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
N/A
New/Continuing Activity: Continuing Activity
Continuing Activity: 18915
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
18915 12183.08 Department of Charles R. Drew 8296 6112.08 Civil-Military $145,000
Defense University Alliance
12183 12183.07 Department of Charles R. Drew 6112 6112.07 Civil-Military $225,000
Table 3.3.03:
Continuing Activity: 18916
18916 11927.08 Department of Charles R. Drew 8296 6112.08 Civil-Military $120,000
11927 11927.07 Department of Charles R. Drew 6112 6112.07 Civil-Military $100,000
Program Budget Code: 15 - HTXD ARV Drugs
Total Planned Funding for Program Budget Code: $0
Program Budget Code: 16 - HLAB Laboratory Infrastructure
Total Planned Funding for Program Budget Code: $250,000
Program Area Narrative:
Overview
A solid laboratory infrastructure and data quality assurance processes are the pivotal links to ensuring accurate diagnosis and
effective treatment and management of the HIV epidemic in Angola. A significant need exists for continued laboratory
strengthening at the national and regional levels. To this end, the USG has achieved noticeable success in building laboratory
capacity over the last year with the completion of the 2007 Ante Natal Clinic (ANC) study (see Strategic Information (SI) narrative).
In the upcoming year, the USG will build upon current laboratory strengths by cross training laboratory personnel as it continues to
forge collaborative relationships specifically with the National Institute of Public Health, Instituto Nacional de Saúde Publica
(INSP), and the National AIDS Institute (INLS). The BED capture enzyme immunoassay (BED-CEIA) will be introduced to
laboratory personnel to provide support for the anticipated 2009 HIV ANC survey with incidence and resistance testing (see SI
narrative). The BED-CEIA measures the increasing proportion of HIV-1 IgG to total IgG after seroconversion to estimate HIV-1 in
a population. This information will help identify a more strategic approach to address HIV in Angola.
Although the Angolan Ministry of Health (MoH) has developed and expanded the Prevention of Mother to Child Transmission
(PMTCT) program covering a good portion of the country's provinces, only a few children <15 years old are on anti-retroviral
(ARV) drugs. This represents a small percentage of the total population on ARV, and is due primarily to the lack of early diagnosis
and follow-up systems. As a result of laboratory staff turnover and difficulty establishing needed partnerships, early infant
diagnosis (EID) training was initiated but not fully implemented. The USG is working in conjunction with the INLS and the INSP to
identify the appropriate partners for this effort and to provide technical assistance to a broader group of laboratory personnel to
implement the laboratory segment of the EID program in Angola.
Leveraging and Coordination
Building close collaboration and synergy between the three USG funded initiatives in Angola (President's Emergency Plan for
HIV/AIDS Relief (PEPFAR), the Presidential Malaria Initiative (PMI) and Avian Influenza (AI)) is the most effective way to ensure
continued improvement of laboratory conditions in Angola to ensure innovation, quality assurance, and sustainability of the lab.
Laboratory training of personnel has been leveraged across the USG initiatives. Special emphasis has been placed on common
equipment purchases, safety training, and molecular biology diagnostic techniques that can be utilized across the various
initiatives. The Global Fund to fight HIV/AIDS, Tuberculosis and Malaria (GFATM) and the Clinton Foundation support will be
leveraged for support of molecular laboratory test kits and supplies for EID and BED-CEIA analyses.
Current USG Support
The U.S. Centers for Disease Control and Prevention (CDC) continues to address staff training needs and laboratory equipment
challenges. Equipment maintenance is a critical aspect of laboratory management and data quality assurance. Therefore, the
maintenance contracts on the sequencer and other key pieces of equipment were renewed. USG provided technical support to
address critical elements for building laboratory capacity to successfully implement the 2007 national Antenatal HIV
Seroprevalence study. Implementation of these objectives were coordinated with the Ministry of Health, support from the
International Lab Branch of GAP/CDC (Atlanta), "South-to-South" cooperation with Brazilian laboratory scientists (FIOCRUZ and
FURJ), and APHL. 43 individuals were trained throughout the completion of this study.
USG funding was leveraged to coordinate planning for the provision of hands on training with on- site follow-up, including Good
Laboratory Practices, Laboratory Management, specific training on the conduct of specific tests, and Quality Assurance/Quality
Control. The latter effort is identified as an area of increased emphasis for the upcoming year. Existing partnerships, such as with
APHL and South-to-South Collaboration with CDC/Brazil, FIOCRUZ, and the Federal University of Rio (FURJ) were initiated to
assist in the training initiatives.
FY09 Activities
Several discussions have taken place with the Ministry of Health and the National Institute of Public Health, to address laboratory
staffing and infrastructure issues. The USG will support the establishment of a synergistic collaboration between the PEPFAR,
PMI and AI initiatives in Angola to strengthen the INSP laboratory infrastructure.
Continued technical support and guidance for previously initiated projects will be provided to the INSP. However, there will be
three major laboratory activities launched in FY09 identified below:
•External Quality Assessment (EQA) Program:
The USG will continue to support the establishment of a retest program for the rapid tests performed by the INSP using dried
blood spots in addition to the following proposed in 2008.
- Develop protocols and SOPs for the quality assurance programs to sustain the national quality assurance program for HIV and
TB testing
- Determine the percentage and number of specimens that need to be retested
- Estimate the cost and time frame for these activities
- Train the appropriate laboratory staff on the proper technique to collect, package, storage and transport dried blood spot using
Whatman 903 filter paper for testing
- Anticipate problems and methods to resolve them, such as retraining staffs as needed.
- Organize refresher training on the basis of the results of the re-testing.
•Early Infant Diagnosis (EID):
The USG will continue to support the INSP in undertaking early infant diagnosis using DNA PCR.
CDC-Angola is currently working in partnership with CDC-Atlanta, APHL South-to-South Collaboration CDC/Brazil, and the
Federal University of Rio (FURJ) to establish an EID pilot project in conjunction with the INSP and INLS laboratorians. Financial
support for this initial effort will be provided by CDC-Atlanta through APHL. Through CDC/Brazil and the FURJ, the support will
cover a laboratory assessment, and on-the-job training technical assistance and mentoring for 3-4 individuals for a 2-month period
to become fully competent in EID technology. Subsequent to the initial effort, identified PMTCT and pediatric sites will be provided
training in sample collection, storage, and transport. The USG will leverage with the Clinton Foundation to provide support for test
kits and reagents.
The INSP laboratory has the necessary instruments and can quickly develop a pilot program to implement early infant diagnostics
around the Luanda area, with the long-term goal of scale-up and capacity building in the regions. The following steps will be
taken to operationalize the pilot program as soon as feasible:
- Train laboratorians for the DNA PCR techniques and report results.
- Train nurses and clinical staff for the collection of dried blood spots
- Develop logistics for sample storage and transport
- Develop protocols and SOP's for HIV testing in children dried blood spots
•HIV-1 incidence and resistance testing:
The BED-CEIA can be used to estimate HIV-1 incidence in cross-sectional serosurveys, including sentinel surveillance surveys
among ANC attendees or other populations, and population-based surveys.
A 2009 HIV Incidence study in Angola is planned and is described under Strategic Information. BED assay training is important to
the conduct of the study. Training will be conducted for INLS and INSP lab personnel to analyze samples for the study. Training
will take place in collaboration with CDC-Atlanta and identified partners used in EID training to promote consistency and data
quality. Reagents will need to be purchased. The CDC-Angola will leverage with the Global Fund to provide support for test kits
and reagents for BED analysis.
Technical Assistance to lab personnel will include the following:
- Training on laboratory and epidemiological procedures for the BED-CEIA assay;
- Incidence estimation; and
- In-country laboratory and epidemiological technical assistance for implementing the BED-CEIA assay for incidence estimation in
surveillance activities and data analysis and integration.
Resistance testing allows for the identification of resistant virus. Resistant testing has led to improved outcomes in randomized
clinical trials in which treatment decisions are made with resistance data compared to those made without this information. In
addition, results from clinical trials demonstrate improved virologic outcomes when patients receive more agents to which their
virus is sensitive as determined by resistance tests. Training laboratory personnel to conduct resistance testing will enhance the
laboratory capacity in Angola. Thus, resistance testing will be an important component of the HIV Incidence study.
•Staff Scientist Position:
The incumbent will serve as the key advisor on programmatic and technical/scientific issues. Oversight and integration of
laboratory processes and training efforts for HIV, Malaria, and Avian Influenza initiatives is a primary focus of this position. In
addition, the staff scientist will provide support for the implementation of the Field Epidemiology Laboratory Training Program (see
HSS and HCD narratives).
Targets
12.1 Number of laboratories with capacity to perform 1) HIV tests and 2) CD4 tests and/or lymphocyte tests 6
12.2 Number of individuals trained in the provision of laboratory-related activities 82
12.3 Number of tests performed at USG-supported laboratories during the reporting period: 1) HIV testing, 2) TB diagnostics, 3)
syphilis testing, and 4) HIV disease monitoring 44,950
Table 3.3.16:
DOD Humanitarian Coordinator all costs and travel to Angola of the DOD Point of contact at HQ.
Continuing Activity: 19164
19164 19164.08 Department of Charles R. Drew 8296 6112.08 Civil-Military $95,000
Table 3.3.19:
