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: 2010 2011 2013 2014 2015 2016 2017 2018
In January 2008, Kalangala District Local Government received PEPFAR funding to implement a full access 100% home based HIV counseling and testing (HCT) and basic care (BC) in Kalangala district and the surrounding fishing communities. The objectives of the five 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 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.
Kalangala District, located in Central Uganda is comprised of 84 Islands in Lake Victoria of which 64 are permanently habited. The district was specifically targeted with this program to respond to the unique geographical location where the population of 100,000 is served by only 11 health facilities (two Health Centre (HC) IVs, six HC IIIs and three HC IIs).In addition, fishing communities are among the highest risk groups with susceptibility to HIV in Uganda, stemming from the complex interactions of occupational mobility, large amounts of time spent away from home, easy access to cash income, and the easy availability of commercial sex in fish landing sites.
In the first year of program implementation (FY 08) the program operated in the confines of Kalangala district to implement both HCT and BC services. During FY 09, started the expansion process to cover HCT and BC needs of the surrounding fishing communities of Rakai and Masaka districts. In these two districts, service provision was limited to communities in sub counties neighboring Lake Victoria. In addition to the expansion process, the project received additional funding to implement two program areas: TB/HIV and Prevention (Abstinence/Be faithful, AB and Other Prevention, OP) that were started within Kalangala district.
Key constraints to service delivery included the high cost of water transport and the limited number of identified HIV-positive individuals that accessed chronic care at Kalangala Health Centre IV.
In FY 10, the project will provide HCT and BC services in additional neighboring districts, depending on assessed needs and services provided by other players. The project will collaborate with other stakeholders and districts to ensure provision of quality HIV/AIDS services to the target communities. The camping strategy will be utilized where appropriate to minimize on transport costs, the project will continue to support the referral process for CD 4 monitoring and strengthen access to chronic care clinics for HIV-positive individuals.
The basic care component of the program was initiated in the first year of the project. Project staff received orientation on planning, implementation and monitoring of the adult care and treatment component. The project Basic Care Officer working with the Community Educators, counselor and laboratory supervisor lead this component In FY 2009, by 31st August the program provided HIV counseling and testing services to 13,035 of whom 2621 were HIV positive, 123 couples inclusive and eligible for Basic care services. Major challenges for this component included low turn up of the referred cases to the referral sites possibly due to difficulties encountered with water transport as a result of water barriers between the islands and the referral sites. On and off stock outs of these Basic Care kits from PACE given the high demand in this high HIV Prevalence project area. In FY 2010, the program will target 25,000 individuals with HIV counseling and testing services of whom 5,000 are expected to be HIV-positive and 98 discordant couples. Through this program people infected with HIV (PHAs), discordant couples, and family members will be 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 Kalisiizo hospital, Kakuuto health centre IV, Masaka and Kitovu Hospitals, for more specialized care. The program 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). Over 1558 people were started on Septrine prophylaxis including index HIV/AIDS clients at Kalangala HCIV which is our main referral site. Safe water vessels and supplies, insecticide treated bed nets, and condoms, as appropriate, are provided through leveraging with other the PEPFAR partner PACE to provide adequate Basic Care Packages for HIV+ individuals and their families.
In FY 2010 the program will continue to expand access to referral services 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 will be provided to all individuals who test HIV-positive 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 PACE program to provide adequate Basic Care Packages for HIV+ individuals and their families.
This basic care initiative will be further strengthened through enhanced referrals to Kalangala Health Centre IV, Entebbe, Kalisizo, Masaka and Kitovu Hospitals to ensure that all patients have access to chronic care services and ART eligibility screening. 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.
The program will continue to work to provide access to basic and palliative HIV/AIDS care services and support to PHAs in Kalangala District and the surrounding fishing communities. Cotrimoxazole, treatment of OI, and diagnosis and treatment of malaria will continue to be provided to PHAs in collaboration with the available health facilities. 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 PACE 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.
The basic care component of the program was initiated in the first year of the project. Project staff received orientation on planning, implementation and monitoring of the adult care and treatment component. The project Basic Care Officer working with the Community Educators, counselor and laboratory supervisor lead this component
In FY 2009, by 31st August the program provided HIV counseling and testing services to 13,035 of whom 2621 were HIV positive, 123 couples inclusive and eligible for Basic care services.
In FY 2010, the program will target 25,000 individuals with HIV counseling and testing services of whom 5,000 are expected to be HIV-positive and 98 discordant couples. Through this program people infected with HIV (PHAs), discordant couples, and family members will be 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 Kalisiizo hospital, Kakuuto health centre IV, Masaka and Kitovu Hospitals, for more specialized care. The program 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). Over 1558 people were started on Septrine prophylaxis including index HIV/AIDS clients at Kalangala HCIV which is our main referral site. Safe water vessels and supplies, insecticide treated bed nets, and condoms, as appropriate, are provided through leveraging with other the PEPFAR partner PACE to provide adequate Basic Care Packages for HIV+ individuals and their families.
Major challenges for this component included low turn up of the referred cases to the referral sites possibly due to difficulties encountered with water transport as a result of water barriers between the islands and the referral sites. On and off stock outs of these Basic Care kits from PACE given the high demand in this high HIV Prevalence project area
The HIV counseling and testing (HCT) component of the program was initiated in the first year of the project. Project staff received training on the basic HIV counseling and testing skills as well as the home-based HCT approach. In addition, staff received orientation on planning, implementation and monitoring of the adult care and treatment component. The program Counselor and Lab supervisors and Basic care officer working with 13 Counselor/Laboratory assistant pairs lead this component.
In FY 2009, by 31st August the program provided HIV counseling and testing services to 13,035 clients of whom 2621 were HIV positive hence, eligible for Basic care services including 123 discordant couples.
In FY 2010, the program will target 25,000 individuals with HIV counseling and testing services. Major challenges for this component included high cost of water transport, poor road networks, poor sanitary facilities and the limited number of identified HIV-positive individuals that accessed chronic care services at Kalangala Health Centre IV, Masaka, Kitovu & Kalisizo hospitals. The major reason for low enrollment in the chronic care clinics include large water barriers between the health facilities and the islands from where clients are identified which has a lot of financial implications for vulnerable fishing communities. Other challenges included; un-anticipated expenditures during scaling up of HCT activities in Kalangala (Call back Strategy) at the same time expansion to neighboring Districts (Rakai and Masaka), Lack of CD4 count machine in Kalangala district which affected enrollment of positive clients referred by the programme for Anti Retroviral Therapy/Treatment , rough waters and heavy rainfall
In FY 2010, the program will continue with the door-to-door HCT initiative in the surrounding fishing communities of Masaka and Mpigi Districts in order to increase the number of individuals who receive HCT in the region as part of scale -up. Kalangala District will also continue to be covered as part of a call back mechanism due to the migratory patterns of the fishing communities. This activity proposes to reach 25,000 individuals with HBCT services with FY 2010 funding. The programme will continue to use the available HCT teams trained to provide HBHCT and 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 and in the surrounding districts to increase the capacity to provide comprehensive HIV/AIDS services as needed to individuals in the area. The testing teams will be routinely supervised by our experienced Laboratory and Counsellor supervisors. For Quality assurance, all positive samples will be taken to the CDC reference Laboratory as well as 2% of all the negative samples. All the identified positive clients will continue to be refered for comprehensive care to Kalangala H/C IV, and the nearby facilities that provide comprehensive HIV/AIDS care. All the HIV negatives will be encouraged to remain negative by giving them the appropriate preventive messages.
In FY 2010, working with Baylor College, the project will support the provision pediatric HIV care and treatment services at Kalangala Health Centre IV and lower level health facilities.
Child clients will be facilitated to access a comprehensive package of high quality pediatric care and treatment services as advocated by the African Network for the Care of Children affected by AIDS (ANNECA). Pediatric care and treatment services to be offered include; early confirmation of HIV infection status; growth and development monitoring; immunizations according to the recommended national schedule; prophylaxis against opportunistic infections especially Pneumocystis Pneumonia; treatment of acute infections and other HIV-related conditions; counseling caretakers on optimal infant feeding, personal and food hygiene, disease staging; ART where indicated, psychosocial support for the infected child, caregiver & family; and referral of the infected child for specialized care if necessary; and community-based support programs. This activity proposes to reach 1,250 children with HIV care and treatment services
Pediatric care and treatment program area is related to the program areas of PMTCT, adult care and treatment, TB/HIV, psychosocial support, Counseling & Testing, ARV Drugs and laboratory infrastructure and will be delivered as part of an integrated service.
The partners will use a continuous quality improvement approach to enhance data management, as well as conduct quality assurance support visits and clinical mentoring. Staff from the district health teams, Kalangala HBHCT Project and Baylor will conduct regular quarterly mentoring, support and supervisory visits to health facilities, outreaches and community drug distribution points to support basic primary care services for HIV exposed and infected children, OI management, TB/HIV integration and PMTCT. Support supervision will entail assessment of clinic infrastructure, training needs, staffing and other HR issues, logistics, transportation, children/client satisfaction, liaison with families and communities. Continuing Medical Education will be ensured through clinical case reviews, assessment of guideline use and ART regimen decisions.
In FY 2010, working with Baylor College, tje project will support the provision pediatric HIV care and treatment services at Kalangala Health Centre IV and lower level health facilities.
The prevention component of the program was initiated in the second year of the project. Project staff received orientation on planning, implementation and monitoring of the AB component. The two Community Educators and 89 trained Peer Educators/Community mobilisers lead the prevention component that was implemented in school and community based approaches.
In FY 2009, the program reached 1,048 individuals by community outreach that promoted HIV/AIDS prevention through abstinence against a target of 30,000 and 209 individuals through community outreaches that promoted HIV/AIDS prevention through abstinence and/or being faithful and with AB messages against an FY 2009 target of 50,000. The wide variance between target and actual achievements was mainly because; a number of prevention related activities took place such as information on prevention for positives, condom education & distribution within the HCT operational sites which data could not reliably count for the indicator as by preliminary reporting period, this indicator needed further clarifications. Following technical support from CDC- Entebbe, it was streamlined that for reporting purposes, AB indicators are reported against community outreach activities and NOT mass media campaigns or prevention counseling for people receiving HCT services as previously had anticipated, and that groups should be manageable, lead to discussion/interaction between the service provider and recipients/community members, and that rallies at market places did not qualify as community outreaches, whereas mass media campaigns & talk shows were important for community sensitization and had been part of KDLG activities these did not count towards reporting for AB.
Major challenges for this component included indicator misinterpretation, age of children in primary schools that was not uniform as most of them were between 10-14, and some 17, 18 and 19 years who qualified to receive messages of AB and OP which needed much caution at this school level. People especially at the landing sites always wanted to be facilitated for the time spent with them yet it was not budgeted for. Others included illiterate population that could not write their names on the attendance lists.
In FY 2010, the project will continue implementation of AB activities in Kalangala district. The objectives of this component will be to provide targeted community behaviour change communication interventions aimed at stemming HIV infections among individuals, couples, and families. This activity proposes to reach approximately 10,000 individuals with AB interventions in FY 2010. The expected population of people we shall be serving is 53,900 out of which the % of Abstinence and/ or Being Faithful which is all people 10 years and above is 60.5% equivalent to 32,609 individuals. Mobilization of communities for prevention programs will be done through radio programs, community meetings, and education sessions at fish landing sites. Once mobilized, small group interactive sessions will be organized and conducted for age disaggregated audiences. Abstinence messages will be disseminated to age groups 10 to 15 years through school based programs. The project will work closely with the district education department and other stakeholders to disseminate messages that encourage staying in school, delaying sex and promote life skills.
Be-faithful messages will be disseminated to age groups 15 years and above and also to the married/cohabiting people. Messages will center on mutual fidelity, reduction in sexual partners and addressing gender norms.
In collaboration with the District Directorate of Health Services, other district departments (education, fisheries and community development) and local fishing groups this program will use a variety of communication channels to reach communities, including music, dance and drama; and community meetings. Working with local community groups, the program will support the set-up and/or strengthening of community-based support groups and post-test clubs to assist in providing psychosocial support to persons who have accessed HIV testing.
The prevention component of the program was initiated in the second year of the program. Project staff received orientation on planning, implementation and monitoring of the OP component. The two Community Educators and 89 trained Peer Educators/ Community mobilizers lead the prevention component that was implemented in school and community based approaches.
In FY 2009 as of 31st August, the program reached 3963 individuals with OP messages against an FY 2009 target of 10,000. The variance between target and actual achievements was mainly because a number of prevention related activities took place such as information on prevention for positives, condom education & distribution within the HCT operational sites which data could not reliably count for the indicator as by preliminary reporting period, this indicator needed further clarifications. Following technical support from CDC, we realized that for reporting purposes, OP indicators are reported against community outreach activities and NOT mass media campaigns or prevention counseling for people receiving HCT services as previously had anticipated, and that groups should be manageable, lead to discussion/interaction between the service provider and recipients/community members, and that rallies at market places do not qualify as community outreaches and that whereas, mass media campaigns & talk shows were important for community sensitization and had been part of KDLG activities these did not count towards reporting for OP.
Major challenges for this component included indicator description, age of children in primary schools that was not uniform as most of them were between 10-14, and some 17, 18 and 19 years who qualified to receive messages of AB and OP which needed much caution at primary school level. The population especially at the landing sites always wanted to be facilitated for the time spent with them yet it was not budgeted for. Other challenges included illiterate population that could not write their names on the attendance lists.
In FY 2010, the project will continue implementation of OP activities in Kalangala district. The objectives of this component will be to provide targeted community behavior change communication interventions aimed at stemming HIV transmission among individuals, couples, and families. This activity proposes to reach approximately 10,000 individuals with OP interventions in FY 2010.
Mobilization of communities for prevention programs will be done through radio programs, community meetings, and education sessions at fish landing sites. In other prevention methods, the program will promote correct and consistent condom use for casual relationships as well as dispel myths around condom use. Condoms will be availed through increased number of service outlets through free distribution and social marketing. The program will also support 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 community group meetings and radio talk shows, the program hopes to foster a dialogue among residents, with a view towards reducing negative attitudes about PHAs.
In addition, the program will promote knowledge of and related prevention behaviors including promotion of HIV testing, knowledge of partner HIV status and disclosure of HIV test results. Emphasis will be laid on the importance of couple testing to identify discordant couples, as well as knowledge of the HIV status of biological children for mothers who test HIV positive. Efforts will be made to target commercial sex workers and their clients, as well as addressing excessive alcohol consumption and gender-based violence.
Among HIV-positive individuals, the program will encourage partner testing, promote referral to chronic care centres, and promote STI treatment as well as family planning and PMTCT services for eligible mothers and families.
In FY 09, the project in collaboration with MOH and NMS staff at Kalangala Health Centre IV and lower level health facilities will be supported to plan, forecast and procure drugs and diagnostics to support the scaled up ART services. I
The project will: (1) Provide buffer supplies of ARVs and Septrin while ensuring transportation of drug supplies to the district stores and to the various health facilities. (2) Liaise between the districts and MoH, and SCMS in communicating and following up the facility pharmaceutical supplies while mentoring key pharmacy staff in the districts.
(3) Provide supportive supervision to ensure MoH ARV reports are collected and sent to the necessary authorities. (4) Conduct logistics management training (district-based) targeting HCWs actively involved in procurement, dispensing and storage of drug supplies. (5) Hold meetings with some of the HIV/AIDS partners who are implementing similar services in the two districts while working towards an MoU for synergistic output rather than duplication. (6) Promote Continuing Medical Education opportunities in the health facilities and deliver MOH LMIS (Logistics Management Information System) tools to enable efficient data capture. (7) Lobby the MoH to increase the medicine credit line budget for the two districts to cater for the increasing number of clients infected with HIV/AIDS and other illnesses that require septrin for instance.
With regard to the three new districts we intend to conduct a needs assessment and rapidly transfer the lessons learnt from the two existing districts to improve systems for accessing MOH drugs while retaining a fund for buffer stocks.
The TB/HIV component of the program was initiated in the second year of the project. Project staff received orientation on planning, implementation and monitoring of the TB/HIV component. This component is led by the Project Laboratory Supervisor in conjunction district TB/Leprosy Officer and with the health facility laboratory staff.
In FY 2009, the program targeted 112 individuals with TB/HIV services at 12 outlets. By 31st August 2009, out of the 147 clients screened for TB on sputum microscopy, 56 clients sputum positive and started on treatment. The number of service outlets providing treatment for TB increased from three to nine. In addition 59 registered TB patients received HCT and received their results. Initially, there was a low turn up for HIV positive clients who needed to be screened for TB at the health facility and this prompted the program to change strategy as detailed; (1) Two health facility staff were identified and facilitated to conduct TB/HIV related activities. (2) Active involvement of the Basic /Palliative care team in TB case finding and sample collection at field level, a strategy that has minimized the cost of water transport for the vulnerable fishing community. (3) Supporting & encouraging service providers from the rest of the health units to refer TB suspects for sputum microscopy at Kalangala Health IV. Major challenges have included collection of all the three sputum samples from individuals at field level viz-a-viz the costly water transport and high population mobility.
In FY 2010, this activity proposes to reach approximately 255 individuals with TB/HIV interventions at 12 facilities. The project will continue implementation of TB/HIV activities in Kalangala district. The objectives of this component will be to increase TB case finding, improve infection control at health facilities and improve TB treatment completion.
The project will ensure that all identified 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 and TB medication.
In collaboration with the PEPFAR laboratory strengthening initiative and national TB and Leprosy Program, this project will contribute to the functionality of health facilities' laboratory capacity for TB and HIV services to ensure timely and accurate TB diagnosis, through staff training, availability of laboratory supplies and reagents and standard operating procedures and support supervision.
Finally in working with the district education and communication (IEC) team, 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 will ensure a constant supply of TB drugs, Septrin and ARV's to TB/HIV co-infected patients. Support supervision and on-job training will strengthen TB/HIV integrated services.
