. In fiscal year (FY) 2008, PEPFAR introduced new mobile and outreach HVCT
services in Yei and Juba counties to meet the increasing demand for HVCT services.
While couples HIV counseling and testing (CHCT) remains a priority for PEPFAR Sudan, demand for couples testing remains low.
Female involvement in HVCT services is limited due to cultural barriers against women. In FY 2008 alone, 28,386 people were
counseled and tested and received their HIV test results in the PEPFAR supported CICT sites. In general, PEPAR sites utilize a
parallel testing algorithms using simple rapid HIV test kits, with a third kit available to resolve discrepant results.
Comprehensive HVCT Guidelines incorporating CICT and provider initiated testing and counseling (PITC) has been developed by
Southern Sudan AIDS Commission (SSAC) and Ministry of Health (MoH), with a draft produced in June 2008. This effort was
supported by World Health Organisation (WHO) with assistance from PEPFAR partners and USG PEPFAR team members,
including reviews by the HVCT technical working group (TWG) in Atlanta. Once finalized and launched, the HVCT guidelines will
be implemented throughout Southern Sudan.
Standardized reporting and monitoring and evaluation (M&E) systems are now in an advanced formative stage by the MOH and
SSAC. A Health and HIV M&E framework (Year 2008 - 2012) is being developed with external technical support from partners,
including that of PEPFAR to guide the health and HIV/AIDS programs. This M&E framework is part of the National Strategic
Framework (NSF, 2008 - 2012) developed by Government of Southern Sudan (GoSS). PEPFAR partners contribute to the
development of the harmonized data collection and reporting tools that are utilized by all stakeholders.
Logistics management remains a challenge in Southern Sudan, due to low levels of infrastructure and high costs of transporting
supplies and other items. Despite slow improvements on roads, Southern Sudan remains largely undeveloped and transporting
goods by air remains the primary mode of moving supplies and people. Much effort is needed to support partners for proper
planning and logistics management, to ensure consistent availability of supplies and services
CURRENT PEPFAR SUPPORT
PEPFAR continues to be the principal supporter of CT services in Southern Sudan. USG partners are currently operating 36 CICT
sites, a figure which has increased from 23 sites at the beginning of FY 2008. These sites are located in Yei, Juba, Morobo,
Lainya, Magwi, Rumbek, Yambio, Nzara, Tambura, Source Yubu, Mvolo, Otogo, and Maiwut counties. Target HVCT services for
high-risk populations have been initiated in some locations. A stand-alone CICT site was established in an urban market area in
Juba, which is frequented by truck drivers, traders and their associates. This stand alone site integrates recreational facilities,
such as cable television, as well as distribution of information, education for HVCT services. Additionally, three integrated sites
have been established in army barracks, specifically targeting the military populations. HVCT service delivery is concentrated in
the areas considered at greater risk of spread of the epidemic, such as transport corridors, certain towns and hubs including
boarder towns and areas with high volume of persons returning from neighbouring countries that have high prevalence.
The PEPFAR team continues to support HVCT training both for new lay counselors and refresher trainings for existing
counselors. Currently the USG team conducts these trainings along with an experienced trainer / technical advisor from a partner.
This is in fulfillment of the mandate to develop CT training capacity in Southern Sudan. A PEPFAR partner has recently hired an
experienced trainer from the region to support these training efforts in addition to the existing capacity. These professionals are
working as a team to provide technical leadership in client initiated and provider initiated HVCT, as well as training of new HVCT
providers. A total of 78 counselors, up from 40, at the beginning of the FY 2008, are now offering CICT services at PEPFAR
supported sites. Additionally, the first cadre of six HVCT counselor supervisors has been trained to offer support supervision to
counselors in Yei, Juba, Rumbek and Kajo Keji. These supervisors also receive mentorship from the two USG and partner staff.
The USG staff also offers general HCT technical assistance to PEPFAR implementing partners, including the government and
other stakeholders. Leadership is also provided in the area of HVCT laboratory quality assurance (QA). QA for rapid HIV testing
services is done using standardized dried blood spot (DBS) specimen collection techniques and centralized testing conducted at
the CDC's laboratory in Kenya.
The PEPFAR Sudan team has faced many challenges maintaining the quality of HVCT services, given the complex environment
of the region. Despite these challenges, the PEPFAR team has taken a lead in strengthening existing CICT services by providing
specific technical assistance to USG partners, conducting frequent field visits to HCT sites, and making recommendations to CICT
partners. Additionally, it has played a key role in the establishment of new CICT centers in Southern Sudan.
The team and its implementing partners have also actively participated in the process of development of the HVCT guidelines
which are awaiting finalization and launching. The incorporation of guidelines for routine PITC into the comprehensive HVCT
guidelines is an opportunity to advance the cause of this important approach to HVCT in health facilities, which is not widely
implemented. Additionally, the guidelines offer an opportunity to highlight other key areas of focus, such as quality assurance of
HVCT services, and prioritization of couples HIV counseling and testing.
PLANNED FY 2009 SUPPORT
PEPFAR Sudan plans to implement a comprehensive HIV prevention package that includes HIV education and targeted outreach
efforts for youth and other at-risk populations, as well as condom distribution and education, HIV counseling and testing, and
provision of basic palliative care. In the coming years, the PEPFAR team will focus efforts on scaling up PITC, with targeted
efforts in at least two PEPFAR supported health care facilities. Couples HIV counseling and testing (CHCT) will also be prioritized
in FY 2009. HIV prevention partners will be engaged to educate the population on the benefits of this service and the facts about
HIV discordance among couples. Hence the USG team will expand the existing models of service provision to include more
emphasis on quality assurance, PITC and couples HCT, as these are also key priorities for Southern Sudan.
Partners engaged in HIV sexual prevention education, stigma reduction and creation of demand for services will continue
emphasizing the importance of couples and partner testing, recognizing that discordant couples are relatively common and must
be an important intervention target. Sudan's HVCT program emphasizes the importance of mutual disclosure of HIV status among
sex partners, and decision making based on each individual's status, through CHCT. Emphasis will also be put on addressing
barriers to females accessing HVCT services. To further increase demand for the HCT services in static sites, strategies to make
the sites clients friendly will be encouraged to attract more clients to the sites. This will be done by integrating recreational facilities
into the HVCT sites e.g. cable TV, DVD's with informative and entertainment contents and IEC materials including books,
magazines and newspapers with HIV/AIDS- related contents. Also, considering the low literacy rate in Southern Sudan, some of
the IEC materials will be translated to local languages at very basic level, and increased emphasis will be provided on community
mobilization activities like drama and posters.
Quality Assurance (QA) strategies will be scaled up so as to ensure HVCT services meet and maintain minimal standards of
quality. The number of counselor supervisors will be increased, and their skills developed, so that more HVCT counselors can
access these support services. The first cadre of HVCT trainers will also be trained and mentored to train service providers. USG
team and partners will continue assisting SSAC and MOH in the development of the HCT training curricula and guidelines for QA
and HVCT supervision. The USG PEPFAR team will continue to offer HVCT technical assistance to PEPFAR partners, the
government and other stakeholders in HVCT issues. An additional experienced Sudanese CICT counselor and trainer will be
hired by a PEPFAR partner in line with the MOH mandate to develop HVCT training capacity in Southern Sudan.
HVCT service delivery will continue to be targeted to both general and high risk population groups. One approach to increasing
access to HVCT services will be offering services at flexible hours when targeted populations are more likely to use them. Some
of the high risk populations that will be targeted include the military personnel, truck drivers, traders and their associates, sex
workers, and returnees. In addition, more HIV counseling and testing sites will be established in high volume areas like urban
markets, truck drivers resting spots, and other semi-urban areas.
Outreach HVCT services have recorded a comparatively higher service uptake than stand alone HCT sites. Partners operating
stand alone sites will be encouraged to offer outreach services on a regular basis, with the aim of having all sites that have
capacity to offer these services, offering them. More service providers will be trained to support the increase in outreach HCT.
Additionally, services should primarily target locations with limited or no HCT sites, but have demand for HVCT. These may also
be potential locations for establishing stand alone sites in the future.
Intensified efforts will be made to address the continued high levels of stigma around HIV counseling and testing. Mass Media
campaigns, ‘information, education and communication' materials (IEC), and peer education strategies will continue to be used to
mobilize and inform communities about HIV counseling and testing, to encourage uptake of HVCT, including couples HVCT, and
to reduce stigma around HVCT. Appropriate messages will continue to be developed and communicated for this purpose.
Referrals to other services like care and treatment are a pivotal component of HVCT services. Referral systems and linkages will
be strengthened to ensure that all HVCT sites are appropriately referring clients to available services. Follow-up of these referrals
will also be done to determine the extent to which people access the services they are referred to. Social support services that
clients are referred to including support groups for people living with HIV/AIDS (PLHA) and post test clubs (PTC) will also be
strengthened to ensure their services are meeting the needs of their clients.
Finally, logistics management remains a challenge in Southern Sudan, due to low levels of infrastructure and high costs of
transporting supplies and other items. Despite slow improvement, roads in Southern Sudan remain largely undeveloped and
transporting goods by air remains the primary mode of moving supplies and people. To address this, PEPFAR Sudan team will
work more closely with the MoH and other partners from GFATM and MDTF to leverage and enhance the supply chain
management in Southern Sudan.
COLLABORATIONS AND LINKAGES
TB/HIV collaboration activities with WHO will continue in the coming FY 2009. This linkage will be strengthened so that all TB
patients and suspects receive testing and counseling for HIV and all HIV positive clients are screened for TB. These models of
PITC and diagnostic testing in TB programs utilize rapid test algorithms identical to those in use in client-initiated programs.
EXPECTED RESULTS FY09
Number of service outlets providing counseling and
testing according to national and international standards 40
Number of individuals who received counseling and
testing for HIV and received their test results (including TB) 0
Number of individuals trained in counseling and testing
according to national and international standards 50
testing for HIV and received their test results (excluding TB) 35,000
Table 3.3.14:
TBD for ROADS 2.
Table 3.3.17:
Table 3.3.18:
