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 REVISED SIGNIFICANTLY FROM FY2008COP
TITLE: HIV Anti-retroviral Therapy for Adults in Dar es Salaam
NEED and COMPARATIVE ADVANTAGE: Of the 3 million person population of Dar es Salaam region,
267,000 (8.9%) are estimated to be living with HIV/AIDS (PLWHA). Of these, it is estimated that 53,400
(20%) will need ART.
The Muhimbili University of Health and Allied Sciences (MUHAS) is part of the MUHAS, Harvard School of
Public Health (HPH) and Dar es Salaam City Council collaboration, the so-called MDH. MDH has involved
in training and research for more than 15 years.. This collaboration has improved the health system through
increasing space, improving laboratory facilities, training bases, patient monitoring and tracking loss to
follow up. There is strong commitment from the local authorities to advance HIV care and treatment
services.
ACCOMPLISHMENTS: By September 2008: 1) 36 sites provide comprehensive HIV care services,
including ART. 20 of these sites are public and 16 are private facilities (to boost public-private partnership).
2) A total of 25,435 and 17,200 adult HIV patients will have been initiated and actively on ART, respectively.
Previously, among the MDH-supported sites, it was possible increase the median CD4 count from 143/mm3
to 277/mm3, and from 131/mm3 to 317/mm3 among the six and 12 months cohorts of patients on ART,
respectively.
ACTIVITIES:
Expansion of ART services to public and private health facilities.
ART services will be expanded to public dispensaries in each of the three districts. These dispensaries will
be identified together with the district and regional medical offices; discussion is underway.
Staffing support -MDH will support the human resource requirements for delivery of ART in the city
through: recruitment and hiring of necessary staff within the government system with acceptable
compensation, creation of a conducive work environment and training and career planning to ensure job
satisfaction and retention.
Laboratory services - Expand the Ministry of Health and Social Welfare's (MOHSW) zonal quality
assurance\quality control activities. MDH will work with regional and facility level Quality Assurance Officers
to support zonal Quality Assurance Officers in conducting supportive supervision at all regional and district
CTCs in the zone.
Support implementation of the zonal external laboratories' quality assurance activities by: 1) supporting the
quarterly meetings and 2) ensuring enrollment and participation of 22 regional labs in the national and
international external quality assurance (EQA) programs. Support equipment services and maintenance by
training 66 lab staff and 12 zonal equipment engineers on planned preventive maintenance. Support zonal
equipment engineers to perform quarterly supervisions, produce quarterly updates on equipment status and
report to the zonal director, ART partner and equipment engineer at MOHSW diagnostic. Work with Supply
Chain Management Systems (SCMS) and the USG lab team to build the capacity of 50 CTC laboratories'
staff in laboratory supplies and reagent forecasting logistics to ensure uninterrupted quality laboratory
services. Procure reagents for hematology, chemistry, CD4 count and DNA polymerase chain reaction
(PCR) for early infant diagnosis (EID).
Procure 30 additional CD4 machines and chemistry and hematology analyzers for hard-to-reach care and
treatment centers.
ARV provision support - MDH will continue supporting the district medical offices and all the supported
sites in forecasting, acquisition, transport, distribution, storage and stocking of ARVs from the Medical
Stores Department.
Quality management program (QMP) - MDH has developed a comprehensive quality of care assessment
and improvement program. The program has indicators for all aspects of HIV prevention, treatment, care
and support, including PMTCT and TB/HIV. On a regular basis, data is collected, and used to monitor and
improve the quality of patient care. QMP will cover all the existing, as well as new, sites. All the national
M&E indicators are included in our QMP.
Tracking patients on ART lost to follow up: MDH has a patient tracking system to trace those who missed
their scheduled visit, those lost to follow up and those with abnormal laboratory results. Currently, the team
has 37 nurses; an additional 34 will be recruited. We will also involve PLWHA and volunteers with the care
and treatment tracking system. MDH will continue strengthening linkages with other organizations to
ensure continuity of treatment and care to their homes.
Training: In order to continuously build the capacity of all the MDH health care providers, and the district
health management team, a cascade of year round training sessions (introduction and refresher courses)
on the full spectrum of HIV treatment will be conducted using the national curricula. MDH will provide on site
training and follow up, monthly supportive supervision and preceprtorship together with Council Health
Management Teams (CHMT) teams. System strengthening and logistical improvement will be prioritized. In
consultation with the DHM, further training opportunities for selected MDH staff will be offered.
LINKAGES: Within all supported health facilities, mechanisms are in place to: 1) identify pregnant women to
be tested for HIV, 2) assess their eligibility for either prophylaxis (PMTCT) or HARRT, and 3) refer or escort
them to CTC services. Special days for pregnant women's ART management are now in place, and will be
strengthened. MDH is putting all systems in place to be able to screen, diagnose and initiate anti-TB
treatment for HIV patients as per the current national guidance and algorithms. MDH is also working with
partners such as PATH to counsel and test TB patients for HIV; initiating ART for all those who are eligible.
MDH will continue referring to, and working with, other organizations providing services at the community
and home level to ensure continuity of care.
Activity Narrative: CHECK BOXES: Emphasis will be given on the vulnerable groups including adolescents and youth.
Friendly services will be established to attract more youth to the clinics by addressing their needs. MDH will
1) train of service providers in adolescent and youth-focused care, 2) set separate operating hours for them
and 3 ) provide a package of services under one roof.
MONITORING AND EVALUATION: MDH will continue collaborating with the National AIDS Control
Program (NACP) to implement the national M&E system for care & treatment. Patient records at all sites
will be managed electronically using the CTC2 database to generate NACP and USG reports, as well as
local site-level data for use in program planning, monitoring and improvement purposes. MDH will provide
ongoing and regular support, through training and supportive supervision, to all ART-providing sites in order
to build their capacity for optimal data use. MDH will support training for health care workers (HCWs) and
data personnel in SI and provide technical assistance to all CTCs, three district offices and one regional
office. MDH will regularly perform data analyses to evaluate treatment outcomes, and document the lessons
learned which will be shared through various forums, including conferences and publications.
SUSTAINAIBLITY: MDH is working with regional and district authorities in the day to day activities of the
existing system's program. Planning, implementation and monitoring of the activities are done jointly with
the district staff. All MDH activities will be in line with the Comprehensive Council Health Plans. MDH will
continue with district capacity building in infrastructure and human resources. Financial and program
management system capacities will be strengthened through training and technical assistance.
New/Continuing Activity: Continuing Activity
Continuing Activity: 13486
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
13486 3475.08 HHS/Health Harvard University 6519 1513.08 Track 1.0 $5,428,858
Resources School of Public
Services Health
Administration
7719 3475.07 HHS/Health Harvard University 4539 1513.07 Central Budget $5,428,858
3475 3475.06 HHS/Centers for Harvard University 2877 1513.06 Track 1 $0
Disease Control & School of Public
Prevention Health
Emphasis Areas
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $788,597
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.09:
Continuing Activity: 13487
13487 10179.08 HHS/Health Harvard University 6519 1513.08 Track 1.0 $1,357,214
10179 10179.07 HHS/Health Harvard University 4539 1513.07 Central Budget $1,357,214
Estimated amount of funding that is planned for Human Capacity Development $322,149
