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 new Community Empowerment through Self Reliance Program (COMETS) project
is based on a comprehensive community support and project graduation model designed to enhance
critical services including HIV Prevention, Counseling and Testing (CT), and the care of Persons Living with
HIV/AIDS (PLWHA) and Orphans and Vulnerable Children (OVC). COMETS is designed to release the
latent capacity of rural communities for self-help in these service delivery areas, so as to optimize self-
reliance in the promotion of sustainability. COMETS seeks to empower the communities to better negotiate
vertically in the health care delivery system for the assured delivery of quality services and commodity
supplies.
In FY09, COMETS will expand the two existing GDA's to 12 private sector partners in the mining and
agribusiness sectors. The GDA partner workplace programs will enhance and strengthen the rural response
to the HIV/AIDS epidemic in underserved rural communities. COMETS will provide support to local
communities through a multi-pronged capacity building process that includes the provision of technical
support, training, sub grants for HIV prevention and care, and the establishment of long-term community
learning resources. COMETS Mobile HIV Units (MHU) will accelerate the obtainment of national roll-out
goals in HIV prevention, CT services and the care and treatment of PLWHA
COMETS will scale up the delivery of PMTCT services in the workplace and the community through on site
and of site health facilities, the scale up of the MHU and the engagement of the HIV Resource Persons
Network ( HRPN). The MHU implements opt out testing in the PMTCT setting in line with the Governments
guidelines and practice. The workplace and the HRPN will play an integral role in the delivery of workplace
and community based PMTCT sensitisation with supportive supervision from COMETS.
Project support in PMTCT services will focus on building the capacity of HRPN (106) particularly in the rural
communities. The MHUs will provide supportive supervision to the HRPN in rural communities providing
PMTCT sensitisation and PMTCT CT review meetings, referral follow ups and monitoring and evaluation
support. Interaction and collaboration between the RHC, HRPN and the MHU is critical to ensure forward
planning and review to ensure mothers who are HIV + are monitored, reassured of the benefits of the
service and receive ART at the appropriate time. PMTCT service clients often fear stigma and
discrimination by their peers requiring consistent counselling during pregnancy, delivery, and treatment
adherence later on.
In the workplace setting the HIV Workplace Policy and the HIV Workplace Programme are enhanced by the
inclusion of PMTCT services. In CHAMP's experience it has been observed in the mining sector that
sensitisation of the miner in the workplace and implementation of opt out HIV testing in antenatal clinics
results in over ninety percent uptake of PMTCT CT and PMTCT ART services.
The Workplaces, RHC, MHU and HRPN will work closely with community groups and faith based
organizations to identify opportunities for PMTCT sensitisation to integrate and collaborate with existing
initiatives.
The implementation of COMETS PMTCT strategies will be guided by the National HIV/AIDS Strategic Plan
and guidelines from the MOH and other relevant government institutions and will be integrated into local
institutions and structures. Through ensuring collaboration and consultation at all levels project resources
allocated will have the optimum impact and will support the continuum of care.
During FY09, the Treatment Adherence Agents (TAA) that have been trained in the existing 24 GDA rural
health center catchments populations to support patients on HIV treatment, including those who have
accessed PMTCT ART, will be strengthened and supported. This model will be expanded to the new rural
health center sites in linkage with Zambia National AIDS Network and the Global Fund.
New/Continuing Activity: New Activity
Continuing Activity:
Emphasis Areas
Gender
* Addressing male norms and behaviors
* Increasing gender equity in HIV/AIDS programs
Workplace Programs
Human Capacity Development
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
The Community Empowerment through Self Reliance Program (COMETS) project is based on a
comprehensive community support and project graduation model designed to enhance critical services
including HIV Prevention, Counseling and Testing (CT), and the care of Persons Living with HIV/AIDS
(PLWHA) and Orphans and Vulnerable Children (OVC). COMETS is designed to release the latent capacity
of rural communities for self-help in these service delivery areas, so as to optimize self-reliance in the
promotion of sustainability. COMETS seeks to empower the communities to better negotiate vertically in
the health care delivery system for the assured delivery of quality services and commodity supplies.
To increase access to comprehensive HIV/AIDS prevention information on COMETS will support the
dissemination of information on Prevention AB and behavior change through the implementation of a robust
sensitization program in workplaces and communities through existing and new partnerships. COMETS will
strengthen the existing GDA HIV Resource Persons Network (HRPN) and train an additional 2,416
individuals in Prevention: AB strategies in the GDA workplaces and outreach communities. The HRPN will
be selected through a participatory consultative process with the GDA partners, community groups, DHO
and DATF. The existing active HRPN will be strengthened in identified gap areas where attrition and loss of
members has occurred. In the rural communities, the trainees will be from the COMETS supported rural
health center catchment populations, thus integrated into the district, provincial and national response
through linkages between COMETS, the Rural Health Centers (RHC), Neighborhood Health Committees
(NHC), and DHO's and will support sensitization and mobilization activities around the rural health centers.
supportive supervision and receive
The COMETS HRPN in the workplace and the community will reach 388,000 individuals with messages and
activities that will promote AB prevention and behavior change. The dissemination of prevention information
will enhance the ability of employees, dependents and community members to make informed decisions
that will result in social change leading to the reduction of the sexual transmission of HIV. The strengthening
and capacity of the HIV Resource Persons network in the workplace and the GDA and COMETS
communities, the creation of referral linkages to CT and other prevention services and the implementation
of activities to support AB sensitization will be in place to ensure success of efforts to expand AB
prevention. The GDA partners will continue to provide prevention messages in all new employee inductions,
safety talks and payroll messages as well as promote the circulation of IEC materials in the workplace to
employees and their dependents.
Through COMETS-linked Behavior Change interventions through the MHU, local FBOs and CBOs, the
project will increase the numbers of individuals reached with prevention information and messages with the
aim of reinforcing social norms as to the delay of sexual debut, abstinence and faithfulness so as to
increase the number of people practicing primary or secondary abstinence, and reduce the number of
partners. Through community mobilization, the project will reach discordant couples and youth both in and
out of school, especially girls.
There will be a specific focus on gender related prevention messages for the mining industry who are
mostly male employees and for the cotton agribusiness industry employee who are mostly female. The
HRPN will work closely with community groups and faith based organizations to spread the messages on
Prevention AB to faith based congregations and youth groups. In communities COMETS will work closely
with the various DHO and District Education Offices in the rural district areas to continue to pilot HIV
education programs for school pupils who are 16 years and over on Prevention AB. This methodology is
currently being piloted in Mkushi where CHAMP is working closely with the District Health and District
Education Officer through the existing GDA program.
The implementation of COMETS prevention strategies will be guided by the National HIV/AIDS Strategic
Plan and guidelines from the MOH and other relevant government institutions and will be integrated into
local institutions and structures. Through ensuring collaboration and consultation at all levels project
resources allocated will have the optimum impact and will support the continuum and sustainability of
prevention intervention.
Program Budget Code: 03 - HVOP Sexual Prevention: Other sexual prevention
Total Planned Funding for Program Budget Code: $11,781,600
Total Planned Funding for Program Budget Code: $0
Table 3.3.03:
Comets will work with high risk groups including migrant populations outside Zambia, seasonal workers,
truckers and contractors. A number of the GDA partners are in isolated sites, near borders, in some cases
they are the only employer in a district, and/or establishing new sites with a large number of short-term
contractors on site. COMETS will build on the existing GDA HIV workplace and community programs and
HIV Resource Persons Network (HRPN) focusing on specific activities such as ABC education, condom
distribution, and the support of recreational activities in order to provide the high risk populations with
activities to alleviate the boredom that is inherent in mobile situations. There will be emphasis with the
female seasonal workers on education in empowerment, negotiation skills and the female condom. With the
predominantly male migrant workers in the mining industry, there will be an emphasis on education
programmes around behavior change, multiple concurrent couples, life skills, cash management, effects of
drug and alcohol use and condom use.
COMETS will train 2,416 HRPN with representation from the migrant, seasonal worker and contractors in
the workplace and the community. The HRPN will reach 371,200 individuals with messages on Prevention
Other through education and mobilization activities in the workplace and community to promote behavior
change. COMETS will provide technical supportive assistance and sub grant support to the HRPN in the
carrying out of their activities that target high risk populations.
In FY09, the activities of the MHU's will increase sensitization and mobilization activities to reach 56 rural
health catchment populations supported by their mobile services. Prevention Other services will focus on
patients who are receiving Pre-ART or ART services for condom distribution and education whilst promoting
treatment adherence, the risks of developing drug resistance if both partners are HIV positive and on
treatment. Condoms for the rural health centers communities will be distributed through the MOH following
MOH condom distribution practice and WHO guidelines for high risk groups with uptake captured as part of
the national response at district level.
goals in HIV prevention, CT services and the care and treatment of PLWHA. The GDA Partners work
closely with the Ministry of Health (MOH) and the National HIV/AIDS/STI/TB Council (NAC) to ensure
harmonization of the private and public sector responses and approaches.
In FY 09 COMETS will scale up the delivery of palliative care in the workplace and the community through
on site and of site health facilities, the scale up of the MHU and the engagement of the HIV Resource
Persons Network (HRPN). The HRPN will play a pivotal role in the delivery of community based palliative
care with supportive supervision from the MHU. COMETS will focus on palliative care Pre-ART, palliative
care ART, Home-based care integrating palliative care TB by building the capacity of Palliative Care
providers particularly in the rural communities.
The MHUs will provide supportive supervision to the PC providers through review meetings, referral follow
ups and monitoring and evaluation support. Interaction and collaboration between the RHC, HRPN and the
MHU is critical to ensure forward planning and review to avoid loosing track of clients will be critical
particularly in PC Pre-ART service provision as these clients often feel well and do not attend clinical
monitoring appointments.
The number of existing HRPN will be increase with an additional 643 trained in the catchment populations
around the rural health centers. The HRPN will be selected through a participatory consultative process with
the GDA partners, community groups, DHO and DATF. The existing active HRPN will be strengthened in
identified gap areas where attrition and loss of members has occurred. Selection criteria for trainees will
give preference to those who are already actively involved on HIV activities. In the rural communities, the
trainees will be from the COMETS supported rural health center catchment populations, thus integrated into
the district, provincial and national response through linkages between COMETS, the Rural Health Centers
(RHC), Neighborhood Health Committees (NHC), and DHO's and will support sensitization and
mobilization activities around the rural health centers. They will be provided with supportive supervision and
receive financial support for activities through the COMETS sub grants.
The RHC, MHU and HRPN will work closely with community groups and faith based
organizations to identify potential clients for palliative care including home based care with a view to
integrate and collaborate with existing home based care initiatives. The implementation of COMETS
palliative care strategies will be guided by the National HIV/AIDS Strategic Plan and guidelines from the
MOH and other relevant government institutions and will be integrated into local institutions and structures.
Through ensuring collaboration and consultation at all levels project resources allocated will have the
optimum impact and will support the continuum and sustainability of prevention intervention.
health center catchments populations to support patients on treatment will be strengthened and supported.
It is anticipated that this model will be expanded to the new rural health center sites in linkage with Zambia
National AIDS Network and the Global Fund.
Table 3.3.08:
COMETS will scale up of the number of GDA partners offering on site facilities to employees and their
families with at least 3 new GDA partners Lumwana Mine , Chibuluma Mine, and Luanshya Mine providing
free/subsidized ART services to employees, dependents and the outreach community through their hospital
and/ or clinics. COMETS will increase the number of private sector clinics offering ART services in the
within the existing GDA partnership.
The number of mobile HIV Services Units will increase from the existing 3 to 7 districts supporting a total 56
rural health centers. Through the deployment of a MHU in seven districts, COMETS will provide mobile
outreach services designed to help the DHO overcome deficiencies in the provision of vital HIV/AIDS
services in rural communities. The roll out of MHUs as part of COMETS will build upon CHAMP's
experience in deploying MHUs in three Zambian districts. The use of MHUs in these three districts have
been heralded by the MoH for its innovation and for its effectiveness in the rapid scale up of CT, HIV care
and treatment, which are provided in support of the HIV mission of the rural health centers(RHCs). The
MHUs also provide an array of HIV services supportive of a community response.
The COMETS' MHUs will be operated by a four-member multidisciplinary team, including two clinical officer,
one nurse counselor and a field assistant. The team, their vehicle, tents, and other equipment will be based
within the District Health Office to assure smooth coordination with DHO officials. Following site selection by
the DHO, the MHUs will provide outreach services on a pre-determined route to eight communities within a
district every two weeks. MHUs will coordinate their activities and visits with the RHC and local FBOs and
CBOs to assure a unified response and continuum of care. The MHUs will support the capacity of the RHCs
to provide quality services and will provide the RHCs, with support to ensure there are no ART stock outs by
facilitating timely supply of ART medications under a MOU with the MoH, which will supply these
commodities free of charge to COMETS.
The treatment offered by the mobile HIV unit will not be all-encompassing, and will build the capacity of
existing mid-level providers such as the RHCs and Palliative Care providers to bridge the gap created by
geographic distance and service delivery. The MHUs will provide CT services and support RHCs in their
provision of ART with referral to district-level health facilities as required as a way of integrating into MoH
protocols and systems. Deployment to RHC will also assure the rapid expansion of community access to
quality CT and ART services, through referrals and clinical support services, with the expectation of
reaching significant numbers of people during the first six months of the project.
All the ART Service Centers under the GDA's will be supported by the prevention and CT campaigns and
the sensitization and mobilization activities in the workplace and the community which will be carried out
and supported by the HIV Resource Persons Network (HRPN) supportive assistance from COMETS, and
sub grant funds. The integration of activities and interventions confirms that HIV sensitisation and the
mobilisation from HIV testing are the entry point for the continuum of care for the HIV + client
In FY09 COMETS will increase the number of service outlets providing ART to 24 and will initiate 4168 new
clients on ART whilst attaining 8,460 current clients and number of patients ever on treatment at 9378 at the
end of 2009.
Table 3.3.09:
COMETS will scale up the delivery of OVC services through existing and new initiatives in rural
communities. Local groups and initiatives will be supported to increase the beneficiaries and reach of
activities responding to the needs of OVC. The three essential services that will be provided will be health
care, educational and vocational training and economic opportunity strengthening. The education and
economic strengthening initiatives will be implemented through the grant mechanism.
Orphans and Vulnerable Children initiatives will target households where children are in need. The
identification of households will be carried out by local level leaders such as FBO and CBO representatives,
the District Health Office (DHO) with guidance from District Department of Social Welfare. The community
will be invited to submit proposals that will target identified households. Proposals to be considered for
funding could be, but not limited to, education as school uniform, direct support to household and capacity
building for parents, guardians and grandparents through a support group model.
The implementation of COMETS OVC strategies will be guided by the National HIV/AIDS Strategic Plan
and guidelines from the MoH for pediatric HIV care, the Ministry of Community Development and Social
Welfare and other relevant government institutions and will be integrated into local institutions and
structures. Through ensuring collaboration and consultation at all levels project resources allocated will
have the optimum impact and will support the continuum and sustainability of OVC interventions.
It is expected that $25,000 will be spent on food and nutrition (commodities) activities, $34,000 on economic
strengthening activities, and $6,000 on education activities.
Health-related Wraparound Programs
* Child Survival Activities
Table 3.3.13:
The new Community Empowerment through Self Reliance Program (COMETS) project is based on a
In FY 2009, COMETS will expand the two existing GDA's to 12 private sector partners in the mining and
In FY 2009 COMETS will scale up the number of CT service outlets providing counseling and Testing in the
GDA workplaces and outreach communities to reach 57,600 individuals with HIV counseling and testing
who receive their test results. This will be achieved through the training of 448 counselors who will
strengthen the existing GDA workplace and community HIV Resource Persons Network(HRPN) the
expansion of opt out and DCT services to forty rural health centres through the MHU, the and the scale up
of opt out CT and DCT services in the GDA on site clinics and hospitals.
The scale up of CT will also be supported by specific campaigns such as the "Need to Know" campaign
launch just before World Aids Day which emphasizes the need to know your status, what to do when your
negative and what to do when positive, and focused campaigns in the GDA workplace and outreach
communities supported by the HRPN, MHU, sub grants and the provision of IEC materials and mobile CT
services. Information on linkages to services, living positively and access to treatment will be made
available to all CT clients on testing negative or positive.
COMETS will provide technical support for the formation of new and existing support groups in both the
workplace and the community focusing on effective referral resulting in client enrollment following HIV
testing. Strategies to ensure the inclusion of clients who have tested negative will be an important focus as
almost seventy-five per cent of those tested test negative.
The GDA partners will also continue to implement innovative interventions in the workplace and the
communities such as the "door to door" campaign, workplace mobile CT, activities around traditional
ceremonies and functions, church events, corporate social responsibility programme events, before and
after shift on site CT services in the mining sector , and sports sponsored activities with CT services.
During FY 2009 emphasis will be placed on referral processes after CT particularly for those individuals that
need to seek further tests such as CD4 and pre ART/ART treatment which has been a challenge for the
GDA on site and off site service providers particularly in the work environment where issues of job security
and stigma are rampant.
* Increasing women's access to income and productive resources
* Increasing women's legal rights
* Reducing violence and coercion
Table 3.3.14:
goals in HIV prevention, CT services and the care and treatment of PLWHA for the assured delivery of
quality services and commodity supplies.
COMETS will provide support to local communities through a multi-pronged capacity building process that
includes the provision of technical support, training, sub grants for HIV prevention and care, and the
establishment of long-term community learning resources. COMETS Mobile HIV Units will accelerate the
obtainment of national roll-out goals in CT services and the care and treatment of PLWHA. COMETS will
focus on the identified GDA partner community population living within the catchment area of a rural health
centers as identified by the MoH's District Health Office (DHO). The size of such communities feeding into a
RHC typically ranges between 5,000 and 15,000 individuals.
COMETS will implement a sub grant mechanism to support the HIV activities of the GDA partners, FBOs
and CBOs operating within the rural communities. The capacity of community coalition to manage the sub
grant review and recommendation process will be developed and applications receiving recommendation
will come from the community.
COMETS will strengthen local partnerships, reinforcing both vertical and horizontal linkages, providing
technical advice and support to the community in implementing community-level training and M&E activities,
maintaining the Community Learning Centre, and developing the community's capacity to raise funds to
sustain local activities beyond the life of COMETS.
Table 3.3.18:
