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
Related activities: Eastern Province Health Office HVCT (#9005), Southern Province Health Office HVCT,
(#9018), and Western Province Health Office HVCT (#9047) and all other prevention and counseling and
testing (CT) activities under CDC.
This activity is linked to all prevention narratives, AB, Other Prevention including Male Circumcision. It is
also linked to antiretroviral (ARV) treatment section addressing prevention with positives as well CT. In FY
2009, the focus will be providing technical assistance (TA) in working with communities and various points
of care to integrate prevention and to link those who are negative and positive to the various discussion
groups at the clinics and community. The TA will be provided to partners to implement the new prevention
strategy expected to available in FY 2009. Provincial meetings will he held with partners to address the key
areas of the national strategy and to build capacity of local USG staff to take leadership in promoting
comprehensive and effective prevention for sustainability.
Zambia has a population of approximately 10 million citizens (US Department of State, 2006), and overall
HIV prevalence is still 14.3% among the general population and 13% among men (Zambia Demographic
Health Survey (DHS, 2005). While it is evident through the DHS survey that many Zambians know about
HIV/AIDS and its modes of transmission, there has been minimal reduction in HIV prevalence in Zambia in
the last few years. A clear indication that knowledge is not translating into behavior change as expected.
This activity will work with the government, other donors and experts from other PEPFAR countries to share
lessons learned and revitalize prevention strategies in Zambia.
Funding for this activity will provide behavioral science support for care, treatment, and prevention services
to people living with HIV/AIDS and other opportunistic infections while developing leadership in the
behavioral science arena. This activity will provide technical guidance in the implementation of PEPFAR
activities in relation to care, treatment, and prevention. This activity will be in close collaboration with
Zambian implementing partners and other USG agency technical specialists. In addition, the activity will
provide oversight to ensure that PEPFAR-funded activities are programmatically sound and consistent with
the Zambian National Health Strategic Plan; train technical officers in relevant behavioral science to build
local capacity; develop evaluation and assessments to measure impact and programmatic effectiveness of
interventions; recommend best practices; participate in design of programs and represent the USG in
national planning and technical committees.
New/Continuing Activity: Continuing Activity
Continuing Activity: 17577
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
17577 17577.08 HHS/Centers for Comforce 7169 3011.08 Comforce $100,000
Disease Control &
Prevention
Emphasis Areas
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $150,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.02:
(#9018), and Western Province Health Office HVCT (#9047) and all other CT activities under CDC.
Funding in FY 2009 is requested to provide technical assistance (TA) for the scale-up of counseling and
testing (CT) access for rural disadvantaged communities, migrant populations, and general population in
Zambia. CT is scaling-up rapidly in Zambia and extending access to many rural areas hence increasing the
need for oversight and monitoring to ensure quality of services. The TA will make certain that couple
counseling and testing (CCT) is prioritized and training for capacity building is provided to partners on
couples CT for prevention. Emphasis will be on the new Zambian testing protocols, data management and
quality assurance and that appropriate data is being captured at all sites and reported accordingly.
The TA will also ensure that all CT programs are all working in collaboration with government under the
MOH and remain within the confines of government health guidelines. The focus will be to establish a
sustainable program through training of health care workers, developing standard testing protocols,
strengthening physical and equipment infrastructures, implementing facility level quality assurance/quality
improvement program, improving laboratory equipment and systems and development, and strengthening
health information systems.
Continuing Activity: 17357
17357 17357.08 HHS/Centers for Comforce 7169 3011.08 Comforce $85,000
Estimated amount of funding that is planned for Human Capacity Development $135,000
Program Budget Code: 15 - HTXD ARV Drugs
Total Planned Funding for Program Budget Code: $26,864,913
Total Planned Funding for Program Budget Code: $0
Program Area Narrative:
Sustaining access to anti-retroviral therapy (ART) is a key U.S. objective, Antiretroviral (ARV) drug procurement and enhancing
the capacity of the supply chain management systems are priority areas. Great progress was made in improving the availability of
ARV drugs at the national level during FYs 2005 - 2008.
With about one million Zambians living with HIV/AIDS and 200,000-250,000 of these persons requiring ART, the Government of
the Republic of Zambia (GRZ) has prioritized making ART available to all Zambians in need—as evidenced by the August 2005
policy rendering all public sector ART services free of charge. As of March 31, 2008 there were 172,022 people on treatment, up
from 110,000 in August 2007.
In FYs 2005 and 2006, the U.S. Mission in Zambia and JSI/DELIVER took the lead, in close collaboration with GRZ, to facilitate
the development of multi-year ARV drug forecasts and quantifications; these are now updated on a quarterly basis. The process
included developing the first national, long-term ARV drug procurement plan. The plan encompassed procurements made by the
U.S. Mission in Zambia, GRZ, the Global Fund to Fight AIDS, Tuberculosis, and Malaria (GFATM) Principal Recipients (Ministry of
Health (MOH) and Churches Health Association of Zambia (CHAZ), and Clinton Foundation. These drugs are placed in the MOH
central warehouse, Medical Stores Ltd. (MSL), for distribution to all accredited ART sites (governmental and non-governmental).
There are approximately 315 accredited ART sites in Zambia and more are being assessed for accreditation. In FY 2007 this
process was strengthened and further refined, to work with the increased number of ART sites that were added in to the system.
U.S. Zambia ART Track 1.0 partner Catholic Relief Services/AIDS Relief (CRS) was added to the system after successful
accreditation of sites, including four private sites.
Building on improvements made to the ARV supply chain in FY 2006, JSI/DELIVER continued its strong role in coordinating and
addressing ARV logistics system issues in FYs 2007 and 2008. Also in FY 2006, the U.S. Mission in Zambia strengthened the
logistics system in the Zambia Defense Force Medical Services (DFMS). This facilitated the inclusion of DFMS in the national
system enabling them to access drugs through MSL. In FY 2007 USAID/DELIVER focused on supporting the MOH in
coordinating ARV drug forecasting and procurement planning capacity at the central level, quantifying required ARV drugs,
reinforcing the standardization of ARV drug inventory control procedures at delivery sites, and developing and installing a software
tool for ART sites to collect and use for ordering ARV drugs which significantly reduced the time and effort required for ordering
and reporting.
In FY 2007, the MOH changed the first line ART regimen in Zambia for new patients to Tenofovir + Emtricitabine (FTC)/3TC +
Efavirenz or Nevirapine. Patients on the previously recommended first line therapy were to continue on the old regimen until either
treatment failure or toxicities occurred. The decision to change regimens followed concerns about toxicities such as peripheral
neuropathy, lipodystrophy and suspected lactic acidosis and was made after wide consultations on best practices by the National
ART treatment working group. Anemia was also commonly associated with AZT in Zambian patients. These toxicities sometimes
affected adherence to ART and deaths due to suspected lactic acidosis have occurred. The change to the Tenofovir based
regimen is expected to lead to better outcomes due to decreased toxicities and better adherence to therapy. The U.S. Mission in
Zambia is developing a public health evaluation to assess the cost effectiveness of Tenofovir based ART combination.
In FY 2008, the U.S. Mission in Zambia continued its strong collaboration with GRZ, GFATM, UNITAID/Clinton Foundation to
assist the national ART programs in fulfilling demand for ART services. On behalf of the U.S. Mission in Zambia, SCMS
purchased the following drugs: 3TC, AZT 100mg, LPV/r syrup, AZT/3TC, ddI 100mg, ddI 50mg, EFV 200mg, EFV 600mg, NFV
250mg, NLF LPV/r133/33 caps, NVP 200mg, and Tenofovir/Lamivudine. This will continue in FY 2009. Purchases may change: 1)
as additional ARV drugs become approved by the Food and Drug Administration (FDA) and registered in Zambia, 2) as GFATM
donations become solidified, 3) as Clinton Foundation ARV drug donations are scaled down; and 4) if GRZ changes the national
ARV treatment protocols. These specific ARV drugs, in conjunction with the ARV drugs procured by GRZ and GFATM, will go
directly to MSL where all accredited ART sites (GRZ, faith-based hospitals, NGOs, and work-place/private sector entities) have
access to these critical supplies. It is estimated that approximately two percent of the total SCMS budget will be used to procure
pediatric ARV drugs; this figure is based on the UNITAID/Clinton Foundation's commitment to provide all required pediatric first
line formulations during this time period.
As funding for FY 2009 is a straight-line of the FY 2008 level, the U.S. Mission in Zambia plans to spend $24M on drugs in FY
2009 unless needed additional funding becomes available. In addition, with Track 1.0 funds, CRS is planning to set aside
$100,000 as back up for purchasing drugs in case of a stock out from the national supply. As compared with FY 2007 when
several partners procured outside of the system, in FY 2008 all procurement was through the MSL. This will continue in FY 2009.
All partners will continue receiving their drugs from MSL through the GRZ system, a significant achievement made possible in part
by U.S. support. It is estimated that U.S. procurements, in combination with GFATM and Clinton Foundation purchases, will
enable Zambia to place 230,000 patients on ART by the end of 2009 (the MOH's target).
The biggest challenge with ARV drug procurement for national ART needs is the anticipated ARV drug procurement financing gap
in FYs 2009 and 2010. Two main factors drive the anticipated gap: 1) the increase in patients combined with a steady budget;
and 2) the change to the more expensive Tenofovir based regimen. PEPFAR I was to place 120,000 people on treatment by
2008. This goal has already by far been exceeded, supported by level funding with ever increasing demand. At current prices, the
Tenofovir based combination costs over $200 more per patient, which has a dramatic impact on the overall finances required.
Even if the cost of Tenofovir came down, with current funding levels and demand, the gap would remain. Discussions are
ongoing with GRZ for an increased budgetary allocation to ARV drugs. Yet based on current and projected GRZ funding in the
2009 budget, this will not significantly reduce the deficit. Another possible source of funding is the GFTAM. While the outcome of
Round 8 application, which includes some ARV drugs, is still pending, Zambia plans a Round 9 proposal focusing on treatment.
The national ARV drug logistics system and the quantification process will assist in achieving a sustainable national ART program
following intensive PEPFAR support.
Table 3.3.15:
ACTIVITY UNCHANGED FROM FY 2008.
This activity is linked to Centers for Disease Control and Prevention - Technical Assistance (CDC-TA
#3706.08), Chest Diseases Laboratory (CDL #3703.08), Unive3702.08), University Teaching Hospital (UTH
# 9798), EGPAF-CIDRZ (# 16956), Associated Public Health Laboratories (APHL), Ministry of health
laboratory Information System (MOH-LIS) in the laboratory infrastructure section.
This activity allows international laboratory experts to spend time in Zambia working side-by-side with
Zambian nationals to transfer laboratory technical skills rather than sending Zambian laboratory staff to the
United States or other countries for training. With the experts in-country, a larger target population for skills
transference is reached. The experts in -country are able to see, work in, and transfer skills relevant to the
Zambian laboratory environment and to identify and implement practical solutions and not just transferring
Western or developing country laboratory techniques to Zambia.
In FY 2007 this activity allowed one international laboratory expert to work in Zambia to provide technical
assistance to more than 150 laboratory technicians in five provinces. The laboratory technical experts
worked in-country with partners and CDC staff (including four CDC Zambian public health laboratory
technologists) to strengthen national sustainability for good laboratory practices, planning and quality
assurance on a daily basis for diagnosis, care, and treatment support.
The funds from FY 2008 contributed to support this laboratory expert to work with the Ministry of Health
(MOH), Department of Defense (DOD), CDC Zambian laboratory staff and other partners focusing on 1)
rapid HIV testing roll out planning and training, 2) strengthening skills and expanding quality assurance
programs for automated- and non-automate laboratory testing procedures such as CD4, hematology, and
chemistry for monitoring care and treatment support to persons on ARV and TB therapy as well as carry out
duties as described in FY 2007. In addition, the FY 2008 funds was also used to support a HIV virologist to
work with partners such as UTH, CIDRZ, TDRC, and CDC laboratory team to establish and strengthen
quality assurance program for early infant diagnosis within the country as well as drug resistance testing.
In FY 2009, this activity will support these two laboratory experts to enable them to continue to provide
technical assistance to the MOH, DOD, partners and CDC. While the first laboratory expert will continue
previously described activities, the second consultant in HIV virologist will work with the MOH, partners,
under the direction of CDC Chief for Laboratory Infrastructure and support program to establish and/or
strengthen an integrated national quality assurance program for laboratory testing services including HIV
rapid testing, CD4, hematology, chemistry, TB, malaria, and bacteriology. This activity provides support for
lodging, consultant fees, travel, training costs, needed supplies, and other costs related to work with the
MOH laboratory unit, and the national HIV/TB program in Zambia. Technical support from two international
experts brings expertise and provides efficient and sustainable human resource capacity building in local
laboratory personnel. Continuous onsite in-country training and monitoring will allow several laboratory staff
to expand technical expertise as well as in management, leadership and problem solving skills in both
provincial and districts laboratories within Zambia.
Continuing Activity: 15514
15514 3704.08 HHS/Centers for Comforce 7169 3011.08 Comforce $550,000
8996 3704.07 HHS/Centers for Comforce 5002 3011.07 Comforce $550,000
3704 3704.06 HHS/Centers for Comforce 3011 3011.06 ORISE Lab $164,322
Health-related Wraparound Programs
* TB
Workplace Programs
Estimated amount of funding that is planned for Human Capacity Development $400,000
Table 3.3.16:
The funding level for this activity in FY 2008 will remain the same as in FY 2007. Only minor narrative
updates have been made to highlight progress and achievements.
This activity relates to EGPAF SI, JHPIEGO SI, AIDSRelief - Catholic Relief Services (CRS), Ministry of
Health (MOH), and Technical Assistance/Centers for Disease Control and Prevention (CDC) and Zambia
National Blood Transfusion Service (ZNBTS).
To support the continued transition of software upgrades and development in 2008 to in-country talent, the
United States Government (USG) will continue to provide support for the ‘lead' professional
programmer/developer who is working closely with the SmartCare team on-location in Zambia to continue
bringing skill levels of the Zambian team up to the level required to maintain and adapt the software in the
future. In addition to this lead staff, the Centers for Disease Control and Prevention (CDC) strategic
information (SI) section will continue to support a national hire as an understudy. The purpose of having
these two SI staff in-house is for closer monitoring and evaluation of their capability and contribution, and to
make it easier to provide close guidance for the next phase of the project as the Ministry of Health (MOH)
assumes more leadership in a new technical area.
The intent for the ‘national hire' developer is to provide an option for a longer term and lower cost technical
bridge between the US-based technical expertise that jump-started the project, and the locally sustainable
ownership of the technology. This provides CDC an alternative method of placing essential software talent
at the disposal of the ministry; this is particularly crucial due to the recent Ministry reorganization and
technical gaps.
The high end technical professional possesses experience in developing clinical software applications,
including Electronic Health Records (EHR), and will be employed no more than two years (thired in 2007).
This lead professional works daily with Zambian colleagues to ensure transparent and shared engineering
of the system as it being deployed.
This activity provides a critical one to two year bridging capacity, while the US based developers who gave
the project its initial jump start are tapered down to small contributions and backup roles for what is
becoming the Zambian EHR (SmartCare). August 31, 2006, the Ministry held a high level meeting to
announce to all the Cooperating Partners the plan to deploy SmartCare nationwide. In August of 2007 they
announce the MOH intention to deploy the system to 900 sites in less than two years - with support from
partners, most specifically PEPFAR. They were able to announce that the latest consensus revision of the
ART software ‘forms' were entirely developed in Zambia. However there remain some challenging technical
areas yet to be mastered by the in-country team, despite the tremendous success of the project concept at
a political level and deployment level.
Targets set for this activity cover a period ending September 30, 2009.
Continuing Activity: 15515
15515 9692.08 HHS/Centers for Comforce 7169 3011.08 Comforce $300,000
9692 9692.07 HHS/Centers for Comforce 5002 3011.07 Comforce $300,000
Table 3.3.17:
