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:
ACTIVITY 1: Technical Assistance and Scale-up of Early Infant Diagnosis
Using FY 2009 funding, The Wits Pediatric HIV Clinics (WPHC) and National Health Laboratory Service
(NHLS) aim to assess the implementation challenges and develop guidelines to scale up early infant
diagnosis for infants born in prevention of mother-to-child transmission (PMTCT) programs. Technical
assistance will be provided to the provinces (and other countries on request) to help escalate the rollout of
early infant diagnosis services. This project was specifically requested by Gauteng's Department of Health
(DOH), with strong support from the National Department of Health and its PMTCT Early Diagnosis
Committee. Technical assistance for the introduction of the new automated Taqman assay to replace the
HIV DNA polymerace chain reaction (PCR) assay will be provided. In particular, monitoring the performance
of this new assay in the field will be done in relation to the new dual therapy PMTCT program; the age of the
infant and the ability to use the assay for viral load monitoring on dried blood spots; monthly PCR test
statistics for monitoring the progress of the program will be provided to HIV program managers in Gauteng
and the monitoring database will be upgraded to a national level (except for KZN data); incorporation of
rapid HIV tests for infants and children; updating of diagnostic algorithms for children in an evidence-based
manner; and establishing a system for feedback from clinics for central monitoring (e.g., service issues,
quality control, etc.). A program that increases peripartum HIV testing of women to improve identification of
HIV-exposed infants is being assessed. All women are offered HIV testing in the peripartum period, newly
diagnosed HIV-infected women's babies are given post-exposure prophylaxis and infants are followed to 6-
weeks of age for PCR testing. Monitoring of the accuracy of the rapid tests supplied by DOH is done using
"Determine" as a gold standard test because health-care worker confidence in these tests that are
frequently changed is low.
ACTIVITY 2: Capacity Building
In FY 2009, WPHC and NHLS will continue to facilitate training clinic health-care workers including nurses,
doctors and lab technician in the area of early infant diagnosis. Training content will be updated as practice
evolves. The training will ensure that infants exposed to HIV accessing immunization clinics at six weeks of
age are offered PCR testing. Training will help facilitate an average increase in test volumes from 3,500 to
4,500 per month in the Johannesburg laboratory. Serum panels from infants and children will be
prospectively stored for testing rapid HIV tests. The latter are currently evaluated only on adult samples.
ACTIVITY 3: Linking the Expanded Program for Immunizations at Primary Health-care Clinics with Early
Infant Diagnosis
In FY 2009, WHPC and NHLS will continue to explore systems to ensure primary health-care clinics (PHC)
clinics act as entry points for HIV-affected children by identifying HIV-infected children (and other family
members) for comprehensive HIV medical care, including referral between PHC and hospital facilities.
-------------------------------------------
SUMMARY:
The Wits Pediatric HIV Clinics (WPHC) and National Health Laboratory Service (NHLS) will use PEPFAR
funds to expand a demonstration project that was implemented with FY 2006 and FY 2007 funding. The
project is aimed at increasing access to early HIV diagnosis for infants, and developing guidelines for rollout
of the project on a national level. This project was specifically requested by the Gauteng provincial
Department of Health (DOH), with strong support from the National Department of Health (NDOH) and its
Prevention of Mother-to-Child Transmission (PMTCT) Early Diagnosis Committee. Local organization
capacity building, in-service training and ongoing operational research validating suitable HIV assays will be
the major emphasis areas for this program, with minor emphasis given to commodity procurement,
development of networks, linkages, and referral systems (especially between immunization clinics, early
infant diagnosis and treatment, care and support),and logistics. The primary target population will include
HIV-exposed infants (birth to five years old) and infants who are not infected, and secondary target
populations include lab workers, doctors, nurses and South African government policy makers.
BACKGROUND:
Early infant diagnosis of HIV is vital for monitoring PMTCT programs and identifying HIV-infected children to
receive care. Diagnosing HIV in children is more complex than in adults because of the interference of
maternal HIV antibodies during infancy and ongoing exposure to the virus during breastfeeding. To date,
HIV diagnostic services for children in low resource settings have been neglected and healthcare workers
are not familiar with its theory or practice. About five million people in the country are HIV-infected and it is
estimated that about 500,000 of these, which include 60,000 children, are in urgent need of antiretroviral
(ARV) therapy. One frequently cited reason for so few children accessing treatment is the fact that
mechanisms to diagnose infants early are not in place. Although NDOH Guidelines have made provisions
for early diagnosis with HIV DNA PCR, in most places this has not yet replaced the previous protocol of
using HIV ELISA tests at 12-months of age. In reality, infants are not followed up either die before
accessing care or only present once they are already ill with their first HIV-related illness. Lack of early
diagnosis for exposed infants and the integration of PMTCT services with services providing ARV drugs
have been identified as keys to improving access to care for HIV-affected children and their families, and
thereby increasing the number of HIV-infected people receiving treatment.
ACTIVITIES AND EXPECTED RESULTS:
ACTIVITY 1: Technical assistance and scale-up of early infant diagnosis
Using FY 2008 funding, this activity aims to assess the implementation challenges and develop guidelines
to scale-up early infant diagnosis for infants born in PMTCT programs. Technical assistance will be
Activity Narrative: provided to the provinces to help facilitate the rollout of early infant diagnosis services. This project was
specifically requested by the Gauteng province DOH, with strong support from NDOH and its PMTCT Early
Diagnosis Committee. Technical assistance will be provided to improve lab infrastructure to conduct early
infant diagnosis and scale up these services around the province. Technical assistance will be provided to
establish dried blood spot testing in all HIV DNA PCR laboratories; to make monthly PCR test statistics
available, e.g., to "Concerned Pediatricians" to monitor progress; to optimize current and new HIV assays
used; to update diagnostic algorithms for children in an evidence-based manner; and to establish a system
for feedback from clinics for central monitoring, e.g., service issues, quality control, etc.
In FY 2008, WPHC and NHLS will continue to facilitate training of clinic healthcare workers including
nurses, doctors and lab technician in the area of early infant diagnosis and update training content as
practice evolves. The training will ensure that infants exposed to HIV accessing immunization clinics at six
weeks of age are offered PCR testing. Training will help facilitate an average increase in test volumes from
3,000 to 4,500 per month.
ACTIVITY 3: Linking the expanded program for immunizations (EPI) at primary healthcare clinics (PHC)
with early infant diagnosis.
In FY 2008, WHPC and NHLS will continue to explore systems to ensure PHC clinics act as entry points for
HIV-affected children by identifying HIV-infected children (and other family members) for comprehensive
HIV medical care, including referral between PHC and hospital facilities.
The NHLS early infant diagnosis demonstration project directly contributes to PEPFAR's 2-7-10 goals by
increasing the number of infants accessing treatment in Gauteng, and serving as a platform for expansion
of early infant diagnosis programs throughout the country. These activities support the PEPFAR Five-Year
Strategy for South Africa by supporting government efforts to improve quality of and access to care and
treatment for HIV-infected children.
New/Continuing Activity: Continuing Activity
Continuing Activity: 16023
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
16023 16023.08 HHS/Centers for Wits Health 7316 7316.08 CARE UGM $183,262
Disease Control & Consortium, NHLS
Prevention
Emphasis Areas
Health-related Wraparound Programs
* Child Survival Activities
Human Capacity Development
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
Using FY 2009 funding, this activity aims to assess the implementation challenges and develop guidelines
to scale up early infant diagnosis for infants born in PMTCT programs. Technical assistance will be provided
to the provinces (& other countries on request) to help escalate the rollout of early infant diagnosis services.
This project was specifically requested by the Gauteng Province DOH, with strong support from NDOH and
its PMTCT Early Diagnosis Committee. Technical assistance for the introduction of the new automated
Taqman assay to replace the HIV DNA polymerase chain reaction (PCR) assay will be provided. In
particular, monitoring the performance of this new assay in the field will be done in relation to the new dual
therapy PMTCT program, the age of the infant and the ability to use the assay for viral load monitoring on
dried blood spots. Monthly PCR test statistics for monitoring the progress of the program will be provided to
HIV program managers in Gauteng & the monitoring database will be upgraded to a national level (except
for KwaZulu-Natal data); incorporation of rapid HIV tests for infants and children; updating of diagnostic
algorithms for children in an evidence-based manner; and establishing a system for feedback from clinics
for central monitoring, e.g., service issues, quality control, etc. A program that increases peripartum HIV
testing of women to improve identification of HIV-exposed infants is being assessed. All women are offered
HIV testing in the peripartum period, newly diagnosed HIV-infected women's babies are given post-
exposure prophylaxis and infants are followed to 6-weeks of age for PCR testing. Monitoring of the
accuracy of the rapid tests supplied by DOH is done using Determine as a gold standard test because
healthcare worker confidence in these tests that are frequently changed is low.
In FY 2009, The Wits Paediatric HIV Clinics (WPHC) and National Health Laboratory Service (NHLS) will
continue to facilitate training of clinic healthcare workers including nurses, doctors and lab technicians in the
area of early infant diagnosis and update training content as practice evolves. The training will ensure that
infants exposed to HIV accessing immunization clinics at six weeks of age are offered PCR testing. Training
will help facilitate an average increase in test volumes from 3,500 to 4,500 per month in the Johannesburg
laboratory. Serum panels from infants and children will be prospectively stored for testing of rapid HIV tests
which are currently evaluated only on adult samples.
with early infant diagnosis. In FY 2009, WHPC and NHLS will continue to explore systems to ensure PHC
-----------------------
SUMMARY: The Wits Paediatric HIV Clinics (WPHC) & National Health Laboratory Service (NHLS) will use
PEPFAR funds to expand a demonstration project that was implemented with FY 2006 and FY 2007
funding. The project is aimed at increasing access to early HIV diagnosis for infants, and developing
guidelines for rollout of the project on a national level. This project was specifically requested by the
Gauteng provincial Department of Health (DOH), with strong support from the National Department of
Health (NDOH) and its Prevention of Mother-to-ChildTransmission (PMTCT) Early Diagnosis Committee.
Local organization capacity building, in-service training and ongoing operational research validating suitable
HIV assays will be the major emphasis areas for this program, with minor emphasis given to commodity
procurement, development of networks, linkages, and referral systems (especially between immunization
clinics, early infant diagnosis and treatment, care and support),and logistics. The primary target population
will include HIV-exposed infants (birth to five years old) and infants who are not infected, and secondary
target populations include lab workers, doctors, nurses and South African government policy makers.
using HIV ELISA tests at 12-months of age. In reality, infants are not followed up and either die before
ACTIVITY 1: Technical assistance and scale up of early infant diagnosis
provided to the provinces to help facilitate the rollout of early infant diagnosis services. This project was
Activity Narrative: available, e.g., to "Concerned Pediatricians" to monitor progress; to optimize current & new HIV assays
In FY 2008, WPHC & NHLS will continue to facilitate training of clinic healthcare workers including nurses,
doctors and lab technician in the area of early infant diagnosis & update training content as practice
evolves. The training will ensure that infants exposed to HIV accessing immunization clinics at 6 weeks of
age are offered PCR testing. Training will help facilitate an average increase in test volumes from 3,000 to
4,500 per month.
with early infant diagnosis
In Fy 2008, WHPC & NHLS will continue to explore systems to ensure PHC clinics act as entry points for
HIV medical care including referral between PHC and hospital facilities.
Continuing Activity: 16285
16285 16285.08 HHS/Centers for Wits Health 7316 7316.08 CARE UGM $191,000
Table 3.3.16:
