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: 2010 2011
Goals and objectives: The University of Alabama at Birmingham supports the Ministry of Health (MOH) in expanding access to and uptake of HIV testing, using novel strategies designed for urban and rural settings. Our programs work closely with MOH staff at all levels by assisting in strategic planning and providing technical assistance. Our specific objectives in FY 2010 are to:
1. Provide HIV counseling and testing (CT) in communities through door-to-door initiatives
2. Bolster CT services in health centres
3. Expand access to CT using mobile health outreach activities
4. Enhance individual knowledge about HIV through intensive community engagement, focusing on HIV prevention
Coverage and target populations: We support MOH CT sites in Lusaka district and six districts (Shangombo, Lukulu, Senanga, Kaoma, Mongu, Kalabo) in Western Province. We will reach the seventh district in Western Province, Sesheke, in FY 2010. Our target population comprises adults including pregnant women and children of unknown HIV status.
Contributions to health systems strengthening: The primary focus of our testing strategy is community-based CT, which requires a large cadre of lay counselors equipped to cover broad distances to provide services. This commitment to task-shifting has allowed our program to rapidly expand in urban communities and in remote, rural sites. We also provide support to existing CT services in established health centers. The lay counselors assigned to these posts are cross-trained in basic history taking, vital signs measurement, and adherence counseling so they provide collateral contributions to HIV care and treatment teams on-site.
Cross-cutting issues: CT services are a natural entry point for HIV prevention activities. As part of our services, we provide extensive counseling regarding HIV prevention designed for both HIV-infected and non-infected individuals. This focuses on education about HIV transmission, targeted messages to counter myths regarding the disease, identification of risk factors for transmission, and known interventions for prevention. We encourage couples-based CT in our programs, given its positive impact on lifestyle choices and the potential for HIV prevention among discordant couples. We have worked with local partners to distribute condoms as part of our activities, and have also established referral systems with local health centers and non-governmental organizations for the treatment of sexually transmitted diseases and for male circumcision.
Cost-efficiency strategies: In order to promote cost-efficiencies, we have partnered with ongoing government and NGO initiatives, so that our network of community-based lay counselors is maximally utilized. This includes the use of this network for bednet distribution, community health education, and contact tracing. In addition, we have worked closely with the provincial and district health offices, so that many financial and administrative responsibilities are managed directly by these offices and do not require additional program staff.
Monitoring and Evaluation: We will work closely with the provincial and district health offices to collect routine aggregate statistics regarding our program. We will collect information regarding HIV testing rates stratified by gender and age. On a quarterly basis, these data will be reviewed internally to identify potential weaknesses in our approach, so that the appropriate interventions may be implemented. On a semi-annual basis, we will review these figures with the district health offices to address common obstacles and challenges.
Support for counseling and testing (CT) services in twenty-eight communities: 21 communities across seven districts in Western Province and 7 communities in Lusaka District. In Lusaka, CT is available through quarterly intensive community door-to-door campaigns. In each Western Province community, CT is available through three services: (1) ongoing door-to-door campaigns by trained lay counselors offering in-home testing and counseling; (2) clinic-based HIV testing by trained lay counselors; and (3) mobile health program testing by trained lay counselors, offered as part of existing district health outreach activities.
Program activities in FY 2010 include:
1. Training a minimum of 14 new lay counselors in CT.
2. Continuing to support a minimum of 98 lay counselors in Western Province.
3. Conducting nine new community site assessments (six new communities in six existing districts and three new communities in one new district).
4. Procuring transportation equipment (motorcycles, bicycles, and/or boats) as appropriate for the new communities.
5. Conducting nine intensive mobile CT drives in the nine new communities.
6. Providing ongoing evaluation of CT services in the field, including (a) regularly evaluating counseling and testing skills of providers; (b) supporting quality assurance (QA) of HIV tests in all sites; (c) participating in national QA programs; (d) implementing "refresher" trainings adapted to the MOH/CDC standard training package; and (e) all essential supplies, job aids and tools needed to conduct rapid HIV testing Consideration should be given to hiring a laboratory QA manager to coordinate and supervise lay counselors, liaison with the MOH QA team for program enrollment, and provide feedback in order to ensure high quality of rapid HIV testing.
7. Providing mentoring and supervision to improve the quality of counseling, with a particular focus on promoting couples counseling and integrating HIV prevention messages.
8. Designing and implementing a pilot program for performance-based funding at one district site, to determine its feasibility for broader implementation.
9. Supporting ongoing community outreach activities, including drama performances and meetings with community, church, and traditional leaders.
The CT coordinator will review monthly statistics from all communities, and provide supportive supervision on a quarterly basis to identify areas for improvement and develop a quarterly quality improvement action plan. We will meet with management staff in each district twice a year to address common obstacles and challenges.
