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
In January 2008, Kalangala District Local Government received PEPFAR funding to implement a full access
100% home based HIV counseling and testing and basic care in Kalangala district and the surrounding
fishing communities. The objectives of the four year program were to 1) achieve 100% awareness on HIV
counseling and testing among fishing communities Kalangala district; 2) Provide confidential HIV counseling
and testing to 22,000 adults (including 5,000 couples) and their eligible children; 3) to identify 6,000 new
HIV-positive people and offer them basic care and referral to care and treatment; 4) To reduce the risk of
HIV infection in the population through appropriately targeted prevention interventions.
Kalangala district was specifically targeted with this program to respond to the prevailing needs of the
fishing communities related to vulnerability to HIV. Kalangala District, located in Central Uganda is
comprised of 84 Islands in Lake Victoria of which 64 are permanently habited and 8 habited due to fish
migratory patterns and harsh weather conditions. Kalangala's unique geographical location has resulted in
limited health and human services to this marginalized population of 36,661 (2002 Census) and projected
population of 100,000 people (2008). The district is served by only eleven health units: two Health Centre
(HC) IVs, six HC IIIs and three HC IIs. There is no hospital located within the district. Referrals for patients
with complicated health problems are made to mainland Entebbe, Kitovu, and Masaka Regional Referral
Hospitals which is 80 kilometers from the main island. Results from the 2005 Uganda National Health and
Behavioral Survey (USHBS) demonstrate that the central region, in which Kalangala is located, has the
highest HIV prevalence in the country, reported at 8.5%. The secondary analysis of the USHBS central
region data indicate that Kalangala District, has a prevalence of 27% which is approximately five times the
national average, thus this population of fishermen and their families have been identified as a very-high
risk group.
By July 31 2008, the program office had been established and equipment procured; project staff including
45 full time staff and 100 mobilisers had been recruited and trained; 3,401 individuals including 155 couples
had received HIV counseling and testing and 711 HIV-positive individuals had been identified and provided
basic palliative care and referred for chronic care management. As part of the community education and
counseling support provided to individuals who had accessed the services, messages promoting abstinence
and be faithful (AB) interventions aimed at stemming HIV infections among individuals, couples, and
families were developed. Community mobilisers were trained to conduct prevention education sessions for
the fishermen and their families with a focus on behavior change practices that emphasize mutual fidelity
among partnerships. Field teams and volunteers were trained to disseminate AB prevention messages
when counseling patients. In collaboration with the District Directorate of Health Services, local fishing
groups and PHA networks, this program used a variety of communication channels such as drama,
community meetings, and where appropriate, radio programs at local FM stations to reach target groups
such as women and adolescents to disseminate the appropriate AB HIV prevention messages in the
communities. Working with local community groups and PHA networks, the program supports the set-up
and/or strengthening of community-based support groups and post-test clubs to assist in providing
psychosocial support to persons who test positive for HIV. The program also supports efforts to reduce
HIV/AIDS-related stigma and discrimination by providing information and education aimed at changing
people's perceptions and attitudes about HIV/AIDS. Through radio programs, community meetings,
education sessions at identified community outlets and other similar fora, the program hopes to foster a
dialogue among residents, with a view towards reducing negative attitudes about PHAs.
In FY 2009, the project will continue to support the implementation of sexual prevention interventions
among individuals, couples and families targeted with HCT in the district with a view to increasing the
number of mobilisers trained to conduct these activities. The activities will include the continued training of
mobilisers to conduct prevention education to patients, training of field teams and volunteers to disseminate
prevention messages and the use of communication strategies to reach target groups to disseminate AB
HIV prevention messages. This activity proposes to reach approximately 50,000 individuals with AB
interventions and train 160 volunteers. Additional community-based support groups and/or post test clubs
will be strengthened or established and information, education and communication activities to reduce
stigma and negative attitudes regarding PHAs will also be implemented, including training volunteers to
promote these activities. The number of condom distribution outlets will be expanded to 35.
In collaboration with other partners, Kalangala district local government will increase access to HIV
prevention messages for the communities, beyond abstinence and Be faithful. Condom service outlets will
be expanded and in addition to condoms availed free, the social marketing options through the Uganda
Health Marketing Group will be made available. In addition emphasis on staff and community mobiliser
training will be placed on prevention with positives (PWP) counseling support. PWP interventions include
counseling of patients on disclosure of sero-status to partners, partner testing, and promotion of behavior
change that emphasize correct and consistent condom use among sero-discordant couples and populations
that engage in high-risk behaviors.
New/Continuing Activity: Continuing Activity
Continuing Activity: 13221
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
13221 9456.08 HHS/Centers for Kalangala District 8670 8670.08 $80,000
Disease Control & Health Office
Prevention
9456 9456.07 HHS/Centers for Kalangala District 8792 8792.07 $40,000
Emphasis Areas
Gender
* Addressing male norms and behaviors
* Increasing gender equity in HIV/AIDS programs
* Increasing women's legal rights
* Reducing violence and coercion
Human Capacity Development
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.02:
HIV-positive people ad offer them basic care and referral to care and treatment; 4) To reduce the risk of HIV
infection in the population through appropriately targeted prevention interventions.
population of 100,000 people(2008). The district is served by only eleven health units: two Health Centre
Continuing Activity: 13222
13222 9458.08 HHS/Centers for Kalangala District 8670 8670.08 $70,000
9458 9458.07 HHS/Centers for Kalangala District 8792 8792.07 $55,000
Table 3.3.03:
By July 31st 2008, the program office had been established and equipment procured; project staff including
basic palliative care and referred for chronic care management. Through this program PHAs, discordant
couples, and family members are provided with basic HIV/AIDS care services by the HIV Counseling and
Testing (HCT) field teams and selected Health Units. Additional collaborative linkages have been made with
health units in the mainland, including Masaka and Kitovu Hospitals, for more specialized care. The
program has developed and is implementing a referral system for HIV+ individuals for care and support with
a view to reduce stigma towards HIV, reduce chances of transmission, and improve the quality of life of
PHAs. Cotrimoxazole prophylaxis is provided along with care for opportunistic infections (OI), as well as
malaria diagnosis and treatment. Safe water vessels and supplies, insecticide treated bed nets, and
condoms, as appropriate, are provided through leveraging with other the PEPFAR partner Population
Services International (PSI) to provide adequate Basic Care Packages for HIV+ individuals and their
families. This basic care initiative is fully integrated through referrals to Kalangala Health Centre IV,
Entebbe, Masaka and Kitovu Hospitals to ensure that all patients have access to chronic care services and
ART eligibility screening. In addition, Kalangala HBVCT program has supported the strengthening of the
referral system for HIV-positive persons leading to about less than 10% of the identified HIV+ persons were
enrolled in the HIV clinics within two months after diagnosis. The major reason for low enrollment in the
chronic care clinics remains the high cost of water transport between the health facilities and the islands.
Chronic care clinics at these referral sites will be supported to provide basic care kits to all registered
clients. This program also will promote participation of and enhanced partnerships with community based
organizations (CBOs), and non-governmental organizations (NGOs) operating HIV/AIDS service delivery in
the district, thereby building capacity and infrastructure for sustainable services. In addition emphasis on
staff training will be placed on prevention with positives (PWP) counseling support. PWP interventions
include counseling of patients on disclosure of sero-status to partners, partner testing, and promotion of
behavior change that emphasize correct and consistent condom use among sero-discordant couples and
populations that engage in high-risk behaviors.
In FY 2009, the program will continue to work to provide access to basic and palliative HIV/AIDS care
services and support to PHAs in Kalangala. Cotrimoxazole, treatment of OI, and diagnosis and treatment of
malaria will continue to be provided to PHAs. For more specialized care, individuals will continue to be
linked to Masaka, Entebbe and Kitovu Hospitals on the mainland. Support will be provided to individuals to
access mainland health units when referrals are made. The program will continue to work with PSI Uganda
to obtain safe water vessels, bednets and condoms as needed for patients. The program will also continue
to build partnerships with organizations in the district providing health services so that PHAs and other
family members can be referred to these agencies for services such as family planning and PMTCT as
needed.
Continuing Activity: 13223
13223 9434.08 HHS/Centers for Kalangala District 8670 8670.08 $286,000
9434 9434.07 HHS/Centers for Kalangala District 8792 8792.07 $200,000
Health-related Wraparound Programs
* Child Survival Activities
* Family Planning
* Malaria (PMI)
* Safe Motherhood
* TB
Estimated amount of funding that is planned for Water $20,000
Table 3.3.08:
basic palliative care and referred for chronic care management. Field HIV Counseling and Testing (HCT)
teams comprise a counselor and laboratory assistant who conduct counseling and testing services in
clients' homes. Community mobilization and support is conducted by a team of 100 Community Owned
Resource Persons (CORPS)/ Mobilisers that have been identified by the communities served and trained by
TASO Uganda.
TB/HIV program area is a new component that has not been effectively addressed with FY 2008 funding.
The program plans to contribute to the response to the challenges to effective TB/HIV care for patients.
These challenges include a limited capacity to identify TB cases using either sputum smears or chest x-rays
in most health facilities; limited access to TB treatment centers by patients; shortage of qualified/well trained
health workers and; poor treatment adherence.
With FY 2009 funding the project will ensure that all HIV positive patients are referred to chronic care
clinics where TB screening is routinely done. This program will support efforts that provide cross-referral
and integrated diagnosis, treatment, and support services for TB and HIV in targeted health facilities in
Kalangala. HIV+ patients will be actively screened and treated for TB at initial diagnosis and during follow
up at chronic care clinics. HIV counseling and testing will be offered to all patients in the TB clinics. In
addition, opportunities will be explored to counsel TB patients under the DOTS program about the
importance of HIV testing and treatment adherence for ARVs. In collaboration with the PEPFAR laboratory
strengthening initiative, this project will contribute to the functionality of health facilities' laboratory capacity
for TB and HIV including an assessment of laboratory capacities at targeted facilities to identify areas that
will need priority actions. The assessment will examine factors such as the availability of laboratory staff and
their level of training/experience, the number and types of laboratory services currently available (with an
emphasis on HIV/AIDS and TB diseases), current infrastructure (quality of testing tools, and other non-
expendable equipment), availability of supplies (reagents and protective gear) and supply-chain, availability
of operating procedures and protocols for laboratory management and performance, and the level of
resources allocated to laboratory performance by district planning committees. From the assessment, a
plan to address the gaps identified will be developed according to MOH guidelines and implemented in
collaboration with the National TB and Leprosy Program. Finally in working with the district education and
communication (IEC) teams, the program will provide support for a communications campaign aimed at
increasing TB-DOTS and ART literacy in target health facilities and the surrounding communities. Health
facility staff will be supported in data management and analysis to enable them to better monitor adherence
to relevant treatment regimes and to track progress in the performance of their activities. The Kalangala
District Directorate of Health Services in collaboration with MOH and JCRC will ensure a constant supply of
TB drugs, septrin and ARVs to TB/HIV co-infected patients. Support supervision and on-job training will
strengthen TB/HIV integrated services.
Continuing Activity: 13224
13224 9443.08 HHS/Centers for Kalangala District 8670 8670.08 $80,000
9443 9443.07 HHS/Centers for Kalangala District 8792 8792.07 $50,000
Table 3.3.12:
fishing communities. The objectives of the four year program were to; 1) achieve 100% awareness on HIV
TASO Uganda. Actual HBHCT started on June 11th 2008, and by the end of July 31st 2008, an estimated
3,401 persons had been counseled, tested for HIV and received their results in their homes on the mainland
as well as along the fish landing sites in Lake Victoria. Counseling and testing in-home environment has
been indicated to improve community knowledge and communication about HIV/AIDS among family
members and in turn contribute to the reduction of stigma and discrimination. In addition, as demonstrated
in the other districts implementing this approach, there is a greater potential when targeting the family in
their home to identify undiagnosed HIV among family members especially in the identification of discordant
couples. Results from the 2004-2005 Uganda HIV/AIDS sero-behavioral survey report that 85% of HIV
positive people have not been tested for HIV and approximately half of HIV+ married/co-inhabiting
individuals are sero-discordant creating a high potential for transmission. This program also promotes
participation of and enhanced partnerships with community based organizations (CBOs) and non-
governmental organizations (NGOs) operating in HIV/AIDS services delivery in the district, thus building
capacity and infrastructure for sustainable services.
In FY 2009, the program will continue the door-to-door HCT initiative in Kalangala to increase the number of
individuals who receive HCT in the district as part of scale -up. This activity proposes to reach 23,000
individuals with HBCT services with FY 2009 funding. The number of HCT teams trained to provide HBHCT
will be increased to 35 and the program will continue community mobilization through the CORPS to provide
support and reduce discrimination, stigma and negative attitudes about HIV and HCT. The program will
also work to strengthen partnerships with other CBOs and NGOs providing health services in the district to
increase the capacity to provide comprehensive HIV/AIDS services as needed to individuals in the district.
Continuing Activity: 13225
13225 9429.08 HHS/Centers for Kalangala District 8670 8670.08 $400,000
9429 9429.07 HHS/Centers for Kalangala District 8792 8792.07 $400,000
Table 3.3.14:
