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.
NASTAD will provide support to USG and CDC-Zambia's portfolio of PHE, policy analysis and quality improvement activities by providing logistical support to international and local consultants. NASTAD will work with CDC-Zambia to identify and procure services of short-term consultants with specialized skills that are often outside of the normal technical assistance available through large partners. One example will be the retention of a systems modeling consultant to support CDC-Zambia's PHE on antiretroviral therapy and supportive services. Funds will be used for a consultant to develop a prototype service delivery evaluation model by the end of 2007. Other examples may include experts in quality improvement and policy analysis to complement activities in support of the National HIV/AIDS/STI/TB Council and the Ministry of Health.
Table 3.3.11:
Table 3.3.12: Program Planning Overview Program Area: Laboratory Infrastructure Budget Code: HLAB Program Area Code: 12 Total Planned Funding for Program Area: $ 14,830,000.00
Program Area Context:
Laboratory services play a crucial role in rapidly expanding HIV/AIDS care and treatment services in Zambia. The US Government (USG) began supporting the Government of the Republic of Zambia's (GRZ) laboratory infrastructure reconstruction process in 2002; however, support was limited due to lack of resources. Upon initiation of the PEPFAR program, significant support has been provided to GRZ for strengthening and expanding access to quality HIV/AIDS laboratory services. For example, in FY 2004, CD4 count machines and viral load capability was mainly limited to University Teaching Hospital (UTH) in Lusaka; this situation greatly hindered scale-up of the national HIV testing and ART programs. Other limiting factors were cost of laboratory tests and patient wait time to receive test results -- often weeks or months after initial tests were taken. Therefore, in order to rapidly expand quality HIV care and treatment services, it was critical to update this limited laboratory system, including hematology and biochemistry tests to monitor ART response.
To achieve this objective, USG is working closely with GRZ, Ministry of Health (MOH), Japan International Development Agency (JICA), Global Fund for AIDS, Tuberculosis, and Malaria (GFATM), Clinton Foundation, and World Bank to ensure that an efficient and sustainable laboratory infrastructure is developed nationwide. Zambia has nine provincial hospitals, each with basic laboratory infrastructure supporting district-level hospitals and community health centers. In FY 2004, although CD4 count capacity using the DynaBead technology was sporadically available, it was extremely labor intensive, could only process a limited number of specimens, and often did not have reagents available to run the machines. These provincial laboratories are supported by the following reference laboratories: Chest Diseases Laboratory (CDL) and University Teaching Hospital Virology Laboratory (UTH) in Lusaka Province and Tropical Diseases Research Center (TDRC) in Copperbelt Province. Moreover, most clinics can perform microscopy, but are not equipped to perform tuberculosis (TB) cultures.
To better ensure sustainable laboratory infrastructures throughout Zambia, USG's approach is to assist GRZ in scaling-up the number of trained laboratory personnel, refurbishing laboratory work spaces to increase efficiencies, improving data collection, analysis, and communications within and between laboratory facilities, developing and implementing quality assurance protocols, and procuring HIV/AIDS laboratory equipment, reagents, and consumables. As a result, HIV/AIDS laboratory services have greatly improved; all nine provincial hospitals and several district hospitals are now performing CD4 count tests. Additionally, Polymerase Chain Reaction (PCR) testing for early infant diagnosis is available at two sites in Lusaka Province and two other provinces (Southern and Copperbelt) will have this capacity by the end of 2006.
Other accomplishments include: laboratory personnel trained in bio-safety, reducing contamination, use of the fluorescent microscope, and hematology and biochemistry procedures; communication, through purchasing computers and internet services, within and between laboratories strengthened; specimen referral transport systems expanded to promote same-day testing, especially in rural areas; increased procurements to support availability of testing, such as reagents, iso-temp incubators, Revco fridges, ultra flow fridges, fluorescent microscopes, BACTEC MGIT TB culture systems, and electric generators. Individual USG partners, such as Elizabeth Glaser Pediatric AIDS Foundation (EGPAF)/Center for Infectious Disease Research in Zambia (CIDRZ), and Zambia Prevention, Care, and Treatment Partnership (ZPCT), have also procured critical laboratory equipment and reagents as a stop-gap measure to ensure continuity of quality HIV/AIDS care.
In FY 2006, USG, MOH, Clinton Foundation, and many other partners conducted a national laboratory stakeholders workshop to develop the first national HIV/AIDS laboratory strategic framework and work plan. This watershed gathering enabled MOH to identify key programmatic areas that will increase access to quality HIV/AIDS laboratory services. These areas included: program management, procurement and logistics, instrumentation and infrastructure, human resources and training, and quality assurance and data management. Moreover, in FY 2006, JSI/DELIVER and Partnership for Supply Chain Management Systems
(SCMS) provided support to GFATM Principal Recipients in developing their HIV/AIDS laboratory procurement and logistics plans for Round Four, Phase Two and Round Six proposals. Finally, SCMS is currently assisting MOH in developing the first national medium-term HIV/AIDS laboratory equipment/reagents/consumables forecast and quantification.
Building on these achievements, in FY 2007, USG will continue its strong support to GRZ in strengthening critical HIV/AIDS laboratory services, with emphasis on expanding services to peri-urban and rural facilities as appropriate. Through SCMS, USG will provide the following supplies for the national HIV/AIDS laboratory program: CD4 reagents (Beckman Coulter Epics XL, Becton Dickinson FACSCalibur, Becton Dickinson FACSCount, Guava Easy CD4 System (PCA)); hematology reagents (BX Pentra 60C+, ABX Micros 60, Sysmex pocH-100i); chemistry reagents (Cobas Integra 400, Ortho Vitros DT60, Olympus AU400, Human Humalyzer 2000, Nova Biomedical Stat Profile pHOx Plus); and various consumables (e.g., EDTA vacutainer tubes 5ml, needles 21G, disposable gloves, pipette tips). SCMS will also provide technical assistance to MOH and GFATM Principal Recipients in strengthening the supply chain system for these items, including development and implementation of a standardized HIV/AIDS laboratory information system.
Also in FY 2007, MOH staff will continue to be trained in improving detection of TB cases using liquid culture technology as well as quality assurance activities, such as AFB smear microscopy. In addition to improving testing services, technical assistance will be provided to improve access to same-day test results, determine efficacious use of drugs, monitor ART treatment response, and conduct epidemiological surveillance and research activities to ensure programmatic decisions are based on sound evidence. USG will also support district-level training to expand access to quality bacterial culture procedures for early detection as well as drug susceptibility testing for agents of life-threatening conditions (e.g., septicemia and meningitis). Finally, USG and partners will strengthen the national TB microscopy quality assurance program by developing a referral system for TB culture and drug susceptibility testing services through equipping a regional state-of-the-art reference laboratory in Copperbelt Province to serve the northern section of the country.
With an increased focus on strategic HIV/AIDS laboratory infrastructure interventions, such as increasing the number of trained laboratory technicians, procuring critical supplies, and expanding access to these services, USG is well positioned to contribute to the PEPFAR's global 2-7-10 goals and to achieve the USG Five-Year Strategy objectives.
Program Area Target: Number of tests performed at USG-supported laboratories during the 855,504 reporting period: 1) HIV testing, 2) TB diagnostics, 3) syphilis testing, and 4) HIV disease monitoring Number of laboratories with capacity to perform 1) HIV tests and 2) CD4 tests 296 and/or lymphocyte tests Number of individuals trained in the provision of laboratory-related activities 1,417
Table 3.3.12:
This activity relates to SI (#9023 and #8910) and OHPS (#9024 and #9014).
The National Association of State and Territorial AIDS Directors (NASTAD), in collaboration with the Government of the Republic of Zambia's (GRZ) HIV-related monitoring and evaluation (M&E) capacity building focal points National AIDS Council (NAC), SHARe, and the Central Statistics Office (CSO) will continue to provide technical assistance to NAC and other institutional staff charged with improving M&E tools and processes as part of a long-term program focused on building the M&E workforce in Zambia. In addition to on-the-ground periods of assistance, NASTAD will continue to mentor for long-term individual and institutional capacity building. Funds will also be used to bring recognized M&E experts to Zambia for targeted trainings. In 2007, NASTAD will also conduct an assessment and develop a feasibility plan for expanding work in Eastern and Lusaka Provinces.
This activity is related to OHPS (#8911 and #9030) and SI (#8910, #9013, #9011, and #9023).
In 2006, Unites States Government (USG) supported NASTAD to coordinate and provide technical assistance to Zambia's National HIV/AIDS/STI/TB Council (NAC) national M&E system in partnership with SHARe, University of Zambia (UNZA), and Joint United Nations Program on AIDS (UNAIDS). The continued goals have been 1) to catalyze the flow of information from the district and provincial levels to the central level for improved system-wide planning, and 2) to enable better decision making among district and provincial bodies.
NAC continues to strengthen multi-sectoral planning and data use efforts with NASTAD working in tandem with NAC to support Provincial AIDS Coordinating Advisors (PACAs), District AIDS Coordinating Advisors (DACAs), Provincial AIDS Task Forces (PATFs), and District AIDS Task Forces (DATFs) intensively in refining, prioritizing, resource finding, implementing, and monitoring these activities. In 2006, Southern and Western provinces served successfully as pilot sites for NASTAD's collaborative activities to support planning, and data use in cooperation with partners. NASTAD has carried forward the national M&E manual and curriculum developed by the partners and with technical assistance from CDC. NASTAD and SHARe have worked in close collaboration using their unique approaches to maximize appropriate and timely support as well as geographical coverage. NASTAD is uniquely structured to provide intensive, in-depth support to the districts in need over a sustained period of time. In 2007, NASTAD will continue to provide on-the-ground and distance-based technical support to the PATF in Southern and Western Provinces and in-depth support to two DATFs in Southern Province, Choma and Livingstone. In addition, depending on NAC's needs, NASTAD will include two more districts in Southern and Western provinces and two new districts in Lusaka and Eastern provinces. In-depth technical assistance (TA) will include establishing systems for multi-partner resource tracking, activity-based resource gap analysis, and improving activity-based data collection tools consistent with national requirements. In total, four PACAs will be directly supported with TA while the remaining seven will be directly supported through national activities. At least 15 individuals in each district at each site (12) totaling 180 individuals. As PATFs and DATFs are often made up of various local organizations (on average at least four), NASTAD will aim to assist 64 organizations (note that these targets are in addition to those focused on monitoring and evaluation under the strategic information section activity #9013).
USG will support the University of Zambia (UNZA) (#9030) to become an in-country training and resource center for capacity building in planning, monitoring, and evaluation. To ensure sustainability, NASTAD will work closely with UNZA to develop a business plan for 2007-2011. The business plan will outline an organizational structure, services areas, potential markets, and fee structure to provide planning, monitoring, and evaluation consultation to HIV/AIDS related organizations in Zambia. The plan will also outline potential sources of grants and regional partnerships. USG will work with NASTAD to identify a state or city HIV/AIDS department, a university, or foundation, to establish a long-term relationship of financial and technical support
NASTAD has developed a highly skilled team of state AIDS directors and/or their program staff who currently work within United States State Health Departments managing HIV/AIDS program planning, funding, and implementation activities. The TA team has built peer-to-peer relationships with the PATF and DATFs where the technical expertise has been jointly developed and delivered.
USG has been instrumental in developing a joint capacity building plan with NAC and the national M&E Technical Working Group. An Evaluation Capacity-Building Sub-Committee includes staff from NAC, SHARe, UNAIDS, United Nations Development Program, Global Fund, Ministry of Health, United States Agency for International Development, and CDC. CDC ensures that NASTAD's efforts are focused among the activities of this group. The sub-committee has developed a very specific plan to ensure an integrated and coordinated implementation plan.
