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 2012 2013 2014 2015 2016
The Infectious Diseases Institute (IDI) is a Uganda-registered NGO, owned by Makerere University. It has an independent Board led by the Acting Principal of the College of Health Sciences. IDI is a leading institution in HIV/AIDS training, research, care and treatment in collaboration with local, regional and international partners.
In August 2008, IDI received a five-year PEPFAR cooperative agreement through CDC entitled: Building Capacity for Scaling up HIV/AIDS Services in rural underserved and high prevalence districts in the Republic of Uganda. The objectives of the five-year project were to support target districts to: (1) establish and manage routine confidential HIV counseling and testing services for all patients; (2) provide comprehensive clinical care for persons with HIV, including staff, through provision of basic palliative care services and ART to eligible clients; and (3) support the capacity of the target health facilities to provide comprehensive HIV/AIDS care services through appropriate training, networking, information exchange and planning
In FY 09, the project was initiated in the two districts of Kibaale and Kiboga as a partnership with the two district local governments, two sub partners: The AIDS Support Organization (TASO) and Strengthening Counselor Training (SCOT) and other key HIV/AIDS stakeholders including, Baylor Uganda (pediatric care and treatment), PACE (basic care package supply and training), and PREFA and EGPAF (PMTCT services).
Based on a baseline assessment of the HIV/AIDS care services in the two districts, the FY 09 objectives were further refined to include supporting the districts of Kibaale and Kiboga to: (1) increase access to care and treatment services for HIV/AIDS, STD, OIs; through strengthening existing service providers and introducing new services; (2) increase TB screening and TB/HIV integrated treatment to TBHIV co-infected individuals; and (3) scale up HIV counseling and testing services through the expansion of routine counseling and testing (RCT) in health facilities and in the communities using the HCT approach.
Achievements in FY 09 included: baseline assessment of HIV/AIDS services in the two districts, that informed the operational plan; project start up activities, including signing of Memoranda of Understanding (MoUs) and setting up project offices; trainings for 100 AIDS Care Volunteer (ACV) and over 150 health facility staff: and support for the initiation and/or strengthening of service provision at 10 health facilities in the two districts (including 2 hospitals , 5 Health Center IVs and 3 Health Center IIIs).
In FY 10, the project will expand to 11 additional sites in Kibaale and Kiboga districts (10 HCIIIs and one HC II). In addition, the project will expand to three additional districts: Hoima, Masindi and Bullisa, based on the PEPFAR Uganda call for the rationalization and provision of HIV/AIDS comprehensive services. In the new districts, IDI will provide sub-grants to the districts through MOUs, for the provision of comprehensive HIV/AIDS services based on identified needs and HIV/AIDS work plans. IDI and consortium partners will support recipient districts to plan, implement and evaluate comprehensive HIV/AIDS services. Emphasis will be placed on partnerships, grant management, project planning and management, monitoring and evaluation, procurement and logistics as well as the other technical aspects required to successfully achieve a comprehensive HIV/AIDS program.
Targets:
Targets for FY 2010 in 5 districts are as follows
TB/HIV: 400 HIV+ clients initiated on TB treatment.
Laboratory Infrastructure: Improving and establishing laboratory capacity in 36 health facilities in 5 districts.
Counseling & Testing: 150,000 clients in 5 districts.
Sexual Prevention: The project will target Most at risk populations (MARPS) such as adolescents, school children, discordant couples, commercial motorcycle riders, truck drivers and their sexual partners.
Care & support: Provision of care and support to 16,659 clients (11,709 old and 4950 new).
Treatment: 4,998 clients on ART (old and new).
ARV drugs: Provision of buffer stocks to support the increased demand for care and treatment as well as to support continued counseling and testing in HCT outreach activities.
In FY 2010, IDI will support the district in conjunction with its partners in providing adult care and support services at the 21 health facilities in Kibaale and Kiboga districts (2 hospitals 5 HCIVs 10 HCIIIs and 1 HCII) and the 15 facilities in the three new districts. In addition to the facility based services, the project will support the implementation of community based services to ensure a holistic family based approach for service provision
All the active adult clients (16,659; 11,709 old and 4,950 new) will receive a comprehensive package of high quality care and support services comprising : counseling for clients and family members; screening and treating opportunistic infections; screening and treating sexually transmitted infections (STIs); providing vital information on cotrimoxazole prophylaxis, safe water, nutrition, STI, FP, PMTCT; enrolling clients on cotrimoxazole prophylaxis; providing safe water vessels and promoting safe water use; providing condoms to sexually active clients.
Prevention with positives interventions (PWP) will be supported in the target facilities and communities. HIV-infected individuals and couples will be supported to prevent HIV transmission to sexual partners and children. Individual, couple, family and community based activities will be promoted to ensure access to family planning, PMTCT and reproductive health services.Post test and discordant couple clubs will be strengthened and supported to ensure sustainability of prevention activities in communities.
In partnership with the district health teams, PACE (Program for Accessible Health, Communication and Education) and TASO basic care kits will be provided to eligible clients. Pediatric and adolescent care will be provided in partnership with our Baylor College.
The project will implement an intensive strategy to quickly boost the number of people being tested and counseled and entering into care for those testing HIV+. The project's roll out to date in the ten health facilities has shown that the health care system situation is much more complex than anticipated and requires additional resources and strategies to achieve the projected results. Critical service delivery gaps including human resource; training; equipment and supplies; infrastructure; and information systems will be addressed as appropriate, based on the needs assessment.
The districts of Buliisa, Masindi and Hoima in Western Uganda lie in the Albertine Rift Valley Region. These districts have a combined population of over 800,000 (UPHC 2002), and HIV prevalence of 6.9% among the 15-49 years age group (UHSBS 2005). This region is predominantly rural with hard to reach areas and limited access to health care services. The region also suffers a severe shortage of comprehensive HIV/AIDS services with only limited presence of PEPFAR support.
In FY 2010, Infectious Diseases Institute (IDI) will expand its geographical coverage of PITC, Basic Care, and ART to this region in a bid to rationalize comprehensive HIV/AIDS service delivery among USG implementing partners, as well as provide services to underserved communities. A rapid pre-implementation assessment by IDI however revealed formidable challenges, including few and far apart health facilities with poor infrastructure, severe human resource shortages, limited and/or no functional laboratories and lack of transport, among others. All this occurs in a backdrop of remote, hard to reach communities with MARPS (fisher folks) along Lake Albert landing sites.
Objectives:
To provide PITC services to communities in Buliisa, Masindi, and Hoima
To identify HIV infected individuals and initiate early prevention, care, and treatment services
To build capacity of health facilities in the region to provide quality HIV/AIDS services
This funding will be used to support IDI with high impact start-up activities with the potential of improving quality and utilization of HIV/AIDS services in the region. Specifically, the following activities will be done:
Refurbishing laboratory, counseling, and care facilities in 3 health units that are most in need. These are Buliisa HCIV in Buliisa District, Kigorobya HCIV in Hoima District, and Bwijanga HCIV in Masindi District
Procurement of basic laboratory equipment for diagnosis of TB and OIs in the refurbished labs, and one CD4 count machine for Masindi Hospital
Procurement of one vehicle to facilitate coordination, supervision, and transportation of supplies and samples across the region
In FY 2010, IDI will support the district in conjunction with its partners in providing adult care and treatment services at the 21 health facilities in Kibaale and Kiboga districts (2 hospitals 5 HCIVs 10 HCIIIs and 1 HCII) and the 15 facilities in the three new districts. In addition to the facility based services, the project will support the implementation of community based services to ensure a holistic family based approach for service provision
All the active adult clients (16,659; 11,709 old and 4,950 new) will receive a comprehensive package of high quality care and treatment services comprising : counseling for clients and family members; provision of antiretroviral therapy (ART); screening and treating opportunistic infections; screening and treating sexually transmitted infections (STIs); providing vital information on cotrimoxazole prophylaxis, safe water, nutrition, STI, FP, PMTCT; enrolling clients on cotrimoxazole prophylaxis; providing safe water vessels and promoting safe water use; providing condoms to sexually active clients. This activity will support ART for 3,000 adults.
In partnership with PACE (Program for Accessible Health, Communication and Education) and TASO, IDI will ensure that a basic care kits are provided to eligible clients. Pediatric and adolescent care will be provided in partnership with our Baylor College.
In FY 09 IDI supported HIV Counseling and testing (HCT) provision in Kibaale and Kiboga districts through community and facility based approaches.
In order to access hard to reach communities, the project supported health units conduct HCT outreaches. A total of 152 communities were reached with 24,865 people counseled and tested (including 850 positive). Fishing communities along Lake Albert were targeted through a camping strategy focusing on eight landing sites.
At the facilities, provision of VCT was on-going and in addition 93 health workers in the two districts were trained by SCOT to provide Provider Initiated Counseling and Testing (PICT). Community mobilization for HCT services was conducted through the district leadership and 100 AIDS Community Volunteers (ACVs), trained by TASO.
In FY 2010, IDI and its partners will support counseling and testing in the two project Districts of Kiboga and Kibaale and in the three new districts of Hoima, Masindi and Bullisa through multiple HCT approaches and sites to reach a target of 150,000 individuals. HIV prevention will be enhances through targeting of couples and mothers eligible for PMTCT services.
In collaboration with MOH, National Medical Stores (NMS) and Supply Chain Management Systems (SCMS) IDI will strengthen logistics management to minimize stock-outs of HIV test kits and related supplies.
Regular support supervision and refresher training will be provided to service providers to ensure quality service provision. Technical support will also be provided to improve collection, analysis, distribution and use of data on HCT so as to inform and improve program activities.
Post test support will be provided through the strengthening of existing support groups and/or creation of new groups at facility and community levels. External quality assurance for HIV tests will be done through the district laboratory network.
In FY 2010, working with Baylor College, IDI will support the districts to provide pediatric HIV care and treatment services at the 21 health facilities in Kibaale and Kiboga districts (2 hospitals 5 HCIVs 10 HCIIIs and 1 HCII) and the 15 facilities in the three new districts. In addition to the facility based services, the project will support the implementation of community based services to ensure a holistic family based approach for service provision. This activity targets 4,165 children with HIV care services.
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.
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, IDI 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, IDI will support the districts to provide pediatric HIV care and treatment services at the 21 health facilities in Kibaale and Kiboga districts (2 hospitals 5 HCIVs 10 HCIIIs and 1 HCII) and the 15 facilities in the three new districts. In addition to the facility based services, the project will support the implementation of community based services to ensure a holistic family based approach for service provision. This activity targets 4,165 children with comprehensive care services,of whom 371 will be supported for ART.
In FY 10, PMTCT services will be supported as part of the comprehensive HIV/AIDS
service provision in five districts in Western Uganda (Kibaale, Kiboga Masindi, Hoima and Buliisa ). IDI will utilize a district wide approach employing facility and community based approaches, where the District Health Officers (DHOs) will develop PMTCT plans as a component of the overall district HIV/AIDS plans. Joint MOH/IDI technical teams will assist DHOs in prioritizing their PMTCT activities according to district coverage and uptake needs. Based on these plans, IDI will award conditional grants to support the five districts through the local government enabling the project to offer PMTCT services from the hospital level up to Health Center-IIIs.
The objectives of the PMTCT service will be to: 1) provide high quality PMTCT services (comprehensive family-based HIV and reproductive health services especially family planning); 2) increase community and family involvement in PMTCT program around the selected health facilities; 3) promote the 4-pillar approach to PMTCT programming and contribute to the quality of PMTCT services. This activity proposes to reach 7,879 HIV-infected mothers with PMTCT services.
The PMTCT package will include antenatal/HIV/AIDS education, HIV/AIDS Counselling and testing (HCT); to enhance coping and avoidance of re-infection or getting infected for women that test negative. Mobilization and education for PMTCT will be carried out in the communities using drama groups radio talk shows , film shows and home visits by HCT counsellors and AIDS Community Volunteers (ACV's). Male involvement will be encouraged through drama, with targeted messages that encourage male partners to accompany their wives for antenatal care and HCT. All female and male PHAs of reproductive age will regularly be educated and counselled about family planning and PMTCT. Follow up of pregnant women is critical and will be done by the trained ACVs. This will support follow up of new born babies to ensure early infant diagnosis. The national PMTCT policy and draft HBC guidelines provided by MoH will be followed.
At health facility level, the project will support training of service providers in comprehensive HIV/AIDS care services including provision of PMTCT; provision of prophylactic treatment and on-going counseling; infrastructure improvement to provide more space for counseling and testing; support recruitment of human resource and nutritional supplements for malnourished children and mothers. Additionally the project will train ACV's in PMTCT basics to help with community sensitization and mobilization for HIV care and support services; make referrals for PMTCT services; conduct home visits for HIV+ mothers and their babies and establishing and managing family support groups.
At community level the project will support community sensitization and mobilization to create demand for PMTCT services, enhance family and male involvement and enhance referrals and support. Multiple community education approaches will be utilized including community meetings, IEC materials, radio talk shows and spot messages.
Community based HIV counseling and testing will be conducted to identify eligible mothers and families. Appropriate referral networks will be established through the use of ACVs to link community services to facilities and vice versa. Effective coordination of community activities will be assured through feedback meetings with the ACV's and HCT counselors as well as members of the community supported with regular quarterly supervision.
In FY 2010, IDI and its partners will support host districts to strengthen TB/HIV integration activities across 21 health facilities in Kibaale and Kiboga districts. In the new districts of Hoima, Masindi and Bullisa a similar approach will be taken, targeting 15 health facilities. The objectives of the support will be to support recipient districts 1) improve TB screening for HIV-positive individuals; 2) provide HIV testing to all TB patients and 3) improve care and treatment for TB/HIV co-infected individuals.
The project will support a combination of facility and community based approaches to strengthen TB/HIV services. The project will support the screening of 16,500 HIV+ patients for TB (cumulative) and provide TB/HIV integrated care to 400 TB-HIV co-infected individuals. To ensure sustainability of services, IDI and its partners will support the improvement of existing structures and systems within the health facilities based on the results of a needs assessment that is complete for the two existing districts and will be conducted for the three new districts.
TB Screening and diagnosis
All identified HIV-infected individuals will be screened for TB. In cases where HIV infected individuals are identified at HCT outreaches, TB screening will be conducted and appropriate referrals will be made to the eight health facilities Kiboga and Kibaale that have TB diagnostic capacity. For communities where these facilities are distant, the project will support the establishment of sputum referral mechanisms to ensure timely TB diagnosis and follow-up of clients.
The program will provide support for a communications campaign aimed at increasing awareness about knowledge of HIV status, TB symptoms, TB-DOTS and ART literacy in target health facilities and the surrounding communities.
On-going technical support will be provided to all the laboratories capable of TB sputum examination including introducing florescence microscopy diagnostic techniques in district hospitals.
TB Treatment
The project will support the districts and the facilities to improve the services provided at TB clinics and institute SOPs to enhance quality service provision, to ensure optimal client retention and treatment completion. District Health Offices will be supported to ensure a constant supply of TB drugs, septrin and ARVs to TB/HIV co-infected patients.
CB-DOTS workers will be trained to collect follow-up sputum samples during a patient's treatment course (i.e. at 2, 5, and 8 months of treatment), as part of scheduled follow-up.
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. Support supervision and on-job training will be provided by district teams, supported by IDI and consortium partners.
HIV testing for TB patients
All identified TB patients will be offered HIV testing and if HIV-infected will be accelerated into a care and treatment programme.
TB infection control
The project will support the health facilities to implement client triage to identify and prioritize those with TB-related symptoms for prompt service. All HIV/AIDS clients will be screened for TB, provided with a continuous supply of TB drugs while on treatment, have a separate room for those suspected of TB. The project will support the remodeling as appropriate, to ensure adequate ventilation.
