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.
The funding level for this activity in FY 2008 has increased since FY 2007. Narrative changes include
updates on progress made and expansion of activities.
This activity is linked to SoPHO PMTCT.
Tulane University, through its sub-partner Boston University and local non-governmental agency Boston
University Center for International Health and Development, Zambia (BUCIHDZ) (formerly the Zambia
Exclusive Breastfeeding Study, ZEBS), and in collaboration with the Southern Provincial Health Office
(SPHO) began providing prevention of mother to child transmission of HIV (PMTCT) in FY 2006 in three
districts. By the end of 2007, they directly supported government clinics in eight districts while indirectly
supporting the government initiative in the remaining three districts of the Southern Province.
In FY 2007, BU received additional funds to strengthen the entire PMTCT program with special emphasis
on increasing coverage of rural populations with improved maternal and child health (MCH) services;
providing effective PMTCT antiretroviral (ART) prophylaxis; improving the postnatal care for mother-child
pairs; establishing infant and young child feeding support and lastly, to train traditional birth attendants
(TBAs) in the delivery of PMTCT services. With the plus-up funds, BUCIHDZ also further enhanced the
linkage between PMTCT and ART through improved referrals of all pregnant women for baseline CD4
screening. These funds will also permit the expansion of the successful performance-based bursary aimed
at improving community outreach in the most rural regions. This bursary is a resource for facilities to
strengthen PMTCT specific community outreach programs as well as incorporate PMTCT messages into all
other outreach activities. The pilot has proven successful as the numbers of women tested in the field
during outreach has increased significantly. Lastly, these funds will be used to continue strengthening
MCH programs and efficiently integrating PMTCT services into these services.
Through additional funding, BUCIHDZ also established a comprehensive exclusive breastfeeding (EBF)
demonstration project in one urban site (George Clinic, Lusaka) and in three rural sites (in Mazabuka
District, Southern Province. Provided the project is successful, this funding will be used to add additional
demonstration sites in consultation with national PMTCT partners. There are three specific objectives: 1) to
promote and achieve high levels (> 75%) of EBF through six months of age among pregnant HIV-infected
women booking in the antenatal clinics; 2) to promote and achieve high compliance with first line ART
among HIV-infected pregnant women who qualify according to the national guidelines; 3) to discourage and
minimize cessation of breastfeeding or non-EBF among women who learn their infant's negative HIV
infection status through early infant diagnosis polymerase chain reaction (PCR).
FY 2008 activities will result in: (1) increased access to quality PMTCT services; (2) improved quality of
PMTCT services integrated into routine MCH services; (3) increased coverage of voluntary counseling and
testing (VCT) services; (4) higher use of a complete course of ARV prophylaxis by HIV-positive women; (5)
improved referral to ARV treatment programs as they are developed within the districts; and (6) expansion
of the successfully piloted innovative community-based VCT, and PMTCT program to rural populations not
ordinarily reached through facility-based PMTCT services.
In FY 2008, BUCIHDZ will continue expanding PMTCT services in the Southern Province. In collaboration
with the SPHO and district health management teams, BUCIHDZ will directly support PMTCT services in 8
districts of Southern Province and in partnership with the PHO support PMTCT services in the remaining
three districts. BU will aim to have at least 80% of health centers in these districts establish PMTCT
services. As of March 2007, the United States Government (USG) through its partners, Academy for
Educational Development and BUCIHDZ were supporting 90 health facilities out of a total of 217 MCH sites
in the Southern Province. By the end of FY 2008, BUCIHDZ will provide direct support to 190 sites in all 11
districts (pending direct SPHO support to three districts) and will, in collaboration with the province, provide
technical assistance to sites that will be established by district health teams. BUCIHDZ, in partnership with
SPHO and district teams will train health workers in these facilities on all components of PMTCT services
and integrate these services into routine MCH services, and provide back up commodities for the province.
By working in collaboration with the district health teams, capacity will be increased to ensure that
sustainable programs are developed and maintained. Additionally, BUCIHDZ will continue to focus efforts
on training health workers on data management, ensuring all facilities are correctly filling in government
registers, and reporting accurate and timely data to the DHOs for integration into the HMIS. Sustainability
of the PMTCT program will be achieved through the integration of PMTCT services into routine MCH
activities using existing government health workers and systems. Health workers will continue to be trained
in the implementation of the four-pronged approach to PMTCT in counseling, the minimum package of care
of PMTCT, logistics, data management, and quality assurance, as well as in the early infant diagnosis
package of didactic theory, specimen collection, packaging, transport and follow-up (see Palliative Care
Narrative).
BUCIHDZ will continue to support district efforts to develop networks and referral systems for pregnant
women to access other services offered at health centers and in the communities, including family planning.
These networks are critical for linking HIV-positive pregnant women to antiretroviral therapy (ART) services
and developing an approach where all HIV+ women are referred for baseline CD4 counts and women
needing ART are referred to the nearest ART center. BUCIHDZ will also provide counseling on appropriate
feeding options for infants born to HIV-positive women and those of unknown status. By the end of FY
2008, data on HIV-positive women and infants referred to ART and care services will be available as this
information is currently being incorporated as indicators in the PMTCT monitoring system.
Scarce and unequal allocation of human resources for service delivery is the biggest constraint limiting
coverage of HIV/AIDS services in Zambia. An innovative approach is crucial to extending human capacity
development, especially in the rural areas of Zambia, where access to care is extremely limited. In these
areas TBAs play a key role in implementing effective interventions in remote and rural settings. To address
the shortfall in counseling services, BUCIHDZ developed an innovative program of community-based
training of lay counselors in the provision of pre- and post-test HIV and lactation counseling. A cadre of
community members and traditional birth attendants was identified and trained to perform VCT at the health
posts and/or within the community. As part of their scope of responsibilities, the TBAs also performed real-
time community-based HIV testing using whole blood or oral fluid rapid tests, or linked these counseling
services with same-day HIV testing at the corresponding rural health center. Based on the success of this
approach, the model will be scaled-up to three other districts in the province by the end of FY 2008.
Activity Narrative:
BUCIHDZ will expand and continue providing leadership to the USG partners on the work piloted in FY
2007, involving TBAs in the provision of PMTCT services. This strategy has the potential to extend
essential PMTCT services to an otherwise difficult-to-reach but majority-segment of pregnant women in
rural health districts in Zambia. If successful, this approach can be implemented throughout the entire
Southern Province and other rural areas in Zambia.
Masters level students, from the Department of International Health at the BU School of Public Health in the
US, will continue to be recruited to work with the project in Southern Province on three to six month field-
based applied study projects and provision of cross-training support to health workers and managers.
Targets set for this activity cover a period ending September 30, 2009.
Anti-retroviral (ARV) treatment services and Prevention of Mother to Child Transmission (PMTCT) activities
are rapidly being scaled-up in the Southern Province of Zambia including pediatric treatment which was
introduced at the Southern Provincial Hospital in 2007.
In 2007, Boston University (BU) developed palliative care services to support children who are HIV-infected,
HIV-exposed or have been the subject of HIV-exposure through child sexual abuse. In FY 2008, BU will
continue to provide palliative care to children who are HIV-infected, HIV-exposed or have been the subject
of HIV-exposure through child sexual abuse. Specifically funds will 1) insure that co-trimoxazole is available
and being prescribed to all children born to HIV-infected women within the overall Southern Province
PMTCT Integration Program; 2) actively promote breastfeeding among HIV-infected children; 3) provide
psychosocial therapy to HIV-exposed and infected children in the Child Sexual Abuse Clinic in Lusaka; 4)
facilitate referral to the Pediatric Center of Excellence; and 5) where possible actively promote the capture
into ART care all children who are identified as HIV-infected. BU has special expertise in and is assisting
with the implementation of psychosocial assessment and treatment for HIV-infected children identified at the
University Teaching Hospital (UTH) Child Sexual Abuse Clinic in Lusaka. Child sexual abuse services and
post-exposure prophylaxis of HIV services are intended to soon be provided in Livingstone (Southern
Province). BU's participation in the development and implementation of this pilot program will be key to its
success in Livingstone.
In 2008 BU will provide technical data management, monitoring and evaluation assistance to the Child
Sexual Abuse Clinic (CSAC) at University Teaching Hospital (UTH) in Lusaka. BU will coordinate with UTH
and the director of CSAC to build an efficient data management system using the Teleforms system, and
provide technical assistance for data analysis. This monitoring and evaluation system will improve follow up
and care of HIV-exposed children, indirectly improving palliative care services. Additionally, BU will provide
technical expertise in the area of psychosocial support and trauma-based therapy. With extensive
experience in this area in other developing countries, BU technical staff will develop, validate and implement
culturally appropriate, psychosocial measurement tools which are currently unavailable in the country. BU
plants to integrate these child-friendly and psychosocial aspects to all components of the CSAC clinic. It will
support two full time CSAC staff members as well as a part-time data manager. BU's expert in mental
health and child trauma will build local capacity by training all staff at the CSCA clinic in psychosocial
measurement tools and child-friendly methodology. Child sexual abuse services and post-exposure
prophylaxis of HIV services will soon be offered in Livingstone Provincial Hospital (Southern Province), and
will ideally benefit from the locally trained staff and the psychosocial measurement tools.
Another component of this activity is a continuing to pilot a program on early infant HIV diagnosis that that
was stated in 2007. Funding for this activity will be used to continue strengthening palliative care services
and linkages to support adults and children infected with and affected by HIV/AIDS.
The funding will be used to establish and strengthen palliative care support for mothers and children. Parts
of the Southern Province are very rural and services are scarce and far apart from one another, and extra
effort is needed to establish sustainable palliative care linkages to support treatment and PMTCT services.
Palliative care support will include: infant care and follow-up support for HIV infected children and mothers
including the provision of infant and adult cotrimoxazole; nutritional supplements where necessary; bed
nets; and building linkages with home based care programs in the province. Funding will also be used to
support training for home based care within a rural setting.
In FY 2008 BU will 1) identify large numbers of exposed (at risk) children and ensure that infant and adult
cotrimoxazole is available and being prescribed as per MOH guidelines; 2) actively promote breastfeeding
among HIV-infected children and strengthen infant feeding counseling; 3) facilitate referral to the
Livingstone Pediatric Center of Excellence; 4) work with partners including CIDRZ and the Clinton
Foundation to increase the availability of early infant diagnosis and refer all children who are identified as
HIV-infected to ART treatment centers; and 5) strengthen linkages between PMTCT sites and identified
home based care programs in the province, including, but not limited to, RAPIDS, SUCCESS and Mothers 2
Mothers.
Additionally, BU will use this funding to integrate the Early Infant HIV Diagnosis training into the existing
PMTCT training package, as well as include this program in its in-service facility based monitoring program.
Therefore, all participants trained in PMTCT will also be competent in the didactic DNA PCR theory as well
as specimen collection, packaging, transport and follow-up. BU will coordinate with the Clinton Foundation
and/or CIDRZ to ensure specimen transport is available throughout Southern Province
Another component of this activity will continue working with the Southern Provincial Health Office and
District Health Offices to implement wrap-around palliative care activities benefiting people living with
HIV/AIDS (PLWHAs) and their caretakers. Target areas will include communal areas, schools, and clinics,
strategically located to serve both the host facility and the local community.
Home-based care training will be provided to approximately 200 community members, and will be
coordinated with other partners currently working in home based care such as RAPIDS and CIDRZ. In
addition to working with communities to improve nutrition, community workers will be trained to actively
identify and refer people to local HIV/AIDS services, such as counseling and testing or treatment evaluation.
Health promotional strategy techniques, such as the ART adherence "Buddy System" and the formation of
support groups will also be taught to the community workers.
The following activity is newly proposed ¬for FY 2008 with Plus-up funds.
Early infant diagnosis service has lagged in ART services provision due to lack of capacity leading to high
early mortality of children born with HIV infection. Using Plus-Up funds ($1M total for scaling-up infant HIV
diagnosis nationwide in Zambia), Boston University (BU) will collaborate with Southern PHO and the
National Infant Diagnosis Reference Lab at University Teaching Hospital to make infant HIV diagnosis using
dried blood spots available throughout rural and urban areas of Southern Province. The activity will link in
closely with prevention to mother to child transmission of HIV services and infant follow-up at all health
centers supported by BU in the province. Earlier HIV diagnosis will lead to earlier referral and start of
antiretroviral therapy at a much younger age, leading to improved long-term outcomes. This activity will also
contribute to scaling of pediatric ART services in Southern Province where the number of children
accessing ART services has been low.