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.
Subdivisions of Program Areas, these track general higher level sub-classifications of expenditure.
Subdivisions of Major categories, these are the most detailed expenditure data.
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
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: 2007
With FY 08 funds, USG technical staff will be supported and will continue to work closely with the
interagency management country team and HQ technical staff to provide technical assistance for the
design, implementation, and evaluation of PEPFAR-funded behavioral interventions designed to influence
HIV prevention behaviors, with primary emphasis on efforts to promote abstinence, fidelity, delay of sexual
debut, partner reduction, and related social norms. These are conducted in consultation with the Ministry for
the Fight Against AIDS, other technical ministries (Education, Health, Social Affairs, Human Rights, Youth
and Sport, etc.), non-governmental organizations (NGOs), multinationals, and bilateral organizations.
Ongoing specific activities will include:
- Participation in the behavior change communication (BCC) technical group and assistance, in
collaboration with JHU/CCP and the IEC/CCC unit of the DMS, in the mapping of AB activities implemented
by PEPFAR partners and the harmonization and standardization of BCC tools.
- Support for implementation of the life-skills curricula and coordination of the national BCC working group
- Identification of opportunities for targeted BCC.
- Supervision of official needs assessments.
- Coordination of activities among donors and partners, including UNICEF, UNAIDS, UNDP and PEPFAR-
funded partners Care International, FHI, PSI, JHPIEGO, ANADER, International HIV/AIDS Alliance, JHU-
CCP, and the ministries responsible for Education, Social Affairs, Health, and AIDS coordination).
- Develop a communications strategy, in coordination with JHU/CCP and REPMASCI (network of media
professionals and artists against AIDS in Cote d'Ivoire), to promote all PEPFAR activities.
PEPFAR CI will continue to support RIP+ (network of CBOs of people living with HIV/AIDS), REPMASCI,
and COS-CI (NGO collective against HIV, representing more than 400 organizations). PEPFAR CI will also
continue to support faith-based organizations (ARSIP, a recently created interfaith alliance of religious
leaders), youth organizations, and other community activists and leaders in mobilizing their communities for
the promotion of abstinence, fidelity, delay of sexual debut, and partner reduction in their communities.
With FY08 funds, the USG CI team will provide direct technical assistance to the Government of Cote
d'Ivoire and to our implementing partners, supplemented by targeted assistance from CDC headquarters, in
support of the country TB-HIV program. USG CI will support the in-country travel and logistics for all USG
CI TA and TA requested from HQ.
In the area of HIV-TB, the country team will provide ongoing technical assistance, augmented by technical
assistance from CDC HQ staff, to support the integration and scale up of routine counseling and testing
services at TB facilities, improved screening of HIV patients for TB, joint care of HIV and TB at joint-care
facilities, improved monitoring and evaluation of integrated HIV-TB services, and strengthening of
centralized and decentralized TB diagnostic services, including support for smear microscopy and TB
culture, and surveillance of multi-drug resistant TB.
With FY08 funds, the USG technical staff will continue to work closely with the interagency management
team and HQ technical staff to provide technical assistance for the design, implementation, and evaluation
of HIV counseling and testing interventions. USG technical assistance contributes to the strengthening of
national guidelines and adoption of routine testing policies at health facilities. USG staff consults with the
national VCT technical working group, expert HIV laboratory committee, and other technical forums to
assure the quality of decentralized HIV counseling and testing services. USG staff are providing ongoing
technical assistance for the inspection and supervision of HIV testing services performed at peripheral sites.
Specifically, USG staff will provide assistance in implementing the simple whole blood finger-prick rapid
testing algorithm. These efforts are conducted in consultation with the Ministry for the Fight Against AIDS;
other technical ministries (Health, Education, Family and Social Affairs); nongovernmental organizations,
multinationals, bilateral organizations (UNAIDS and other UN agencies); and PEPFAR-funded partners
(such as EGPAF, ACONDA-VS, Columbia-ICAP, Care International, FHI, International HIV/AIDS Alliance,
JHPIEGO, and ANADER).
Ongoing specific activities will include technical assistance to the MOH and other partners to improve the
quality and monitoring of counseling and testing through evaluation of existing counseling and testing
services. In conjunction with Liverpool, JHPIEGO and other partners, USG staff will provide technical
assistance for the integration of HIV testing at health-care service sites. USG staff will provide technical
assistance to strengthen training for professional health workers, professional counselors, lay counselors,
and labs technicians. This training will improve linkages to care and treatment services for people who test
These activities complement direct USG laboratory and other donor contributions to support the expansion
and reinforcement of a national network of laboratories involved in the development and implementation of
laboratory plans and resources for training, inspection, supervision, and monitoring and evaluation of
laboratory personnel and facilities.
With FY08 funds, USG technical staff will provide technical assistance, laboratory services and HIV
reference laboratory functions in support of all prevention, care and treatment services with direct
Emergency Plan (EP) support and will continue to work closely with integrated management team and HQ
technical staff to provide technical assistance and coordination in the area of HIV/AIDS care and treatment,
including assisting national programs with the development, implementation and evaluation of care and
treatment services in Cote d'Ivoire. These efforts are conducted in consultation with the Ministry for the fight
against AIDS, other technical ministries (Health, Education, Solidarity), non-governmental organizations
(NGOs), multinationals, and bilateral organizations.
Laboratory services provided by USG technical staff include provision of comprehensive biologic monitoring
for screening and follow-up of persons receiving ART, technical assistance to the MOH (PSP and national
HIV and TB care programs) to improve laboratories' commodities management system, procurement and
distribution of substantial laboratory and other supplies to support laboratory services, and management of
the national database of persons screened and taking ART at public sites, with progressive transfer of
service-delivery functions to the national laboratory system.
In addition, USG assists host government, non-governmental organizations and donor partners (e.g.
UNICEF, UNAIDS, UNDP), and EP-funded partners (CARE, FHI, JHPIEGO, ANADER, HOPE Worldwide,
Alliance CI, the Ministry responsible for the fight against AIDS, and other technical Ministries) in continued
cooperation and coordination of care and treatment. USG staff provides direction to collaborators on USG
policies, strategies, priorities, guidelines, and reporting requirements related to ART services.
USG staff provides advice to country partners on the matters of medical and scientific policy and practices
associated with program management and operational support for care and treatment services. USG staff
substantially contributes to the planning and implementation of policies to ensure the ongoing development
of programs to improve health care management and delivery systems of the national public health
activities of Cote d'Ivoire. USG staff provides advice and guidance regarding internal and external public
health programmatic design, procedures, protocols, and studies as well as technical and administrative
policies among various levels of stakeholders. USG staff supports coordination and provides technical
assistance to reinforce public-private partnerships efforts to expend an effective and comprehensive
HIV/AIDS response in the workplace, including facilitating the coordination and jointed actions related to
HIV/AIDS among and between companies, between public and private sectors. In coordination with
UNAIDS, ILO, and other bilateral technical cooperation institutions, this activity will support innovative
public/private/NGO partnerships to promote HIV/AIDS sustainable and quality health services with
expanded coverage, including care and treatment to family members of workers and surrounding
Title: Evaluation of transmitted HIV drug resistance using specimens from unlinked HIV serosurvey
Budget: $175,000 in FY07 carryover funds.
The use of ARV drugs has been associated with the development of HIV drug resistance (HIVDR). Because
of the high mutation rate of HIV and because of the lifelong treatment of the disease, it is expected that
some degree of HIVDR will occur among persons in treatment even if appropriate regimens such as
HAART are provided and good adherence is supported. Antiretroviral treatment has been introduced in
Côte d'Ivoire, specifically in Abidjan since 1998.
Hypotheses are the followings:
1. During the first ten years during which ART is being rapidly scaled up in Côte d'Ivoire, well-functioning
ART programs will result in transmitted HIVDR prevalence remaining below 5% for each drug used in the
standard first-line regimen(s).
2. If transmitted HIVDR prevalence is > 15% to a particular drug or drug class in Abidjan, specific public
health actions will be taken to minimize the emergence and transmission of HIVDR.
The purpose of the project is to evaluate the extent of transmitted HIV drug resistance in Abidjan, the
economical capital of Côte d'Ivoire, where the prevalence of HIV drug resistance is likely to be higher, than
in other areas of the country where antiretroviral treatment (ART) is not, or previously has not been, readily
available to the treatment-eligible population.
Results will alert planners, clinicians, and program staff if additional measures should be considered to
prevent unnecessary emergence of HIVDR and to evaluate whether initial ART regimens will continue to be
The study design is a cross-sectional survey, utilizing data and portions of eligible specimens collected in
HIV sentinel serosurvey.
In Côte d'Ivoire, the target population for sentinel serosurveys is made up of women attending antenatal
clinics (ANC), in both rural and urban areas. In order to restrict the evaluation to persons relatively recently
infected with HIV, eligibility is restricted to specimens from persons < 25 years of age, and, in ANC, to
women in their first pregnancy. No client data will be collected other than those that are collected routinely
for sentinel serosurveys.
Population of Interest:
For this survey, the relevant variables are age group, number of previous pregnancies, and, if available,
information on last negative and first positive HIV tests and previous ART exposure. The duration of this
study is 6 months; eligibility criteria are as follows:
1. Women whose age is < 25 years
2. Women in their first pregnancy.
3. The specimen, when tested for the HIV serosurvey, is confirmed as HIV-1 positive
Using a method based on binomial sequential sampling, up to 47 consecutively collected eligible specimens
will be used. One milliliter of serum is recommended for HIV drug resistance testing. HIV-RNA will be
extracted and amplified for genotyping in the laboratory of CDC/RETRO-CI in Abidjan. The protease region
and relevant positions in the reverse transcriptase region of the pol gene will be sequenced to detect
mutations known to be associated with resistance to drugs in standard first line regimens and other drugs of
The prevalence of resistance will not be estimated precisely, but will be rather classified (for each drug or
drug class) as <5%, 5-15%, and > 15%. If prevalence is classified as <5% to all relevant drugs, the survey
is repeated two years later. If prevalence is classified in the higher categories, additional surveys or more
resource-intensive surveillance may be required, as well as additional public health actions.
HIV-1 subtype distribution will also be evaluated using the nucleotide sequence information obtained in the
Five ANC sentinel sites in Abidjan district will be involved in this survey; the projected eligible sample size
from all these ANC sites is 60 eligible specimens.
The ability to obtain 60 eligible HIV positive specimens depends upon the sample size of the HIV
serosurvey in the geographic setting, the proportion of women < 25 years of age in their first pregnancy
enrolled in the previous serosurvey in the setting and the HIV prevalence among women in the age group of
interest. According to 2005 ANC survey in Côte d'Ivoire, the 2 sentinel sites in Abidjan had a total
serosurvey samples of 600 pregnant women; among them, we found 40% proportion of pregnant women
(281) aged under 25 years and in their first pregnancy. Among these 281 young women, 19 were HIV
positive; so to obtain 60 eligible HIV positive specimens, we need to involved 3600 pregnancy women in all
the five sentinel sites selected in Abidjan for this study.
Fringe benefits: $2,000
Training, counseling and testing support, psychological support, and monitoring: $50,000
Travel and supervision: $60,000
Laboratory supplies and reagents: $13,000
Other costs (per diem, lodging, conference room rental, transportation,
training supportive documents, incentives for clients, tools for results
communication ): $50,000
Activity Narrative: Title: Evaluation of transmitted HIV drug resistance using specimens from unlinked HIV serosurvey
The PEPFAR Cote d'Ivoire USG interagency team continues to use innovative approaches to improve
management and operations while minimizing costs. The PEPFAR CI team was built on the platform of the
CDC Projet RETRO-CI, which was established in 1988 as a research collaboration between the CDC and
the Cote d'Ivoire Ministry of Health to study the HIV epidemic in West Africa. Among the highlights in the
history of RETRO-CI are interventional research studies which have led to international policy
recommendations on HIV care and treatment, including short course zidovudine (AZT) as a safe and
effective intervention to reduce mother-to-child transmission and cotrimoxazole prophylaxis as a simple
intervention to reduce hospitalizations and mortality among HIV-infected persons. In 2000 Projet RETRO-CI
expanded its mission to include programmatic activities as part of the CDC-Global AIDS Program and with
the advent of PEPFAR in 2004 the mission of the laboratory, SI and administrative staff became almost
exclusively focused on the support of PEPFAR programmatic activities. In the absence of a bilateral USAID
mission in Cote d'Ivoire, the CDC platform (including administrative, management, technical, and motor pool
staff) has been used to develop an interagency team structure that is fully-integrated and without
redundancy. While the CDC serves as the primary administrative mechanism for the hiring of local and
international technical and administrative staff, the Cote d'Ivoire USG interagency team is leveraging USAID
contracting mechanisms as needed to expedite the hiring of staff.
In its efforts to ensure program performance at a reasonable cost, optimizing USG human and financial
resources, the PEPFAR USG CI team continues to implement a fully coordinated interagency approach that
includes: 1) weekly PEPFAR-CI (interagency) senior management meetings, 2) capitalizing on laboratory
and informatics expertise at Projet RETRO-CI through direct technical assistance and service to our
implementing partners; 3) providing management and technical assistance to all EP funded partners via an
integrated team of project managers and technical advisors (regardless of funding agency); 4) joint agency
staffing positions (such as the proposed new FY08 positions: a project management specialist and a
community liaison specialist); 5) hosting regular program reviews of all implementing partners that combine
portfolios from all in country agencies and, 5) leveraging USAID contracting mechanisms for Fast Track and
longer term positions in order to address staffing needs in country.
These steps facilitate optimal management, coordination, and performance of USG funded activities and
results in a decrease in the number of USG directly supported staff, reduction in redundancies,
capitalization of technical strengths, improvements in coordination and greater compliance with USG
With a significant increase in the number of implementing partners and activities supported by PEPFAR
Cote d'Ivoire (along with a significant increase in budget—a near tripling of the PEPFAR-CI budget from
FY06 to projected FY08), there is a need for additional staff to responsibly manage the growing portfolio.
Hence, the human capital cost for USG Cote d'Ivoire's management and operations continues to increase.
A large percentage of the management and operations budget is driven by ICASS and OBO charges
associated with the construction and now maintenance of the current embassy compound (see ICASS/OBO
narrative). The chronic politico-military crisis, while slowly improving, is yet to be resolved and has
increased transactional costs including the costs of goods and services. Security in Cote d'Ivoire remains a
concern and general operations costs for the USG reflect additional expenses for security and
With the successful recruitment of multiple senior positions, including a permanent PEPFAR DDO, SI
Liaison/Branch Chief, Care and Treatment Branch Chief, Program Management Branch Chief, and
Laboratory Branch Chief, and the creation of a number of program manager, technical advisor, and
administrative support staff positions in 07—in conjunction with regular step/performance increases and the
overall PEPFAR interagency salary costs have increased.
PEPFAR-CI has focused considerable attention and invested significant human resource time into the
development of high level LES position descriptions for technical and program management staff. PEPFAR
-CI, with support of the Chief of Mission, is working closely with HR staff at the Embassy to address
concerns with the State Department CAJing system to achieve grading which accurately reflects the
responsibilities and competencies of the positions. For FY08 15 new PEPFAR interagency positions are
anticipated (described in detail in the Management and Staffing Overview).
Even though CI appears to be emerging from a long politico-military crisis, the security situation remains of
concern and the post remains a critical threat post and is currently "adult only" with minor dependents not
permitted. This coupled with French language requirements creates additional challenges in filling
international positions. Retaining LES staff remains a challenge as a result of salary limitations, CAJE
classifications and growing competition with other donors and implementing partners for a limited pool of
highly competent technical staff. In FY 07 two newly hired key LES leadership and technical advisors
accepted positions in other countries because of greater opportunities for professional growth and financial
security. In addition, the team is losing a critical operations management position due to retirement.
Despite efforts in FY07 to implement appropriate preventive "mental health" strategies to protect staff from
burn-out associated with living and working in a chronically high stress environment, these were difficult to
implement due to staff shortages, change in senior USG leadership, and a rapidly expanding program which
is responding to change in the politico-military situation. With recent success in recruiting a number of
senior staff positions, FY08 offers the promise of a USG team that is both broader and deeper in its
program management capacity, which should pay dividends not only for the management of our PEPFAR
programs, but also for the USG team itself.