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 2013 2014 2015 2016 2017
The aim of this project is to support the development of expertise in HIV and nutrition, through use of counselors. Activities will include identifying promising practices for integrating food by prescription (FBP) into existing programs, thereby enhancing the effectiveness of the intervention. Support will also be provided for the development of a locally sourced, high energy food which can be provided through pharmacies but which may also have a non-clinical use.
Illustrative Goals, Objectives, and Results are as follows:
Goal: The goal of this project is to prevent malnutrition and promote good nutrition for adults and children enrolled in HIV/AIDS prevention, care, and treatment programs and at risk OVC clients. The secondary focus is to assess and treat malnutrition in these targeted populations when it occurs and support adherence to treatment for AIDS and related opportunistic infections (OIs). Supportive efforts will be made to assure capacity and delivery of both the constellation of nutrition services and nutrition product interventions.
Objective: The overall objective of this project is to act as a catalyst to promote broader and better food and nutrition support by USG agencies and selected partners working with targeted populations, including elements of clinical and community activities, education and training, and nutrition intervention product availability.
Objective 1: Development and evaluation of clinical and community-based nutrition interventions for adults infected and affected by HIV/AIDS in pre-, ART, and PMTCT services.
Illustrative results:
Nutritional interventions designed and evaluated for PLHA entering pre, ART, and PMTCT services.
HIV related nutrition services integrated into existing programs in at least 20 facilities.
Development of linkages between project activities and existing HIV programs providing clinical services for PLHA.
Objective 2: Development and evaluation of clinical and community-based nutrition interventions for children infected and affected by HIV/AIDS.
Objective 3: Support the development and enhancement of Nutrition/HIV specialists at the clinical and community levels.
Training services expanded to encompass nutrition and HIV at clinical and community levels
Diploma level nutrition program expanded to build HIV subspecialty.
Support for placement of new nutrition/HIV subspecialty diploma holders
Objective 4: Establish linkages between agriculture and economic growth activities for the production of nutritious foods for use in clinical and community settings.
Support local organization(s) to develop appropriate foods for malnourished PLHAs
Facilitate linkages between private sector producers and distribution networks for clinics and community-based programs.
Host country ownership and gender will be two key sustainability issues within this project. First, host country ownership will rest on the ability of the project to train local staff to provide quality nutrition services as well as the identification of a local processor to develop the food product. Second, gender will be a focus given the dynamics at the household level which guide food availability and use. A strong gender focus within this project will ideally help to change attitudes and behaviors within the household to target those most at need for food/nutrition at any given time.
Activities in this area will support all four project objectives and will directly tie nutrition activities to adult HIV treatment support. In particular, the project will develop and expand new and existing opportunities to integrate a food by prescription approach to HIV treatment with the expectation that this will result in enhanced patient outcomes. Food and Nutrition Support for malnourished pre-ART and ART patients will follow Zambian draft Food by Prescription guidelines developed by the National Food and Nutrition Commission, as well as adhering to OGAC Food and Nutrition guidance on nutrition assessment, counseling, and support. National guidelines on Integrated Management of Acute Malnutrition (IMAM) may soon require diagnosis and treatment of malnutrition in all clinical settings, including ART.
Illustrative activities include identifying a producer to manufacture a product locally which can then be used in a prescriptive fashion for patients on ART. Other actions include identifying counseling and dispensing mechanisms for use with the prescriptive approach. Emphasis here is on how to integrate nutrition or FBP into the clinical setting without adding undue burden on existing health care providers. In some cases, additional cadres of staff may be required including lay counselors or adherence support workers.
Ideally more than one implementation modality will arise perhaps urban/rural models or high capacity and lower capacity models for integrating FBP into the clinical setting. Regardless, the activities will focus on proving the concept of how services could be provided. Large scale implementation will be the role of existing HIV treatment partners.
Food and nutrition support may also facilitate clinic-to-community linkages between VCT/PMTCT, HBC, and ART that will further reduce loss-to-follow up from HIV diagnosis throughout pre-ART stage and ARV treatment period.
Specific targets will be finalized upon award of the contract.
Activities in this area will focus on the achievement of Objectives 1, 2, and 3. In particular, the focus will be on developing community and clinic-based approaches to reach women and children who are infected and affected by HIV/AIDS through PMTCT services. Ideally, services will be expanded beyond the delivery period to ensure that children born to HIV positive mothers are not lost from the system. Services will include counseling on infant feeding practices as well as practical support for informed choices with regard to infant feeding practices. Support may include the use of food in a prescriptive fashion based on nutritional status. The nutrition project will develop and test activities. Full implementation will be through existing partners with funding and services in these areas.
Food and Nutrition Support for PMTCT clients (HIV positive women and their HIV exposed infants) will follow Zambian national PMTCT guidelines, and will also refer to national Infant and Young Child Feeding (IYCF) guidelines for more in-depth infant feeding advice. It will adhere as well to OGAC Food and Nutrition guidance which prioritizes PMTCT Food and Nutrition support. PMTCT nutrition support will prioritize exclusive breast feeding to six months. The goal is long-term HIV-free survival of infants and maternal nutrition support to ensure maternal health and a healthy birth. Nutrition support will be preventive, and then curative. All HIV positive and HIV exposed infants are high priority for nutrition support. Replacement feeding may be needed in cases such as the death or incapacity of the mother due to HIV/AIDS or other illness.
Training options may range from the one-week IYCF course, to decentralized short courses; the IYCN project may provide technical assistance, training, and materials to USG partners; food support and multi-vitamin, micronutrient supplements, may be provided to infants from six months up to five years, and to HIV positive mothers from six months prenatal to six-months postnatal. Family food security needs of PMTCT clients/infants, and other family income or livelihood needs, will generally be referred to other providers, such as WFP.
