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: 2007 2008 2009
The purpose of this program is to support continued delivery of comprehensive HIV/AIDS prevention, care
and treatment services to an existing pool of 5,000 HIIV positives clients, to expand services in Rakai and
Lyantonde Districts in Southwestern Uganda and to enhance national HIV leadership and management
training. Program initiatives will support the provision of antiretroviral therapy (ART); adherence counseling,
TB screening and treatment; diagnosis and treatment of opportunistic infections (OI); provision of the basic
preventive care package (BCP); prevention with positives (PWP) interventions; confidential HIV counseling
and testing; and, psycho-social support in health centers and established satellite sites. Following national
ART treatment guidelines and service criteria, each service delivery site will be staffed with trained HIV
clinical and ancillary health care professionals and systems to monitor patients in care for ART eligibility and
initiation will be expanded. Those on ART will also receive continuous adherence counseling and support
services. Prevention with positive interventions must be an integral part of the services to reduce HIV
transmission to sexual partners and unborn children, including specific interventions for discordant couples.
Additionally, activities to integrate prevention messages into all care and treatment services will be
developed for implementation by all staff.
This program will maintain the 16 outreach sites (also called HUBS) based at the existing health centers.
This activity will work to identify pregnant women in the districts of Rakai and Lyantonde, refer them to any
of the 16 clinic ‘hubs" located within the districts and provide them with HIV counseling and testing plus
comprehensive counseling in relation to mother to child HIV transmission (MTCT). For pregnant women
found to be HIV- infected will be evaluated for antiretroviral therapy eligibility using a CD4 cut-off of 350
cells per microliter in accordance with revised Uganda National PMTCT guidelines 2006. Women not
eligible for ART will receive dual combination ART e.g. AZT+ 3TC (Combivir), or AZT + NVP in addition to
palliative basic care comprising of daily cotrimoxazole, use of insecticide treated bed nets (for malaria
prevention) and opportunistic infections (OI) care. After delivery, the HIV-exposed infants will be tested at 6
weeks of age for HIV using DNA- PCR through the ‘early infant diagnosis' program implemented by the
MOH. Reproductive health counseling and services will be provided to all women of reproductive age and
pregnancy testing offered to all women in care. In FY08, it is expected that VCT will be offered to 800
pregnant women and a complete course of ARV prophylaxis for PMTCT provided to 150 women, using AZT
and Nevirapine. Additional work will be done by our health education and mobilization team to provide
information to the Rakai and Lyantonde communities regarding PMTCT through community meetings and
at the outreach programs. Target groups will be Adults, PLWA and women in the reproductive age group.
Provision of PMTCT at the HUB enables more women to access this service within their communities and
reduces the level of stigma since the service is provided at the health center.
The program will use a multi-pronged approach to reach a minimum of 13,000 individuals with information
and services to reduce HIV transmission through Abstinence and Be faithful. Modes of delivery of
messages will include (but not limited to): community meetings, music and drama, sports and film shows,
and use of information, education and communication (IEC) materials developed in collaboration with
Ministry of Health (MOH). Communities ill be reached through sensitization and village meetings, music and
drama shows, and sports events. .
Brochures on ART and AB will be produced in Luganda (the local language) and reproduced to reach a
target population of 13,000 people.
This program will be closely linked to VCT and emphasis will be made on the need for couples-counseling
for married couples. Other activities will include consultation of the Community Advisory Board (CAB) and
sensitization of key community leaders and community health workers on issues regarding Abstinence and
Be faithful. Community leaders will help the program develop appropriate messages tailored to the socio-
cultural context of the community and target groups including: Adults, Boys, Girls and discordant couples;
as well as design appropriate modes of delivering these messages. Community leaders will include
community mobilizers, local council leaders, teachers, religious leaders and health providers.
The Government of Uganda (GOU) has recently included medical male circumcision in its National Strategic
Plan, which is near finalization. This program is ideally s ideally suited to support the GOU and USG
Uganda program in training and service delivery, upon request from the MOH, and following the WHO
surgical manual.
The program will use a multi-pronged approach to reach over 6000 individuals with information and services
to reduce HIV transmission through targeted condom distribution and other prevention services. The
program will offer enhanced counseling discordant couples and promote targeted distribution of condoms to
high risk groups such as commercial sex workers, truck drivers and people living with HIV/AIDS.
Community volunteers will be trained to deliver other prevention messages and organize community
education events. This program will closely link to the ‘HCT know you status campaign'.
The program will support the provision of general medical care, treatment and prevention of opportunistic
infections (OIs) for an existing pool of 5,500 HIV-infected patients attending 16 outreach clinics in the
districts of Rakai and Lyantonde in south-western Uganda. This service will be available bi-monthly at each
HUB and offered to all HIV positive patients registered with the clinic. The service will be offered by a cross
section of providers including counselors, nurses/midwives, home visitors, clinical officers and medical
officers depending on the specific need.
In addition, clients will be regularly assessed for ART eligibility and when eligible, treatments will e initiated
in the same locality. Initiatives to integrate HIV prevention within care and treatment will be promoted for
example prevention with positives interventions that include partner testing, disclosure of HIV status,
condom use, prevention of mother to child transmission and STI care.
HIV/TB activities will include screening for TB, active investigation of individuals suspected to have TB using
sputum examination, hematology and radiological investigations. Individuals that are found to be co-infected
with TB and HIV will be managed according to the National ART guidelines. Initiatives to ensure adherence
to treatment, minimizing drug interactions and toxicity will be implemented. Linkages with the National TB
and Leprosy program (NTLP) for TB medications, the national ART program for ARV, and the national HCT
program will ensure HIV testing of all TB patients is available, ARV services are available for TB patients,
and TB medications are availed. The existing HIV care clinics will also provide regular TB screening for HIV
infected individuals.
The program will provide HIV counseling to individuals in the general community of Rakai and Lyantonde
districts, pregnant women, family members of HIV infected persons, and children born to HIV infected
mothers. Community members will be tested through the VCT approach, while family members will be
reached through the Home based HIV Counseling and testing approach. Infants and children born to HIV-
positive mothers will be tested for HIV using ELISA and PCR as appropriate.
Upon receipt of the FY07 plus-up funding to this partner will provide circumcision services to ~2700 men
residing in Rakai District, in the first year of the initiative.The services will be offered within the Rakai Health
Sciences Center (RHSC) which contains three fully equipped operating theaters, a recovery room, sluice,
autoclaves and sterile storage, and a dormitory for overnight stay for men who reside far from the
facility.Men will be offered free VCT prior to surgery, but this will not be mandatory. Patients will remain in
the RHSP dormitory overnight and will be discharged after examination for short-term
complications.Arrangements will be made for patients to contact RHSP in case of complications after
discharge. Furthermore, men will be asked to return four weeks post-surgery to certify wound
healing.Patients will be instructed in wound care and be told to abstain from sexual intercourse until full
wound healing is certified. Records will be maintained of any adverse events related to surgery and
compliance with instructions on abstinence until complete healing is achieved.After resumption of
intercourse, men and their partners will be advised to practice safer sex (i.e., abstinence, monogamy with
an uninfected partner, or use of condoms).
and treatment services to an existing pool of 5,000 HIV positives clients, to expand services in Rakai and
initiation will be expanded.
Those on ART will also receive continuous adherence counseling and support services. Prevention with
positive interventions must be an integral part of the services to reduce HIV transmission to sexual partners
and unborn children, including specific interventions for discordant couples. Additionally, activities to
integrate prevention messages into all care and treatment services will be developed for implementation by
all staff. This program will provide antiretroviral therapy to an existing 1,400 patients. Treatment will be
provided at the 16 HUBs after intensive health education, clinical and laboratory evaluation.
This program will support activities that include assessment for ART eligibility for HIV-infected individuals
either newly diagnosed or in regular care, initiatives that strengthen adherence to ART medication including:
repeated health education and counseling, routine and surprise home visits to monitor adherence and
toxicity, strengthen family support, and identify family members who may need ART services, regular
monitoring of patients on ART either through clinical evaluation of laboratory testing. Community education
will be done to strengthen communities to support people taking ART and to reduce stigma and
discrimination, mobilize people for VCT and ART services as well as address community concerns about
ART. Pregnant women will be prioritized in the initiation of ART in order to minimize the risk of hIV
transmission to the unborn foetus. Following delivery, infants will be tested for HIV at the age of six weeks
using virologic DNA-PCR testing provided through the national MOH program of early infant diagnosis of
HIV.
The Rakai Health Services Project (RHSP) has experienced surgeons and nursing staff to provide training
to health personnel.
With the release of the FY07 plus-up funding, this program will train 40 physicians and/or clinical officers
(contingent on MOH approval) and approximately 50 theater nurses in the first year of this initiative.Priority
will be given to trainees from the five health centers IVs in Rakai district, with appropriate health
professionals from neighboring districts included as spaces become available.Trainees will first study the
WHO manual and observe surgeries conducted by experienced practitioners.They will then conduct a
minimum of 24 supervised surgeries until certified as competent. Records will be maintained on the number
of surgeries required to achieve competency, the time required, and on any operative or postoperative
complications.Data on the number of supervised surgeries, speed of surgery and rates of post operative
complications will be kept for medical officers compared to clinical officers, in order to provide guidance to
the MOH and other normative and programmatic agencies.Training of ~50 nurses in theater procedures,
asepsis and postoperative care will also be provided during the first year.Each health professional trained
will be observed performing circumcisions in the first 3 months after their initial training, in order to assess
their proficiency post-training. The follow up may occur in their place of work, or they may be invited back to
the training site, depending on logistics.Their surgical records on the MC services they provided will also be
reviewed.
Through this program, funding will be used primarily to purchase laboratory consumables to carry out HIV
testing (Double ELIZA with western blot confirmation where indicated), immunological monitoring of ART
using CD4 cell counts, liver function/Renal function tests (LFT/RFT) to monitor drug toxicity and hematology
to supplement clinical evaluation and progress. Additional, non-routine tests will be supported as required
by the clinicians including, but not limited to, viral loads for patients suspected to be failing treatment with
ART, TB diagnostic laboratory tests, malaria smears, urinalysis and microbiology for special samples
(blood cultures, urine cultures, pus swabs, vaginal, urethral and stool samples). The target group for the
tests is adults and children for HIV diagnosis and people living with HIV/AIDS for the additional tests as may
apply.
The Government of Uganda (GOU) has recently included medical male circumcision in its National
HIV/AIDS Strategic Plan 2006-11 which is near finalization. This program is ideally suited to support GOU
and USG Uganda program in training and service delivery upon request from MOH and following WHO
surgical manual. In addition the program will conduct a public health evaluation to compare the safety,
adverse effects, cost and ease of 3 different surgical procedures (forceps guided, dorsal slit and sleeve
procedure). When FY07 plus-up funding is allocated a needs assessment in the five Rakai District health
center IVs which are equipped with operating theaters will be conducted.This will determine the needs for
facility improvements, equipment and supply needs in the district and the information will be provided to the
MOH for use in planning program expansion.In addition, the program will compare the quality of surgical
procedures conducted by medical officers compared to clinical officers (contingent on MOH approval of MC
provision by the latter cadre of health workers).During the recently ended trail, the RHSP trial used the
sleeve circumcision procedure.The sleeve procedure, although technically more demanding, was
considered to be the safest and most effective approach. Health personnel with a basic surgical
background can be readily trained in this technique. As the Ministry of Health may decide to adopt
technically simpler procedures such as the forceps guided or the dorsal slit methods, it is important to
compare the time required for surgery and postoperative complications rates of different
procedures.Therefore, comparisons of different techniques using standardized follow up procedures at day,
day 7 and 30 postoperatively to determine adverse events, safety, the time and equipment required, costs
and ease of surgery, between the three approaches to circumcision will be conducted. Such data will be
crucial in the design of large scale circumcision programs.
The Makerere School will also provide infrastructure and logistics support for conduct of approved CDC
Sero-Behavioral Surveys amongst MARPS.
This is not a new activity in FY08 but a continuation from FY07 Activity ID 10102.
FY07 Activity ID: 10102
Title: Assessing the Relationship between Intimate Partner Violence and HIV Status Disclosure in Rakai
District, Uganda
Time and money summary: We are currently in year 1 (2007) of the activity and are still awaiting year 1
funds ($50,000). We expect to complete year 1 activities approximately 6 months after their initiation and
intend to begin year 2 activities immediately thereafter. We request an additional $50k for year 2 making a
grand budget total of $100,000.
Local Co-investigator: David Serwadda, Professor and Director, Institute of Public Health, Makerere
University and Investigator Rakai Health Sciences Program; Neema Nakyanjo, Coordinator, Department of
Qualitative Research, Rakai Health Sciences Program
Project description:
Three goals of VCT are reaching clients, client disclosure of HIV serostatus to sexual partners and reducing
risky sexual behaviors of clients. However, violence and fear of violence commonly limit women's ability to
engage in such HIV preventive behaviors. There is growing evidence that fear of violence is a major barrier
to testing (for HIV positive and negative women) and to the disclosure of HIV status to sexual partners for
HIV positive women. Violence is also an outcome of disclosure among some women. Further, women in
violent relationships are less able to adopt risk reduction recommendations.
We propose to qualitatively evaluate:
(1) the impact of fear of violence on HIV positive and negative women's decision to get tested for HIV and
decision to disclose HIV results to their partner(s);
(2) women's experience with risk reduction when in violent relationships;
(3) HIV positive and negative women's experiences with violence as a result of disclosure;
(4) the impact of training HIV counselors to use protocols that address violence;
(5) community recommendations for effectively addressing the overlap between violence and HIV/AIDS.
Data collected during this evaluation will help assess the impact of the SHARE Project's ongoing HIV and
violence focused community mobilization and health education, capacity building programs for VCT
counselors, and HIV/AIDS outreach activities. Information gathered will also assist with the development of
HIV testing and counseling protocols for RHSP and other organizations in Uganda and the region.
Additionally, findings from this evaluation would be instrumental to the national plans for VCT scale up.
Finally, information gathered would be useful to global strategies and recommendations to address violence
against women in the context of HIV testing and counseling.
Status of study/progress to date: The protocol is developed, research plans are in submission for
scientific/human subjects/phe review, and research teams are prepared for implementation. We are slightly
behind schedule due to delays in funding. However, we will be able to make up for time lost by adding
more research assistants to qualitative team, and revising our timeline.
Lessons Learned: Activity has not yet been implemented.
Information Dissemination Plan: The Rakai Program has shared data with various US and European
collaborations (University of London, University of Rotterdam, CDC in Atlanta, University of Washington,
among others) and has a written policy on data sharing. All decisions involve the Ugandan Senior
Investigators, and adhere to Ugandan Ministry of Health directives to ensure maximal use of research
findings, along with safeguards to prevent misuse or misinterpretation of data. Senior Uganda colleagues
act as co-authors on shared data. Findings from the proposed study will be orally presented within the
study site communities through health education seminars, village meetings and meetings with district
health officials. We will encourage and work with the local stakeholders and heads of organizations to
disseminate and use our findings in ways that will be helpful to their program's agenda. Reports on the
study results, incorporating recommendations will be written and distributed to researchers, policymakers,
and program leaders in Uganda who are designing and implementing HIV and violence prevention
programs. Study results also will be summarized in papers for peer-reviewed journals focusing on HIV and
violence prevention and promotion of health
Planned FY08 activities:
(1) Organize, code, analyze and interpret data.
(2) Conduct additional in-depth key informant interviews and focus group discussions as needed to fill gaps
that emerge at the level of analysis.
(3) Use findings to develop participatory training modules and an accompanying guidebook/manual that can
be used by counselors and other health professionals working on HIV/AIDS issues to learn how to
recognize and safely and ethically respond to the intersections of HIV and violence. (These tools, the
training resource and guidebook, will be appropriate for professionals in Rakai and all other districts of
Uganda, as well as throughout East/Southern Africa.
(4) Write up findings for peer-reviewed journal submission.
Budget Justification for FY08 monies:
Salaries/fringe benefits: $20,000
Consultant fees: $10,000
Equipment: $2,300
Supplies: $5,000
Travel: $5,000
Participant Incentives: $2,700
Laboratory testing: $0
Other: $5,000
Total: $50,000
This research, analysis and report writing/manual development project is estimated to cost approximately
$50,000. This will include personnel costs (for RHSP field staff work, administration and data analysis
Activity Narrative: teams) and consultant fees (for work to be done by violence prevention expert from Johns Hopkins
University and a local, East African, artist who will work on development of the training manual). Equipment
costs are budgeted for purchase of 1 Dell XPS 210 Desktop ($1000), 1 Eaton Powerware 9120 2000 VA
Tower UPS System ($1000), and 1 Dell Wireless All-In-One 966 Printer ($259). Supplies are budgeted for
computer software (NVIVO v7 Full License at $500) and other field related expenses, particularly as they
apply to office and printing expenditures. Travel costs are budgeted for 2 round trip tickets for US partner to
travel from Baltimore/DC to Uganda. Also budgeted are minimal field expenditures related to additional data
collection and pilot testing of learning instruments, including participant recruitment, research assistant
needs for conducting focus group discussions and in-depth interviews, transport costs, participant
compensation and community mobilization costs. Health education and mobilization activities are done in
conjunction with all research and service activities conducted by Rakai Program. This is done in order to
sensitize community members and local leaders and to begin participant recruitment. Community health
mobilizers (resident in the research areas) are commonly asked to take part in these activities for which
they are compensated on a daily basis (5,000 UGX per diem). All research participants are compensated
3,000 UGX for their time and participation in research activities. (This will apply to key informants who take
part in in-depth interviews, as well as all who participate in focus group discussions.) Other costs are
budgeted for IRB renewal costs, communications, bank fees and printing expenses incurred at Kampala-
based printing company for developing of pilot versions of training manual.
training. Key program activities supported in FY07 include, provision of ART, adherence counseling; TB
screening and treatment; diagnosis and treatment of opportunistic infection, and provision of basic
preventive care package; prevention with positives (PWP) interventions, confidential counseling and testing
at the health facilities and communities or households. Patients on ART receive continuous adherence
counseling and support services. Prevention with positive interventions is an integral part of the services to
reduce HIV transmission to sexual partners and unborn children, including specific interventions for
discordant couples. . The program implements the comprehensive ABC strategy in line with the national
HIV/AIDS plan 2006/ 11.
In the area of Other Prevention and System Strengthening (OP/SS), the program will collaborate with the
MOH, District Directors of Health Services, training institutions and leading HIV/AIDS organizations in
Uganda, to sustain a national training program that promotes a strong public health approach to HIV service
delivery and program management. Using the platform of service delivery in Rakai district, training
initiatives will be developed to provide practicum opportunities for future leaders to study program
management and evaluation, the translation of HIV evaluation study findings into programs, and the
development of HIV strategies and policy guidelines at organizational and national levels. Through
practicum placements, HIV/AIDS organizations throughout the country will be supported to plan and
evaluate HIV programs, develop pilot interventions, strengthen health information management systems,
and develop HIV/AIDS related policies and implementation guidelines to sustain the expansion of national
HIV/AIDS programs. Mechanisms will be established to award medium to long term training fellowships to
professionals and short term management training courses will be organized for fellows and key staff
working with HIV/AIDS organizations including networks of people living with HIVAIDS, Faith Based
Organizations and community based organizations. In FY08 an estimated 530 middle managers will attend
the short courses and over 20 young professionals will be enrolled into medium to long term training
programs.
In FY08 Makerere University School of Public Health will collaborate with Johns Hopkins Center for Clinical
Global Health Education (CCGHE) and the Internet Educational Equal Access Foundation, Inc (IEEAF), a
non-profit that secures donations (currently spanning 17 time zones) of key equipment, co-location facilities,
fiber optic cables, and capacity on existing infrastructure to link together research and education networks
across continents. This public-private partnership between GMRE, IEEAF and the CCGHE brings
$2,000,000 in donated high-bandwidth fiber optic connectivity to the initiative.
