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 Zambia Demographic Health Survey (2007) estimated that 14.3% of Zambians aged 15-49 were HIV positive. About
1.6% of the adults become newly infected each year with approximately 82,000 people infected in 2009. Of new HIV
infections, about 71% are believed to arise through sex with non-regular partner including having a partner that has another sexual partner. It is also estimated that more than 20% of all new HIV infections occur among individuals who have only one partner due to discordancy. The high rates of new HIV infections require implementation of comprehensive HIVprevention strategies. Understanding the behavioral, biological and structural drivers of the HIV epidemic is key to
designing effective prevention interventions. The proposed program will join the National AIDS Council (NAC),
Ministry of Health (MOH) and PEPFAR supported partners to intensify prevention through HIV counseling and
testing (HCT), prevention with positives (PwP) and sexual prevention interventions. HTC
will be a key and essential component of HIV prevention because it is a prerequisite for treatment, pre-ART care and
support services. Couples HTC will be a critical element for identification of sero-discordant couples and promoting the use of ART as prevention in sero-discordant couples. HTC will be gateway to other prevention interventions such as package of services for most at-risk populations (MARPs). TBD will implement comprehensive and quality HIV prevention services in poor and remote areas of Zambia. They will contribute to health systems strengthening by training health workers and community volunteers to strengthen couples HTC service. They will develop a monitoring and evaluation plan to ensure Systematic collection of data for improved programing.
The need to increase rates of HTC coverage and maintain high levels of uptake is underscored by continued low rates of testing, low knowledge of individual and partner sero-status. TBD will ensure appropriate expansion of HTC services to identify HIV positive persons and discordant couples, and strengthen linkages between HTC and other essential services. Strategic HTC scale-up will be forged in order to increase access to treatment, care and support, and prevention services for PLHIV, and to reduce population-level HIV incidence through continued increase in PMTCT, VMMC, and treatment services. Importantly, the strengthening of linkages between HTC points of diagnosis and other HIV services both clinic-based and community-based should fundamentally impact the effectiveness of HTC programs. TBD will ensure that they specifically provide HTC services for couples/partners, and families to enable them know their HIV status with particular emphasis on identifying HIV sero-discordant couples. Two primary approaches to HTC that will be encouraged and utilized are: a) provider-initiated HTC - occurring through a health care provider as a standard component of medical care; b) client-initiated HTC - occurring through active seeking of HTC by clients in settings where these services are scaled up, made more readily available and communities sensitized. The settings in which these approaches will be utilized include clinical and non-clinical or community-based settings. For community based settings, they will implement:
Home-based HTC via index patient or door-to-door HTC;
Mobile or outreach HTC targeting specific communities or populations;
Stand-alone HTC.
To realize efficient and effective use of PEPFAR funds and technical support, optimal HTC programs will ensure that the mix of HTC approaches is strategically applied to communities and populations most affected by HIV.
TBD will work with NAC and MOH to expand access to and uptake of couples HTC, using novel and innovative strategies suitable for underserved urban and rural settings. They will work closely with these government entities at all levels to support strategic planning, implementation and provision of technical assistance. They will partner with the District Health Management Teams to integrate couples HCT into community and government health centers in order to maximize use of existing facilities. They will also continue to ensure high quality service provision and the availability of test kits and other essential HTC commodities.
TBD will work closely with the provincial and district health offices to collect routine statistics regarding couples HCT program. On a quarterly basis, these data will be reviewed internally to identify potential weaknesses in the approach, so that the appropriate interventions may be implemented. On a semi-annual basis, the figures will be reviewed with the district health offices to address common obstacles and challenges.
Other sexual prevention programs will specifically target HIV prevention efforts towards the general population and vulnerable subgroups such as alcohol and other drug-users, mobile populations and persons engaged in transactional sex. TBD will implement combination prevention that will not only focus on individual susceptibility and risk but also on societal factors that affect individual risks and vulnerability. Structural interventions will include policy work with MOH, traditional leaders and civil society to reduce stigma and discrimination; advocacy for adoption and implementation of alcohol policies and legislation; efforts to reduce harmful gender norms. TBD will promote condoms and other prevention services beyond abstinence and be faithful in the general population. They will work with NAC and MOH and other stakeholders to ensure that male and female condoms are distributed and made accessible to all sexually-active target populations, including young people. They will implement social and behavior change communication (SBCC) activities that are linked to clear behavior change objectives. Prevention activities will provide individuals with the relevant motivation and skills needed to adopt safer behaviors rather than solely focusing on improving knowledge or awareness of HIV. TBD will foster culturally appropriate social norms, attitudes, and beliefs and develop skills to reduce multiple and concurrent sexual partnerships. They will scale-up prevention activities for men to proactively change harmful gender norms that support and encourage multiple and concurrent partnerships and cross-generational sex.
TBD will scale-up a minimum, core set of interventions adapted for different sub-groups vulnerable to HIV. Peer education and outreach will be accompanied by risk reduction counseling. Risk reduction counseling delivered through peer outreach or in clinic settings will be utilized to address both alcohol and sexual risk behaviors for target populations. Referrals to MC will be encouraged as part of a comprehensive HIV prevention package for clients of female sex workers and other HIV negative males at high risk of HIV. TBD will also strengthen referrals to HIV care and treatment including PMTCT, adherence support and opportunistic infection prophylaxis. They will implement PwP interventions to contribute to the reduction of people getting infected and promoting a positive life-style for the infected. Monitoring and evaluation will be an important part of these program activities.
IntraHealth is positively impacting on increased access and uptake of HCT in remote areas through trained lay counselors in all districts of operation. Accessibility to HTC services has resulted in increased numbers of community members who know their HIV status and consequently do require care and treatment services. Unfortunately, ART in many remote and hard to reach areas is difficult to access because of limited ART sites in most districts. The limitation to ART accessibility poses great challenges to fulfilling one of the key priorities for COP 2013- that of increased linkages to continuum of HIV services. Furthermore, the limitation is a great threat to the health of persons living with HIV (PLHIV). Due to long distances, many PLHIV do not make it to the ART centers in the first place; many of those who make it often default and fail to adhere to treatment. IntraHealth will support the DHOs and their health facilities to provide ART to remote and hard to reach communities through mobile HIV services. IntraHealths support will be in the form of logistics to facilitate mobility to such places to enable PLHIV receive appropriate care and treatment. Community members will be trained in adherence counseling in order to educate and encourage patients to comply with treatment. This will be done to ensure that there is a reduction in the number of clients defaulting. IntraHealth will strengthen the existing quality control and quality assurance in all ART services.
