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.
SUMMARY:
These activities were in the FY 2008 COP under National Institute for Communicable Disease (NICD), a
parastatal organization that works directly with the South African government to provide laboratory testing
and surveillance for communicable diseases. However, the NICD cooperative agreement has finished and
a To Be Determined (TBD) implementing partner will be awarded the new cooperative agreement in the
next year to implement these activities. FY 2009 funds will be used to support: 1) the dissemination of the
newly enhanced materials augmenting sexually transmitted infection (STI) clinical management and
HIV/STI prevention for health care providers; and 2)marketing and dissemination of an HIV/STI prevention
and condom skills-building video targeting high-risk youth (i.e. already sexually active).
BACKGROUND:
The first activity builds on work funded in FY 2008 and addresses a recommended Effective Program for
most at risk populations (MARP), diagnosis and treatment of STIs. By the end of FY 2008 the provider
survey will be conducted and, based on results, new materials, curricula augmentations, and job aids are
being developed to support public and private sector health care workers in providing more effective STI
management, including integration of HIV/STI prevention activities and promotion of HIV testing. This
activity builds on previous work to disseminate the new materials to public and private health care workers
through professional organizations and national, provincial and district programs through a variety of routes.
In the expanded activity, the target populations are still primary care health care workers providing STI
management (usually nurses and physicians, and as possible traditional providers and other associated
providers [e.g., pharmacists]). Activities have been conducted in collaboration with the provincial, district
and local health departments and professional organizations (for the private sector).
The second activity supports the South African government and Gauteng provinces commitment toward
interventions aimed at HIV prevention among youth. Adolescents have enhanced behavioral and biologic
risk for STI/HIV acquisition, and are recognized as an important population at risk for future HIV infections.
Currently, only limited interventions that promote self-efficacy for safe sex choices are available in South
Africa; and many interventions that currently exist may be losing effectiveness through over use. To change
adolescents' norms, attitudes and behaviors around risky sex, multiple methods of providing safe sex
messages (e.g., correct information, skills that promote self-efficacy for safe sex choices) are needed -
especially methodologies that youth perceive to be fun and acceptable.
ACTIVITIES AND EXPECTED RESULTS:
NICD will carry out two separate activities in this program area.
ACTIVITY 1: Dissemination of Enhanced Health Provider Interventions
The target population is private and public sector health workers providing STI clinical management. The
activities focus on enhancing and strengthening existing provider training curricula, clinical management
guidelines, clinical tools and "job aids" (e.g., laminated cards and posters, checklists). The training will also
focus on correct condom use and incorporating distribution of condoms in clinical settings. FY 2009 funding
will be to: 1) Hire 1.5 FTEs local staff who will help support dissemination of the intervention and will train
private providers and in the public sector; they will be conducting training of trainers workshops; 2) Identify
public and private sector sites, curricula, and informational activities to which enhanced materials can be
directed; these should include pharmaceutical sites and (as possible) traditional providers; 3) Present and
disseminate materials to leaders and managers of STI/HIV management and prevention activities in various
organizations; 4) Solicit feedback on educational materials from collaborators, and identify opportunities for
integrating new materials into already existing curricula, work plans and work settings for health providers;
5) Reproduce and translate new materials into local languages as appropriate; and 6) Collaborate with
national, provincial and local government, private sector (e.g., professional organizations), local NGOs and
CBOS as appropriate to conduct activities. The prime partner will hire needed staff, commodities, and other
services to conduct the activity. It is expected that 300 providers will be trained to provide more effective
STI management, including integration of HIV/STI prevention activities and promotion of HIV testing. The
300 providers will be expected to reach 100 STI patients in the next 12 months for a total of 30,000 clients
reached. Sustainability will be addressed through identification and training of staff who are familiar with the
private and public sector issues and can disseminate the products appropriately through use-friendly
processes, including the internet. In addition, sustainability will be addressed because existing training and
information, communication and educational (IEC) materials will be enhanced rather than developing new
materials. Human capacity development is part of all aspects of the project, as activities are aimed at
enhancing STI clinical management of providers.
The activity will contribute directly to preventing transmission of HIV among infected persons, and
preventing acquisition of HIV among HIV-negative persons. It is also likely to lead to additional HIV testing,
and support HIV-infected men to access HIV clinical care because providers will be trained on HIV testing
so that testing can be offered as part of primary care services without waiting at HIV counseling and testing
sites.
ACTIVITY 2: Adolescent Prevention Video
The target population is high risk youth (i.e., soon to be or already sexually active). Based on results of the
pre-and post-test surveys, the prime partner will collaborate with CDC staff to support marketing and wide
dissemination of the video within youth clinics in South Africa. FY 2009 funding will be used to: 1) Hire a
local staff person familiar with youth venues and marketing strategies who will support dissemination of the
new video; 2) Identify potential youth-friendly venues for provision of the video, and marketing strategies to
target those venues; 3) Travel as appropriate for presentation of the video to directors/staff at potential
venues, events, and relevant meetings (e.g., national and international conferences); 4) Transfer of video
through direct copies, internet services, public health and other services, and national and international
Activity Narrative: conferences; and 5) Collaborate with local, provincial and national government officials as appropriate, as
well as NGOs and CBOs and private sector to conduct activities. The prime partner will hire needed staff,
commodities, and other services to conduct the activity. Targeted sites for dissemination are those providing
youth friendly services, regardless of health or non-health context. Sustainability will be addressed through
use of a local person familiar with youth venues and marketing techniques, and who is able to use multiple
dissemination techniques (e.g., internet based). Human capacity development is addressed through the
information and skills that are provided to youth in the video, as well as through training and development of
the local marketer.
New/Continuing Activity: New Activity
Continuing Activity:
Emphasis Areas
Gender
* Addressing male norms and behaviors
* Increasing gender equity in HIV/AIDS programs
* Reducing violence and coercion
Refugees/Internally Displaced Persons
Human Capacity Development
Estimated amount of funding that is planned for 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:
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
Activity 1: This activity was only partially initiated in 2008, due to lack of funding during the Prime Partner
(NICD) Continuation application approval process. A new partner to be determined (TBD) (STIRC Follow
on) has been identified to allow activities to begin. A close partnership with the Mothusimpilo non-
governmental organization (NGO) in Carletonville has been maintained. A protocol is under development in
collaboration with technical STI partners in Atlanta (CDC/DSTDP), and will be cleared through local and
CDC Ethical Review Boards. Additionally, because of the delays, new approvals are being obtained from
the Gauteng and North West Departments of Health and the West Rand Health Dept. Project staff
announcements have been developed to allow quick hire of project staff when needed approvals are
completed. The initial activities will be completed as described in earlier COP submissions. Additionally,
because of new data on better means of promoting contact tracing and HIV uptake in partners, more
activities are anticipated in this regard -- especially promoting HIV testing in male partners.
Activity 2: This activity will use two nurses rather than one, due to significant operational difficulties
experienced when staff left for other positions and in order to ensure cover for sickness, other leave and
training. The use of two nurses will ensure that projected targets will be met, through an increased
workforce. During 2008 it became clear that a major challenge that needs to be addressed is the poor
attendance of sexual partners to the project site. Some data were collected in this area that will allow
development of additional partner notification interventions that will be tried out in 2009.
---------------------------
ACTIVITY 1: Cervical screening, HPV testing and STI screening in women at high risk of STIs and HIV
(includes sex workers, women with multiple partners, and women whose sex partners have multiple
partners).
This project aims to screen 600 women at high risk for STIs/HIV for STIs, cervical dysplasia/cancer and
HPV infection. The project will be undertaken in collaboration with a local non-governmental organization
(NGO) as well as technical sexually transmitted infection (STI) partners in Atlanta (CDC/DSTDP). The
project will provide capacity to local clinical, counseling and peer educator staff in these areas. This
baseline information will provide the key data on the prevalence of STIs and cervical pathology among a
high risk cohort of women with STIs/HIV, most of whom have never had access to cervical screening before
due to economic issues and living in rural areas. The results of this program project will serve as a model
for other rural areas to conduct STI and cervical dysplasia/cancer screening in high risk women. The
activity is anticipated to contribute directly to PEPFAR 2-7-10 goals in Care by increasing care outlets,
training of staff on palliative care including STI management, and detection and treatment of sexually
transmitted infections and other opportunistic infections including cervical dysplasia/cancer screening.
ACTIVITY 2: STI screening among asymptomatic HIV-infected persons in an HIV clinical care setting.
This project aims to screen 1,200 asymptomatic HIV-infected patients for a number of key STIs which have
been linked to further HIV transmission to HIV-negative partners. Data obtained in 2007, when this project
was initiated highlighted the high burden of asymptomatic STIs in this patient population. All STIs
diagnosed were treated etiologically, and contact tracing initiated. Sex partners are encouraged to return to
the project site, or else to local health care facilities, for appropriate STI treatment, prevention activities
(including training on use of male and female condoms and provision of condoms), and routine offer of HIV
testing and counseling. The activity is anticipated to contribute directly to PEPFAR 2-7-10 goals in Care by
increasing care outlets, training of staff on palliative care including STI management, and detection and
treatment of sexually transmitted infections and other opportunistic infections.
Health-related Wraparound Programs
* Family Planning
* Safe Motherhood
* TB
Table 3.3.08:
This PHE activity, 'HIV/STI Brief Risk Counselling (BRISC) for STI Patients in Primary Care Settings' was
approved for inclusion in the COP. The PHE tracking ID associated with this activity is ZA.06.0208.
Estimated amount of funding that is planned for Public Health Evaluation
Table 3.3.14:
This project aims to screen 1,500 youth for a number of key sexually transmitted infections (STIs), which
may enhance both HIV acquisition and transmission. Many STIs in youth are asymptomatic and will thus not
be treated in the syndromic management approach adopted by South Africa. There are very limited data
available on the burden of asymptomatic STIs among youth. Youth will be screened for gonorrhoea,
chlamydial infection, trichomoniasis, and, if a genital ulcer is present, for chancroid, syphilis and genital
herpes. All youth will be offered serological screening for syphilis and be offered on-site rapid tests for HIV
and HSV-2 antibodies. Sera, de-linked to patient details, will be tested anonymously for HIV and HSV-2
antibodies in the laboratory to obtain prevalence data for all youth who undergo serological screening for
syphilis. All STIs diagnosed will be treated etiologically by the project nurses, and contact tracing initiated.
Sex partners are encouraged to return to the project site, or else to local health care facilities, for
appropriate STI treatment, prevention activities (including training on use of male and female condoms and
provision of condoms), and routine offer of HIV testing and counseling. As well as providing important
surveillance data on the burden of HIV and STIs in youth, the activity is anticipated to contribute directly to
PEPFAR's 2-7-10 goals by increasing HIV VCT outlets, training of staff on STI and HIV management,
detection and treatment of STIs, and detection of new HIV cases and onward referral to HIV
wellness/treatment sites.
In the FY 2009 COP, the STI microbiological surveillance activity will be modified in that only the youth
component of the five groups mentioned in the FY 2008 Activity Narrative will be pursued in terms of this
new STI Reference Center (STIRC/NICD)-DSTDP(CDC-Atlanta) follow-on co-operative agreement.
The proposed activity will now use two nurses rather than one in order to address gender-specific requests
for genital examinations by the youth. Two counselors rather than one will also be employed to ensure that
youth do not have to wait long for HIV counseling/results and will allow counselor sufficient time to assist
with provision of negative STI results and HIV prevention messages to youth. In addition, the employment of
two nurses and two counselors will overcome the sorts of operational difficulties experienced on other
PEPFAR funded activities undertaken by the STI Reference Center in FY 2008 when staff left for other
positions (one 'care' project had to stop for several months pending appointment of a new nurse) and to
ensure cover is available for sickness, other leave and training.
Table 3.3.17:
