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: 21892
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
21892 21892.08 U.S. Agency for World Health 9484 9484.08 $150,000
International Organization
Development
Program Budget Code: 07 - CIRC Biomedical Prevention: Male Circumcision
Total Planned Funding for Program Budget Code: $0
Program Budget Code: 08 - HBHC Care: Adult Care and Support
Program Budget Code: 09 - HTXS Treatment: Adult Treatment
Program Budget Code: 10 - PDCS Care: Pediatric Care and Support
Program Budget Code: 11 - PDTX Treatment: Pediatric Treatment
Program Budget Code: 12 - HVTB Care: TB/HIV
Total Planned Funding for Program Budget Code: $568,660
Program Area Narrative:
Ukraine's rapidly growing HIV epidemic is aggravated by a parallel and rapidly escalating Tuberculosis (TB) epidemic, with TB
being the leading opportunistic infection associated with AIDS morbidity and mortality. While the magnitude of active TB among
those infected with HIV is not reliably documented, a 2006 WHO investigation of HIV prevalence among TB patients in one region
of both the general population and penitentiary setting reported prevalence rates of 15.5% among the general population and
21.9% among penitentiary inmates. As of the end of 2007, 48% of all AIDS cases were diagnosed with TB co-infection. TB is the
leading cause of AIDS mortality, with 53% of AIDS deaths in 2006 associated with TB. In one region, TB patients with HIV were
also found to be nearly twice as likely to have drug-resistant TB as patients without HIV.
The number of TB cases increased dramatically after independence, more than doubling between 1993 and 2003 as a result of
the economic and social challenges that came with independence and continuing to increase rapidly. At present, Ukraine's TB
incidence rate of 101 cases notified per year per 100,000 people is more than twice the regional average for the Eastern and
Central European region and the eighth highest rate of new TB cases in Europe and Eurasia (WHO 2006), making Ukraine one of
Europe's highest priority countries for TB control. According to the Ministry of Health (MOH), TB is today the leading cause of
death from infectious disease, with an estimated 670,000 persons, or approximately 1.4% of the population with active disease.
Ukraine's TB burden is estimated at approximately 40,000 TB cases per year, which occur throughout the country, but as with
HIV/AIDS, there are higher concentrations of TB in the industrial southern and eastern regions of the country. Ukraine's 2007
application to the Global Fund to Fight AIDS, Tuberculosis and Malaria noted that TB was a disease of socially disadvantaged
populations, with 43% of individuals with active TB unemployed and 13.6% retired.
Ukraine's rapidly escalating TB problem is exacerbated by growing rates of multi-drug resistant (MDR) TB, which not only poses
higher risk for people living with HIV but poses a substantial additional burden to the health care system as it is vastly more
difficult and costly to treat. Ukrainian data suggest that MDR TB occurs in 10-15% of newly diagnosed TB cases and in 30-40% of
relapses. According to WHO estimates, Ukraine has the eighth highest number of MDR-TB cases in the world and is considered a
high priority for action to prevent creation of additional cases of MDR-TB and XDR-TB and to detect and treat the cases that exist.
In 2005, the World Health Organization Regional Bureau for Europe (WHO/EURO) declared TB a regional emergency and called
upon host countries and donors to redouble efforts to scale up effective TB control using the internationally-accepted Directly
Observed Treatment Short-Course (DOTS) strategy. In November of that year, the Ministry of Health made DOTS the standard
national protocol for TB treatment and approved the nationwide adoption of the DOTS strategy, consistent with internationally
recommended norms. Nonetheless, DOTS coverage still remains limited to only about 35% percent of the population, while
Government of Ukraine (GOU) TB national program budgets continue to allocate substantial funds to less effective, more costly
practices from the Soviet era, including long term treatment in 26 specialized national TB sanatoriums and use of x-ray and
fluorography diagnosis.
In spite of sharp increases in HIV-TB co-infection in Ukraine, collaboration between the National AIDS Program and National TB
Program remains weak, as does collaboration between the two programs at the regional level. Systems of service provision in
Ukraine remain highly vertical and specialized; there are not horizontal linkages between these systems, and the roles of TB, HIV
and primary care services in addressing TB-HIV co-infection are not delineated. Accordingly, there is no systemic coordination
between HIV and TB services and TB and HIV services are not integrated into primary health services. With no established
system for early TB detection among people living with HIV/AIDS, co-infected clients receive inadequate care and are often
shifted back and forth between services. Lack of provider knowledge and skills on TB-HIV co-infection also represent a significant
barrier.
The USG has provided assistance to Government of Ukraine TB prevention and control efforts since 2000, working through two
primary implementing partners: the World Health Organization (WHO) and Program for Appropriate Technology in Health (PATH).
The overall program goal has been to improve the prevention, diagnosis and treatment of TB in order to contribute to reductions in
TB morbidity and mortality. The USG program aims to assist the Government of Ukraine to implement its commitment toWHO's
Global Stop TB Strategy by expanding the availability of DOTS programs and by enhancing efforts to address TB-HIV co-infection
and MDR/XDR-TB through DOTS-Plus programs.
As the principal donor of TB-DOTS programs in Ukraine, the USG has played a key role in introducing and expanding DOTS
service provision to significantly improve the diagnosis and treatment of TB. Currently, DOTS services are available in eight
regions and cover about 35% of the population. USG policy, advocacy and implementation support for DOTS led to GOU
commitment to DOTS as part of its national TB program.
In FY 2008, the USG began implementation of a new five year program in TB control. The program focuses on expanding DOTS
coverage to 50% of the population and improving the quality of DOTS implementation; building adequate capacity for rapid
implementation of DOTS Plus programs for MDR/XDR-TB; providing access to TB-HIV co-infection services to 30% of the
population; and the development of policies and attitudes to reduce barriers to care and support an appropriate enabling
environment for DOTS implementation.
With PEPFAR 2009 funds, the USG will continue to strengthen the capacity of public sector and civil society organizations to
address TB-HIV co-infection by improving TB/HIV collaborative mechanisms and building systems to provide integrated TB/HIV
services to the groups at highest risk of co-infection. To broaden knowledge of TB among NGOs and others providing HIV/AIDS
services, the USG will continue to train nurses, HIV service NGOs and organizations of PLWHA in basic DOTS service provision.
It will build on pilot work initiated in FY 2008 using HIV service NGOs and NGOs of People Living with HIV/AIDS (PLWHA) as key
service points where at-risk clients can obtain TB symptom screening and referral and treatment support as needed. A TB
symptom screening tool to be piloted with use of FY 2008 funds will be routinely utilized at NGO service points. To promote
service integration and create more client-friendly care models, TB/HIV trainers and staff will be trained in collaborative case
management and TB-HIV case management teams will be established to provide care for co-infected patients. USG assistance
will also assist the GOU to enhance monitoring and supervision of TB-HIV case management and service collaboration. Finally,
the USG will continue to address critical laboratory needs related to HIV-TB co-infection through training of laboratory technicians
on TB-HIV diagnostics and infection control.
With PEPFAR 2009 funds, the USG will give continued assistance to both the MOH Committee on HIV/AIDS and TB and
Regional Coordination Councils on HIV/AIDS and TB to improve national and local planning, implementation and monitoring of TB
-HIV activities. The USG will also assist the MOH in the development of an integrated TB-HIV protocol and support
operationalization of this protocol through the training of providers in TB-HIV co-infection service guidelines. To assist in
operationalizing TB-HIV protocols, the USG will support development of a legal and regulatory framework to establish a client
referral system and establish TB testing at HIV services.
The Global Fund Round 6 HIV/AIDS Grant to Ukraine made resources available to address HIV-TB co-infection to address a
number of critical needs, including the development of protocols for coordinated treatment of HIV, the training of TB specialists in
the management of TB-HIV co-infection, and the strengthening of referral linkages between TB and HIV services. These areas
directly complement activities under the USG's TB control project, and accordingly USG and GF implementing partners coordinate
closely together in this area to achieve maximum output.
Table 3.3.12:
Program Budget Code: 15 - HTXD ARV Drugs
Program Budget Code: 16 - HLAB Laboratory Infrastructure
Program Budget Code: 17 - HVSI Strategic Information
Total Planned Funding for Program Budget Code: $655,340
Data collection and reporting for HIV/AIDS in Ukraine is regulated by a December 2004 Order of the Cabinet of Ministers of
Ukraine. According to this order, Central government authorities are to monitor and evaluate HIV/AIDS programs and activities,
based on an agreed upon set of national indicators. Based on this order, a list of national indicators for monitoring and evaluating
HIV/AIDS activities which are consistent with UNGASS guidelines was developed. Data is systematically collected on these
indicators for development of UNGASS reports; with five central governmental authorities responsible for data collection and
reporting on national indicators, including: the Ministry of Health, the Ministry of Family, Youth and Sports, the Ministry of
Education and Science, the Ministry of Defense, and the State Penitentiary Department of Ukraine.
Primary responsibility for regular reporting on progress on the implementation of the UNGASS Declaration rests with the National
Government. According to the Ukrainian law on AIDS, the Ministry of Health of Ukraine is the authority responsible for
coordination of the national response to HIV/AIDS. Within the Ministry of Health, the Committee on the Prevention of HIV/AIDS
and Other Socially Dangerous Diseases is responsible for overall coordination of the process for UNGASS reporting. In this
capacity, the Committee must manage the process of endorsement of indicators by central governmental authorities, and oversee
the final endorsement of UNGASS reports on behalf of the Government of Ukraine.
The national indicators were an important first step in developing a national M&E system. To date, though, although draft M&E
frameworks have been developed and efforts put in place to strengthen M&E systems in different government ministries and at
the regional level, there is not a GOU- endorsed, national M&E system in line with the Three Ones for use in monitoring the
national AIDS program. In early 2007, however, the Cabinet of Ministers mandated the development of a clear M&E framework
with specific indicators for the National AIDS Program for 2009-2013. To date, however, there is continuing lack of a formal
coordinating structure to provide overall guidance to, and coordinate, the national response to AIDS, nor is there a national M&E
center or unit to coordinate the many HIV data flows into one consolidated M&E system.
During the past few years, with the support of the Global Fund, there has been important progress in expanding surveillance
among key MARP groups. However, there are continuing gaps in surveillance, lack of a clear research agenda, and as of yet
limited capacity to conduct surveillance studies, particularly qualitative studies.
Finally and significantly, information collected on national indicators and through research are not routinely used to inform national
and regional decisions on policy and program planning.
After the Global fund, the USG is the largest donor in HIV/AIDS programming in Ukraine; the organizational and systems
strengthening work it has supported to date has made a significant contribution to national program outputs and outcomes.
Working closely with the Global Fund, UNAIDS and other stakeholders and partners in HIV/AIDS and under the framework of the
Three Ones Principles, the USG has provided critically needed support in strengthening national HIV-related monitoring and
evaluation efforts, especially at the regional level. A few years ago, the USG played a key role in developing the national
indicators for the national AIDS program. Since that time, USAID implementing partners have coordinated closely with UNAIDS in
providing targeted assistance to strengthen monitoring and evaluation systems through the establishment of regional monitoring
and evaluation centers that are responsible for the collection and analysis of regional level data.
Building on this framework, USAID proposes to provide targeted assistance to strengthen strategic information systems in Ukraine
using COP 2009 resources. Efforts to improve monitoring and evaluation processes and the use of data for decision-making will
intensify. Activities will continue to focus on strengthening the role of regional M&E centers by institutionalizing regional level
monitoring and evaluation systems which continually assess the effectiveness of regional HIV/AIDS programs. Assistance to
regional centers will build capacity to collect, analyze, disseminate and utilize data strategically. Working in close collaboration
with other USG implementing partners, UNAIDS and the Government of Ukraine, it is anticipated that by the end of 2009,
strengthened and unified M&E systems will be operational in all regions of Ukraine.
In addition, the USG will work with public and nongovernmental partners to strengthen surveillance systems and monitoring and
assessment methodologies to track and assess program effectiveness and impact. Using COP 2009 resources, the USG will also
focus on strengthening epidemiological data and strategic information approaches in order to ensure that programs for MARPs
are of sufficient quality, scope, scale and quantity. With the aim of building the capacity of central/national and regional level staff
in surveillance, key activities would include training of NGOs on strengthening MARP survey approaches; and a data triangulation
exercise to strengthen monitoring of the progression of HIV and assess the effectiveness of programs. Ongoing focus will be
given to strengthening sub-national M&E as part of the national M&E system and on building capacity at the local level to use
M&E systems, including second generation surveillance systems, to closely and accurately monitor behaviors and trends.
The USG's planned 2009 COP support to strategic information will ensure a coordinated approach to the collection of information
to monitor progress against national program results. To this end, one HIV/AIDS implementing partner is charged with tracking
national and regional level indicators measuring the scope, severity, evolution and response to the HIV/AIDS epidemic. In this,
the Partner coordinates closely with UNAIDS in the collection of data, as well as works with UNAIDS and the Government of
Ukraine in the dissemination, reporting and utilization of this data to more appropriately target program planning and
implementation.
The Ukraine PEPFAR Country Team does not have a strategic information team, although the PEPFAR Coordinator and one
team member provide oversight to SI functions. Plans are under development, however, to scale up staffing in order to expand SI
skills within the team. In addition, discussions are underway with OGAC to support the fielding to Ukraine, in the early part of FY
2009, of a team that will assist the Mission to define a SI strategy and plan of activities blending monitoring and evaluation and
surveillance functions and to provide input and guidance on strategic programming on SI using COP 2008 and 2009 resources.
To improve the collection and utilization of data for monitoring and evaluation of the country program, the USG plans to use COP
2008 and 2009 resources to obtain technical support to assist the team in the design of an overarching monitoring and evaluation
plan for the PEPFAR Country Program as well as an assessment of implementing partner monitoring and evaluation systems and
plans. This would include an assessment of data quality and a plan for the improvement of data quality.
Table 3.3.17:
