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.
April 2009 Reprogramming: Updated Mechanism and Prime Partner from TBD
THIS ACTIVITY NARRATIVE HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
•Updates on current activities
•Expansion plans for FY 2009
Activity Narrative
This activity relates to Columbia ICAP (TBD) pediatric treatment (#3691.08), and TB/HIV (#17633.08), as
well as all UTH supported activities under treatment CSA (#9043), PCOE (9765.08) counselling and testing
FSU (#9044) and Opt-Out (# 9717.08), and pediatric care and support PCOE (PDCS# NEW), EID #(NEW)
community HIV/Nutrition #NEW, palliative care (# 12230.08), mobile initiative # NEW , Nebraska (#
3701.08) and SPHO counselling and testing (#3667.08) and pediatric treatment programs (# NEW)
In March 2005, ICAP began activities in Zambia to support the design, implementation, and evaluation of
Pediatric and Family Centers of Excellence (PCOE) throughout the country in partnership and close
collaboration with the Department of Pediatrics and Child Health at the UTH. Program goal include:
1)Support the implementation of integrated and comprehensive family centered approach to pediatric HIV
support, care and treatment services (HIVSCT) and reduce HIV-related morbidity and mortality
2)Enhance and strengthen the capacity of the Zambian public health system, through partnership with the
UTH PCOE to provide quality pediatric HIV/AIDS related services.
ICAP has supported the development, implementation and strengthening of two PCOEs, the UTH PCOE in
Lusaka Province and Livingstone General Hospital PCOE in Southern Province. PCOE goals are to serve
as:
1)model facilities to provide state-of-the art comprehensive pediatric/adolescent HIVSCT services,
2)referral centers for the nation and province, respectively
3)(UTH PCOE only) training, learning, technical support and dissemination centers for Zambia.
In FY 2009, TBD will transition from providing technical, program, and operations support virtually to
providing this support via an in-country team and office to ensure that more efficient and real-time support is
offered. Program elements TBD will support, with UTH PCOE, include:
Comprehensive pediatric HIVSCT services: TBD will build on site capacity by supporting systems and
healthcare workers to institute program elements that consider the multiple and changing needs of pediatric
clients and of the family. TBD will support:
1)Quality and continuous clinical care for all children living with HIV (CLHIV)
2)Monitoring and assessment of all CLHIV for treatment eligibility
3)Continuous assessment of all children enrolled in HIVSCT services for treatment complications,
outcomes, and failure
4)Increased linkage and coordination to support the HIV needs of the family
5)Implementation of comprehensive care package for the CLHIV at all ARV sites, including cotrimoxazole
prophylaxis and growth monitoring
6)Pediatric adherence, psychosocial programs, and support groups for CLHIV
7)Through collaboration with Zambia Palliative Care Association, improved services for acute and chronic
pain management for CLHIV
8) Support the development and implementation of a USG Zambia food and nutrition strategy, as well as
to consider adopting a common technical approach to food and nutrition support
Neurodevelopmental approach to pediatric HIV services: TBD will support sites to apply a
DEVELOPMENTAL APPROACH to pediatric care, understanding that abilities (cognitive and physical)
evolve and mature over time and through various life stages.. This affects and should be considered critical
to all HIV issues such as adherence, disclosure, physical examination, normative laboratory values which
change over time and life stages
.
Early Infant Diagnosis (EID): TBD will support the development and site level implementation of systems for
supporting EID. This will include the development of services to offer EID, reporting tools, and HCW skills
training on infant diagnosis including:
1)Support EID program with PCR testing for all children <18 month identified through linkage with PMTCT
or rapid test screening programs
2)Enhance PCR reporting systems to decrease post-test counseling turnaround time
3)Ensure that families receive results promptly and as part of a counseling session,
4)Engage and retain infants who are breast fed in care until final infection status is determined.
Patient Follow-up: TBD will continue to support and expand comprehensive community outreach and
patient follow-up activities. This includes enhancing patient follow-up and tracking programs supported by
teams of outreach workers and "expert" caregivers trained in locating and supporting families of clients who
have discontinued care and treatment services. TBD will continue to strengthen the pediatric patient
tracking and monitoring system in the PCOEs and in districts targeted for support.
Malaria: Where relevant, TBD will help strengthen malaria prevention interventions through the PMI and
national malaria centre, including supplying bednets to clients upon enrolment and educating caregivers on
prevention, warning signs, and action steps.
Pediatric HIV Testing: TBD, in collaboration with UTH, will support pediatric case finding in clinical settings:
1)Supporting the implementation of provider initiated inpatient testing and counseling
2)Supporting ART facilities to actively screen for and engage children of all ART/PMTCT clients to be tested
for HIV.
3)Supporting HIV testing and counseling services at all points of encounter children have with clinical
services immunization, TB, under-5, malnutrition, etc
Activity Narrative: Adolescents: Depending on the population, clinics will be designed to support HIV-infected adolescents,
targeting psychosocial and supportive activities addressing their specific needs.
Community level empowerment to provide care for CLHIV: TBD, in partnership with UTH, will collaborate
with the Community Based Intervention Association (CBIA) to support caregivers in the community to
identify, provide care and deliver interventions for to CLHIV that have been diagnosed developmental
delays. This will include support for speech therapy, feeding techniques and physical therapy and cognitive
exercises.
In FY 2009, TBD will continue to work in partnership with the PCOEs to rapidly expand, decentralize and
strengthen pediatric HIVSCT services throughout the country. TBD will do so with a three pronged
approach that supports activities on the national, sub-national and facility level.
I.National level:
1)Policies, Systems and Program: TBD, in partnership with UTH, will engage national level MOH
stakeholders and provide support to strategically plan, implement and evaluate pediatric HIVSCT programs.
Specifically, ICAP will actively participate and engage the technical working groups and planning bodies to
support development, revision, adaptation, dissemination and operationalization of policy, guidelines and
protocols.. Emphasis will be placed on essential program areas such as pediatric TB/HIV integration,
treatment failure, rapid decentralization of pediatric services and pediatric HIV capacity building.
2)Supporting and strengthening UTH PCOE's National Pediatric Training Program: UTH PCOE has been
designated by the GRZ to serve as the national Pediatric Training Center. TBD will support UTH to develop
and implement a training program whereby staff at sites targeted to initiate pediatric HIV/AIDS related
services visit the PCOE to receive on-the-job training and are followed-up regularly to ensure ongoing
transfer of skills and learning. TBD will model the training program after the South-to-South Pediatric HIV
Care and Treatment Training Program, a successful international pediatric capacity building program ICAP
has implemented in partnership with Stellenbosch University in South Africa. TBD will work closely with
UTH and the MOH to adapt the model in the Zambia context and ensure a robust emphasis on providing
post-training follow-up and systems support. TBD and UTH PCOE will also partner with the University of
Medicine and Dentistry- Francois Xavier Bagnoud Center to provide support in the development of training
and performance related resources such as curriculums, job-aids, handbooks, and wall charts.
II.Sub-national (district) level: As appropriate and feasible, TBD, in collaboration with UTH PCOE, will aim to
strengthen the capacity of the district level health authority to implement and manage pediatric HIVSCT
plans to achieve saturation of pediatric services in their area. Initial targets would include the Livingstone,
Siavonga and Mazabuka District Health Management Teams (DHMT). As feasible, illustrative activities will
include providing support to above noted DHMT to enhance the management and support they give to
facilities implementing family-focused pediatric HIV services. Support will include providing the DHMT with
the capacity to conduct site assessments, program quality evaluations, logistics management, supportive
supervision visits, and work planning to ensure greater ownership and leadership of pediatric HIV services.
III.Facility level support:
During FY2009 TBD will provide direct technical support to 5 facilities: UTH COE, Livingstone COE,
Mazabuka Hospital and Siavonga Hospital and Misisi Compound (an underserved area without a health
facility (estimated population 90,000)). TBD anticipates supporting 1,100 children to receive services and
training 200 health workers.
1.UTH COE will be supported to advance from a center providing quality care to children living with HIV to a
National Reference Center that:
•Initiates and stabilizes newly diagnosed children from the catchment area and refers to lower-level facilities
•Cares for complex and difficult pediatric cases including treatment failure, cancers, neurodevelopmental
disease and disseminated and drug resistant TB
•Serves as a technical support and capacity building center to rapidly decentralize pediatric HIV programs
•Provides support for special issues and populations such as sexual abuse and adolescents.
•Pilot special initiatives such as early infant HAART initiation on behalf of the MOH
2.Livingstone COE will be supported to:
•continue to provide quality pediatric HIV services for the catchment area
•deliver outreach pediatric services to be determined priority areas with high pediatric HIV cases and in hard
to reach locations
3.Misisi Compound (Lusaka), Mazabuka District Hospital (Mazabuka) and Siavonga District Hospitals
(Saivonga) will be supported, with their respective DHMT, to provide quality and pediatric HIVSCT to the
catchment population. They will be supported to create active networks with PMTCT facilities in the area to
ensure continuity of care for CLHIV and rapidly initiate them into HIVSCT. This will include supporting the
sites by initially supporting "satellite" clinic services by PCOE staff and building the capacity of the sites to
independently provide comprehensive pediatric HIVSCT. TBD will support training events,
mentoring/coaching, task-shifting, clinic reorganization, and minor renovations.
New/Continuing Activity: Continuing Activity
Continuing Activity: 15513
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
15513 3691.08 HHS/Centers for Columbia 7168 3001.08 Columbia $1,800,000
Disease Control & University Pediatric Center
Prevention Mailman School of -
Public Health
U62/CCU22240
7
3691 3691.06 HHS/Centers for Columbia 3001 3001.06 Columbia $950,000
Prevention Mailman School of
Emphasis Areas
Health-related Wraparound Programs
* Child Survival Activities
* Malaria (PMI)
* TB
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $625,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $50,000
and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Estimated amount of funding that is planned for Water $25,000
Table 3.3.10:
THIS ACTIVITY IS A CONTINUING ACTIVITY FROM FISCAL YEAR (FY) 2008 THAT WAS UNDER THE
HTXS PROGRAM AREA AND HAS BEEN SPLIT INTO PEDIATRIC CARE & SUPPORT AND
TREATMENT. IT HAS ALSO BEEN MODIFIED IN THE FOLLOWING WAYS:
This activity relates to all University Teaching Hospital (UTH) Pediatric activities under counselling and
testing, Family Support Unit (FSU #3758.08) and Opt-Out testing (#9717.08), under pediatric treatment
(PCOE)#9765.08 HIV/nutrition NEW and CSA # 3693.08, pediatric care and support # New mobile, EID, #
New palliative care # 12330.08 and Columbia TB/HIV # 17633.08
3)(UTH PCOE only) training, learning, technical support, and dissemination centers for Zambia.
Comprehensive pediatric HIVSCT services: TBD will build on-site capacity by supporting systems and
6)Pediatric adherence and psychosocial programs, including support groups for CLHIV on treatment
8) Collaborate with USG Zambia partners to support the development and implementation of a USG
Zambia food and nutrition strategy, as well as to consider adopting a common technical approach to food
and nutrition support.
evolve and mature over time and through various life stages and cycles. This affects and should be
considered critical to all HIV issues such as adherence, disclosure, physical examination, normative
laboratory values which change over time and life stages
Malaria: Where relevant, TBD can help strengthen malaria prevention interventions including supplying bed
nets to clients upon enrolment and educating caregivers on prevention, warning signs, and action steps.
TBD will work with the Presidents Malaria Initiative and national malaria centre for these activities.
1)Supporting the implementation of provider initiated inpatient testing and counselling
Activity Narrative: 3)Supporting HIV testing and counselling services at all points of encounter children have with clinical
services immunization, TB, under-five years of age, malnutrition, etc
Adolescents: Depending on the population, clinics will be designed to support HIV-infected adolescents,
1)Policies, Systems and Program: In partnership with UTH, TBD will engage national level MOH
Specifically, TBD will actively participate and engage the technical working groups and planning bodies to
protocols. Emphasis will be placed on essential program areas such as pediatric TB/HIV integration,
II.Subnational (district) level: As appropriate and feasible, TBD, in collaboration with UTH PCOE, will aim to
During FY 2009 TBD will provide direct technical support to five facilities and: UTH COE, Livingstone COE,
facility (estimated population 90,000). TBD anticipates initiating 300 new children on treatment and training
250 health workers.
•Initiates and stabilizes newly diagnosed children from the catchment area and refers to lower level facilities
3.Misisi Compound (Lusaka), Mazabuka District Hospital (Mazabuka) and Siavonga District Hospital
independently provide comprehensive pediatric HIVSCT. ICAP will support training events,
Table 3.3.11:
The funding level for this activity in FY 2009 will remain the same as FY2008. Narrative changes include
updates on progress made and expansion of activities. This activity relates to: Lab (#) University Teaching
Hospital (UTH) Family Support Unit (FSU) (# ), UTH Pediatrics (# ), and activity Columbia PDCS and PDTX.
The mechanism to support this activity ended in FY 2008 and the prime partner has been labeled as to be
determined (TBD) until a new award has been issued.
In March 2005, ICAP began activities in Zambia with the aim of supporting the design, implementation, and
evaluation of Pediatric and Family Centers of Excellence (PCOE) throughout the country in partnership and
close collaboration with the Department of Pediatrics and Child Health at the UTH. ICAP program goal
includes:
1)To support the implementation of integrated and comprehensive family-centered approach to paediatric
HIV support, care and treatment services and reduce HIV-related morbidity and mortality among families
2)To enhance and strengthen the capacity of the Zambian public health system (health care worker,
multidisciplinary team, health facility, regional and national level), through partnership with the UTH PCOEs
to provide quality paediatric HIV/AIDS related services.
ICAP has supported the development, implementation, and strengthening of two PCOEs, the UTH PCOE in
1)model facilities to provide state-of-the art comprehensive paediatric/adolescent HIV support, care, and
treatment services,
providing this support via an in-country team to ensure that more efficient and real-time support is offered.
TBD will hire a Pediatric TB/HIV advisor who will work collaboratively with UTH, the Ministry of Health
(MOH), National TB Working Group and the National TB Program to provide technical support, training and
logistics management to TB/HIV related products, services and systems. This will help build capacity in
Zambia and allow for future sustainability of program in Zambia. TBD will continue to work in partnership
with the PCOEs to rapidly expand, decentralize and strengthen pediatric TB/HIV services throughout the
country. TBD will do so with a three pronged approach that supports activities on the national, sub-national
and facility level.
Policies, Systems and Program: TBD, in partnership with UTH, will engage national level MOH stakeholders
and provide support to strategically plan, implement and evaluate pediatric support, care and treatment
programs. Specifically, TBD will actively participate and engage the technical working groups and planning
bodies to support development, revision, adaptation, dissemination and operationalization of policy,
guidelines, protocols plans, and tools. TB/HIV specific areas TBD will support, in collaboration with UTH
PCOE, include:
1)Develop practical algorithms and guides for screening and diagnosis of TB in HIV-exposed and HIV-
infected children and facilitate implementation of these algorithms. TB takes a particularly large toll in
infants and children with HIV where the risk for progression from latent to active TB disease is accelerated
and impacts morbidity and mortality in the infant. TBD will work with the MOH to adapt an adult TB
screening questionnaire currently used in TBD supported programs and pilot its use at two Pediatric ART
programs to assess the feasibility and efficacy of identifying TB in infants and children women.
2)Develop policy, protocol and training materials to ensure that all children and family members diagnosed
with TB are currently routinely counseled and tested for HIV under the National TB and HIV program. TBD
will work with the National TB program to help strengthen the implementation of the routine testing in follow
up care of children with TB and link with HIV care and treatment services
3)Develop policy, protocols and training materials to ensure children > 5 years of age in the households of
adults with active TB receive INH prophylaxis for prevention of TB infection.
Supporting and strengthening UTH PCOE's National Pediatric Training Program: UTH PCOE has been
and implement TB/HIV related training events and tools for implementation at the PCOEs and dissemination
for other partner's training needs. TBD and UTH PCOE will also partner with the University of Medicine and
Dentistry- Francois Xavier Bagnoud Center to provide support in the development of TB/HIV related training
and performance related resources such as curriculums, job-aids, handbooks, and wall charts that support
providers to read pediatric x-rays, screen and treat children for TB.
II. Sub national (district) level: As appropriate and feasible, TBD, in collaboration with UTH PCOE, will aim
to strengthen the capacity of the district health authority to implement and manage family focused pediatric
HIV support, care, and treatment plans. Initial targets would include the Livingstone, Chongwe, Monze, and
Mazabuka District Health Management Teams (DHMT). Activities will focus on enhancing the diagnosis
and management of TB in children infected with and exposed to HIV at several large facilities as described
above. In addition, TBD will expand upon work currently focusing on adults to include infants, children and
adolescents. TBD will explore the feasibility of instituting the following activities:
•All children and adults diagnosed with TB are currently routinely counseled and tested for HIV under the
National TB program. ICAP will work with the National TB program to help strengthen the implementation of
the routine HIV testing and linkage of HIV-infected children to care and treatment services
•Institution of contact tracing for pediatric family members in households of adults with HIV/TB. All children
will be assessed for TB risk (as described above) and those less than 5 years of age without evidence of TB
will receive INH prophylaxis. Routine counseling and HIV testing will be offered to all children and
household members of adults with HIV/TB.
•TBD will work with the DHMT to develop practical algorithms and guides for diagnosis of TB in children and
facilitate implementation of these algorithms
II.Facility level support:
As described in narrative #PDCS and PDTX, during FY 2009 TBD will provide direct technical support to
four facilities: UTH COE, Livingstone COE, Chongwe, Mazabuka Hospital, and Monze Hospital and Misisi
Activity Narrative: Compound in Lusaka. TB/HIV specific activities will include:
•TBD would like to use pediatric HIV testing service as an opportunity to provide routine tuberculosis
screening to all children and their families, particularly those who test HIV positive and all those negative but
under the age of five years. A screening algorithm will be adapted to include history of tuberculosis related
symptoms, clinical indicators suggestive of tuberculosis, and history of TB contact within and outside the
household.
•TBD will support the implementation of routine TB screening questionnaire to the adult caregivers and
household members of all children testing HIV positive. Most children are exposed to TB through adult
caregivers within the household and in child care settings and this has been demonstrated to be an effective
way to identify HIV infected adults at high risk for TB disease. Adults with a positive screening questionnaire
will be referred for further evaluation.
•TBD will work with the multidisciplinary teams at the COEs to establish routine and systematic TB
screening for all HIV infected children followed in care and treatment at the centers. This will include a
routine periodic assessment of clinical and historical findings indicative of TB as well as queries about new
household contacts recently diagnosed with TB. The feasibility of TST will be assessed in the group of
children who are immunologically reconstituted and stable on HAART.
Sustainability: TBD's main goal will be to build and strengthen capacity of Zambian systems, programs and
healthcare workers to implement comprehensive pediatric HIV services. At the national and sub-national
level, TBD will work to strengthen existing efforts in accordance with the Zambia National HIV and AIDS
Strategic Framework 2006-2010 and work with appointed officials and support them to manage pediatric
HIV programs. On the site level, the cornerstone of TBD's efforts will be to work with existing programs and
human resources to provide pediatric HIV services. TBD will target (government and non-government)
clinical and management site staff and include continuing and phased-in skills building, knowledge transfer,
supportive supervision, clinical mentoring and modeling to improve quality of care, strengthening clinical
critical thinking/reasoning skills, supporting job-realignment, and instituting a multidisciplinary approach to
service provision. TBD will also explore the feasibility of instituting a clinical fellowship program for
advanced-level pediatric fellows to rotate in the PCOEs and support clinical and teaching activities. To
promote sustainability, fellows from the US will partner with Master of Medicine in Pediatrics fellows at the
UTH to ensure exchange of knowledge and local building capacity.
Targets set for this activity cover a period ending September 30, 2010.
Continuing Activity: 17633
17633 17633.08 HHS/Centers for Columbia 7168 3001.08 Columbia $650,000
Estimated amount of funding that is planned for Human Capacity Development $650,000
Table 3.3.12:
