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
N/A
New/Continuing Activity: Continuing Activity
Continuing Activity: 18861
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
18861 12094.08 U.S. Agency for International 8283 6063.08 Sunrise Project $1,040,000
International HIV/AIDS Alliance (121-A-00-04-
Development 0071)
12094 12094.07 U.S. Agency for International 6063 6063.07 Sunrise Project $679,803
Program Budget Code: 04 - HMBL Biomedical Prevention: Blood Safety
Total Planned Funding for Program Budget Code: $0
Program Area Narrative:
As noted in a 2005 UNAIDS/UNICEF-funded "Review of Work with IDUs in Ukraine in the Context of the HIV/AIDS Epidemic",
since 1999 the Ministry of Internal Affairs (MOI) has registered, on average, between 21,000 - 25,000 people who use drugs for
non-medical purposes. 60% of this group has been diagnosed as drug addicts, with a total of 173,594 drug users recorded as of
2008, up from 152,000 in 2007. MOI numbers usually include drug users detained by law enforcement officials for the production,
sale, distribution or transportation of drugs, along with users who have completed a course of treatment at a drug clinic.
It is estimated that there are between 325,000 and 425,000 injecting drug users (IDUs) in Ukraine, with Ukraine ranked as having
the sixth highest rate of increase in drug abuse in Europe. With an average age of 20-29, 65% of IDUs are estimated to be living
with HIV, along with 95,000 of their non-IDU partners. The age of initiation of injecting drug use ranges from 13 to 30 years of age,
with initiation of drug use occurring earlier among males than females. Anecdotal information from health care specialists
suggests an increasingly young age of patients with drug-related disorders, with the age of initial drug use seen in some instances
as low as 7-8 years of age.
The most popular and problematic drug in Ukraine is a homemade opiate, known as shirka, which is extracted opium from poppy
straw. However, there is a trend toward use of home-made psychostimulants for injection. Generally, the expanding epidemic in
Ukraine reveals a changing drug situation, with increased amphetamine-type stimulant use; emerging sub-groups such as
younger IDUs, new injectors and increasing numbers of female IDUs; and high risk injection-related practices associated with
home-made opiates, such as pre-loaded syringes that may be shared and shared drug solutions from which syringes are loaded.
With 2005 data from the Ukrainian AIDS Center indicating that injecting drug use accounted for approximately 44.8% of HIV
transmission in Ukraine, HIV transmission related to injecting drug use remains the driving force of the HIV/AIDS epidemic. Data
indicate that 97% of all registered drug addicts are opioid IDUs and that more than 70% of people living with HIV have a history of
injecting drug use. 2006 sentinel surveillance among IDUs indicated that the prevalence of HIV-infection among this population
was significantly higher than in any other MARP, with HIV prevalence ranging from 18% to 62.8%. 2007 national HIV estimates
indicate that there are approximately 164,000 cases of HIV among adult IDUs, or 41.4% of all adults living with HIV, as well as
over 95,000 HIV-positive non-IDU partners of IDUs. Twenty-four percent of female sex workers are also IDUs, and 6% of IDUs
sell sex. Since IDUs engage in high-risk sexual practices such as unprotected sex or exchanging sexual services for money
and/or drugs, the overlapping sexual and injection risk practices of multiple risk groups are undoubtedly contributing to increases
in heterosexual transmission and have critical implications for the HIV epidemic.
Opiate medication assisted therapy is key to halting the spread of HIV among IDUs. However, only about 1,499 IDUs (816 on
buprenorphine-based medication assisted therapy, or MAT, and 670 on methadone-based MAT) are currently enrolled in MAT
programs against the current target of 20,000 patients. AIDS service providers, knowing that MAT increases adherence,
frequently require IDUs to either be in sustained remission or to start MAT as a precondition for initiating antiretroviral therapy.
With some estimates as high as 60,000 IDUs needing MAT in the years ahead, it is clear that the current scale of coverage is too
limited to have a significant impact on the epidemic.
However, there are a number of challenges to the continuing scale up of MAT. First, with no GOU resources allocated for MAT,
there is no formal state system or structure to oversee MAT programming and lack of a centralized state monitoring system for
MAT implementation. At the facility level, there is a lack of trained specialist staff to work with MAT patients and often low
commitment regarding MAT among health care authorities; as a result, enrollment of patients for methadone-based MAT is
extremely slow and MOH orders on MAT are often not implemented. There is a clear need to increase the engagement of non-
narcologists in the delivery of MAT.
In addition, current legal regulations on narcotic drugs are highly restrictive and do not facilitate expanded implementation of MAT.
These include the mandatory patient registration system, policies on handling narcotic drugs at medical institutions, types of
methadone treatment available, availability of trained professionals in provision of MAT, distribution of drugs to outpatients, and
the transfer of MAT patients to other facilities.
Building on the MAT programs of the Global Fund and the Clinton Foundation, during 2008 the USG initiated implementation of a
pilot activity to expand access to methadone-based medication assisted therapy. The pilot will develop, implement and assess
models of integrated medical care and support in ten sites in five regions in Ukraine for 300 HIV-infected IDUs. Focus will be given
to ongoing monitoring of the quality and effectiveness of integrated services and analysis and documentation of pilot outcomes
and lessons learned. The patients, at least 30% of whom will be women, will receive methadone as well as HIV and related
medical treatment and health and non-health support services. Pilot program results are expected to serve as a foundation for
replication and progressive scale up of MAT throughout Ukraine.
With FY 2009 resources, the USG will continue to scale up MAT activities to include additional treatment models. The integrated
methadone-based MAT program will continue to develop, implement and assess models of integrated medical care and support in
different institutional settings. Ongoing emphasis will be given to the provision of a comprehensive package of prevention services
with MAT, including STI testing, counseling and condoms to prevent sexual transmission, and voluntary counseling and testing
services.
FY 2009 resources will also be directed to supporting advocacy and policy work to accelerate development of the legislative and
operational policy adjustments needed to allow for more rapid and sustainable scale up of methadone-based MAT. Attention will
be given to addressing policies: to deregulate methadone-based MAT services to expand reach and access; and to the
establishment of law enforcement policies to reduce criminal prosecution of IDUs when in possession of minor quantities of
narcotics, or to eliminate police harassment of IDUs carrying a large number of syringes or visiting a needle exchange site.
Program Budget Code: 05 - HMIN Biomedical Prevention: Injection Safety
Program Budget Code: 06 - IDUP Biomedical Prevention: Injecting and non-Injecting Drug Use
Total Planned Funding for Program Budget Code: $950,000
Table 3.3.06:
New/Continuing Activity: New Activity
Continuing Activity:
Emphasis Areas
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $75,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Continuing Activity: 18862
18862 12100.08 U.S. Agency for International 8283 6063.08 Sunrise Project $80,000
12100 12100.07 U.S. Agency for International 6063 6063.07 Sunrise Project $76,365
Program Budget Code: 14 - HVCT Prevention: Counseling and Testing
Total Planned Funding for Program Budget Code: $650,000
The national system of voluntary counseling and testing (VCT) is one of the most highly developed components of the national
response to HIV/AIDS. There is an established and widespread network of VCT sites, including 214 centers, ‘cabinets' for HIV
testing and an additional 648 service sites providing counseling. There is wide coverage of VCT, with 2.86 million tests performed
in 2008. Testing coverage among blood donors is universal, and data indicates that over 95% of pregnant women are tested.
However, despite strong national coverage figures, there are significant disparities between regions in coverage of testing and the
number of new cases reported depending on whether or not local budgets are used to procure test kits to compensate for
unreliable central procurement and distribution of test kits. Moreover, coverage of VCT among MARPs remains uneven and
inadequate.
In spite of wide coverage, VCT remains an underutilized resource in Ukraine. It is estimated that only one in five individuals from
the general population have been tested and are aware of their HIV status. In 2007, according to the Comprehensive External
Evaluation of the National AIDS Response, client initiated VCT represented less than 2% of all HIV tests, indicating extremely low
uptake of anonymous VCT. The National Law on AIDS specifies that all HIV testing must be both free and voluntary; however,
people must often pay out-of-pocket for an HIV test, the quality of counseling remains, for the most part, suboptimal, and there is
poor reliability of informed consent and confidentiality processes. Effective pre- and post-test counseling is largely available only
at AIDS centers, or through NGO services contracting with AIDS Center service providers. At other testing locations counseling is
often not provided at all, or is provided only for patients with a positive diagnosis and is frequently of poor quality when provided.
Rapid testing was introduced by the MOH only a few years ago, although only for use in maternity hospitals when a pregnant
women presents for delivery without a prior antenatal HIV test. With the support of the Global Fund, however, since 2006 NGOs
have been able to provide point of care rapid testing for MARPs, although the scope of this program is still quite limited. A
National Plan for Scaling Up Rapid HIV Testing is in place and was endorsed by the MOH in 2007; however, this plan has not yet
been implemented, and there remain serious shortcomings related to the registration, validation, and quality assurance/quality
control of rapid testing.
Ukraine's whole-population approach to VCT is not appropriate to its concentrated epidemic, with too much testing of the general
population, too little testing of populations most at risk and lack of an operational system for rapid testing. There is a need for
standardized protocols for VCT and provider-initiated counseling and testing, including rapid testing, that: outline which population
groups should be provided with VCT and when testing should be provided; include both public and NGO provision of VCT; clarify
testing policies and algorithms on issues such as confirmatory testing; and link with prevention services. In addition, there is
urgent need for systems to ensure the quality of both testing and counseling, as well as policies which regulate use of regional
budget funds to support provision of VCT by local NGOs for MARPs.
USG support to date has supported activities to improve the quality and reach of voluntary counseling and testing services
through the training of VCT specialists; strengthening of NGO capacity to provide VCT services; and the provision of targeted
technical assistance to VCT centers. USG support has catalyzed the development of innovative models of collaboration between
NGO HIV service organizations and public sector clinical facilities in which public sector clinicians provide testing and NGOs
provide pre-and post-test counseling, referral assistance, adherence support, social and legal assistance, and palliative care. To
date, over 7,700 MARPs have received HIV counseling and testing from over 190 service outlets providing counseling and testing
services provided by 260 trained staff, and all individuals tested have obtained their test results.
With FY 2009 resources, the USG will continue to support NGO-public sector collaboration in the scale up of VCT services for
MARPs as part of a comprehensive prevention package. Increasing the availability of and access to rapid HIV tests for MARPs,
particularly IDUs, will form an important component of this strategy; accordingly, USG resources will be directed to enabling wider
provision of rapid testing services. Continued support will be provided to strengthen the capacity of civil society and public sector
organizations providing VCT services. Finally, the USG will also continue efforts to standardize training for counseling and testing,
institutionalize this training in pre- and in-service settings, and improve the quality of VCT services and commodities
With FY 2008 resources, the USG supported efforts to improve national policies to scale up access to and improve the quality of
VCT services, facilitating efforts of a multisectoral working group which proposed initial amendments to the national VCT protocol.
With FY 2009 resources, the USG will continue support to update national testing protocols. Through coordinated advocacy
efforts with the GF, other donors and civil society, the USG will use FY 2009 resources to continue efforts to reduce policy, legal,
regulatory and fiscal barriers inhibiting access to quality HIV/AIDS related services that meet international standards. One key
area of ongoing focus will be regulating role of NGOs in the delivery of prevention services, including rapid testing, to IDUs and
other most at risk groups.
PEPFAR funding support for US Department of Defense collaboration with the Ukrainian military has to date resulted in the
establishment of five counseling and testing centers, the development of related laboratory capacity and improved staff technical
skills. The DOD has also facilitated the utilization of rapid testing technology into these facilities that serve military personnel and
their families.
With FY 2009 resources, the DOD will continue to enhance the delivery of VCT services and effectiveness of laboratory diagnostic
systems through the provision of related equipment and supplies. It will also provide ongoing support to strengthen military HIV
prevention programs through the training of military trainers to educate military personnel on HIV prevention.
Table 3.3.14:
Continuing Activity: 18863
18863 12103.08 U.S. Agency for International 8283 6063.08 Sunrise Project $460,000
12103 12103.07 U.S. Agency for International 6063 6063.07 Sunrise Project $348,355
