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 FY08 funds, USG technical staff will continue to work closely with program management staff and HQ
technical staff to provide technical assistance for the design, implementation, and evaluation of PEPFAR-
funded interventions aimed at preventing mother-to-child HIV transmission. These activities are conducted
in consultation with relevant ministries (Family and Social Affairs, Health, Fight Against AIDS), non-
governmental organizations, multinationals, and bilateral organizations.
Ongoing specific activities will include:
1. Supporting the implementation and coordination of PMTCT activities among donors and partners (e.g.
UNICEF, UNAIDS, UNDP, and PEPFAR-funded partners including EGPAF, ACONDA-VS, Columbia-ICAP,
and technical ministries)
2. Providing laboratory support at Projet RETRO-CI for quality point-of-service HIV testing with quality
assurance at PMTCT sites, purchasing of laboratory commodities and supplies, training of peripheral-site
staff, supervision, and quality-assurance services
3. Participating in the PMTCT working group and assisting the MOH to develop innovative approaches for
rapid scale-up, including:
• A district approach with strengthening of PMTCT monitoring and evaluation at the district and site levels, in
collaboration with RETRO-CI/SI, Measure, DIPE, and other key partners
• Early infant HIV diagnosis by PCR, in collaboration with RETRO-CI/Lab and CDC HQ
• Routine HIV counseling and testing in ANC services
• Rapid testing in labor-and-delivery services
• Linkages with care and treatment
4. Providing technical assistance to the MOH and national experts to complete the validation, dissemination,
and regular updating of PMTCT policies and guidelines, with anticipated revisions related to couples
counseling, HIV testing algorithms, infant feeding, and reaching women during and after labor
5. Establishing a formal monthly discussion involving EGPAF, ACONDA-VS. Columbia-ICAP, the
CDC/USAID country team, JHPIEGO, and other key partners to follow PMTCT activities, focusing on major
points such as commodities management at the central and the district levels, longitudinal postnatal follow-
up of mother/infant and linkages with pediatric care, and coordination with other partners (UNICEF, PATH,
HIV/AIDS Alliance, UNFPA, WFP, ANADER, Care International, and PLWHA)
6. Assisting EGPAF, ACONDA-VS, and Columbia-ICAP to develop new partnerships with the public and
private sectors, FBOs, and CBOs to expand PMTCT activities nationwide
This funding represents a percentage of Alliance CI 's OP funds reprogrammed to CDC HQ to support
adaptation and translation of culturally appropriate HIV prevention for positive tools and materials which will
be disseminated to all clincal facilities implementing a comprehensive care and treatment program.
With fiscal year 2008 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 program in the following areas: sexual prevention for positives, at
risk, and highly vulnerable populations, such as professional and transactional sex workers, uniformed
services and ex-combatants, truckers, and prisoners. USG CI will support the in-country travel and logistics
for all USG CI TA and TA requested from HQ.
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's palliative care program. USG CI will support in-country travel and logistics for all
USG CI TA and TA requested from HQ.
In the area of palliative care, the country team will provide ongoing technical assistance, augmented by
technical assistance from CDC HQ staff, to support the integration and scale-up of prevention, diagnosis
and treatment for OIs, including TB, malaria, and STIs; provision and distribution of cotrimoxazole for all HIV
-positive patients who qualify according to national guidelines; basic pain management; insecticide-treated
bed nets; interventions to improve hygiene and water safety; and psychosocial support.
With FY08 funds, USG technical staff will continue to work closely with the interagency country
management team and HQ technical staff to provide technical assistance and coordination for EP-
supported activities aimed at improving the lives of orphans and other vulnerable children (OVC) and
families affected by HIV/AIDS. USG technical staff assists the host government and nongovernmental
organizations with ongoing implementation and coordination of OVC-related activities.
These efforts are conducted in consultation with the Ministry for the Fight Against AIDS, other technical
ministries (Education, Health, Family and Social Affairs, Human Rights), multinationals, bilateral
organizations (UNICEF and other UN agencies), and EP-funded partners such as FHI, HIV/AIDS Alliance,
CARE International, ANADER, and JHPIEGO.
USG technical staff contributes to the development and implementation of policies and programs pertaining
to OVC populations and ensures the ongoing development of programs to improve delivery systems of the
public health sector of Cote d'Ivoire. USG staff provides technical support to partners to expand quality
services for OVC and their families and provides technical assistance in program design, supervision, and
monitoring and evaluation of EP-supported OVC activities.
With FY07 funds, Projet RETRO-CI, the CDC-MOH collaborative USG-funded project, will continue its
support to the tiered MOH national public health laboratory system and will reinforce the institutional
capacity and the coordination role of the national HIV, TB, and malaria programs in building sustainable
national infrastructure, managerial and technical workforce capacity and expanding services to provide
quality diagnostic testing, clinical laboratory monitoring of treatment, and surveillance.
While building capacity at the national reference laboratories, RETRO-CI will continue to provide HIV
reference testing and quality assurance to support quality services within the national laboratory network. A
major and expanding activity is the progressive transfer of competence and technologies to the designated
national reference laboratories to provide the minimum package of HIV laboratory services at all levels
nationwide. RETRO-CI's technical assistance will support achievement of both PEPFAR country goals and
national strategic plan goals. In support of the effort to scale up HIV testing, RETRO-CI will complete the
assessment and operationalization of a simplified rapid HIV testing algorithm and the assessment and
operationalization of the new CDC Rapid HIV Testing Logbook. In support of the scale-up of early infant
diagnosis, RETRO-CI will provide DNA PCR services for conventional and DBS whole-blood specimens.
RETRO-CI will continue to support the laboratory component of strategic information activities, including
HIV testing and analysis of the 2007 national antenatal sero-prevalence survey and sentinel surveillance of
transmitted and emerging HIV drug resistance as part of the treatment program evaluation. These activities
will be implemented in collaboration with the MOH national HIV and TB programs (PNPEC and PNLT), the
national reference laboratory (LNSP), the national TB reference laboratory (Institute Pasteur CI), the UFR of
Pharmacy and Medicine, the national training institution of health care workers (INFAS), the National Blood
Bank, the WHO, HHS/CDC/HQ, CDC international laboratory cooperative agreement partners, and all
relevant PEPFAR implementing partners and stakeholders.
In FY08, activities will be based on lessons learned from the implementation of FY07 activities. A principal
activity will be the collaborative development of a five-year strategic laboratory plan that will serve as the
basis for the development of a sustainable national laboratory system. In addition, RETRO-CI will
concentrate on the following priority activities in an effort to scale up quality lab services supporting HIV
prevention, care, and treatment programs:
Support of laboratory networks and integrated laboratory services by:
1. Supporting the rapid scale-up of HIV testing services to improve access at CT, PMTCT, TB/HIV, and care
and treatment sites throughout the country. This support will consist of:
- Implementing at all PEPFAR-supported medical and non-medical sites simplified whole-blood finger-prick-
based rapid-testing algorithms
- Assessing the proficiency of non-laboratory professionals (nurses, midwives, lay counselors) to perform
HIV rapid-testing algorithms and related QA activities
- Providing recommendations for any changes needed in the national HIV testing policy based on these
2. Supporting expansion to access of biological monitoring for patients on ART at all levels by conducting
and promoting field validation of simple technologies at the point of care where appropriate
3. Supporting the MOH by creating a specimen referral system from sites without laboratories to regional
laboratories. This will include a system for the timely reporting of site laboratory results to the reference
4. Implement the logbook for HIV rapid testing developed by CDC at all HIV testing sites to standardize
reporting of results.
5. Providing TA for the roll-out of early diagnosis of HIV infection in HIV-exposed infants at 6 weeks-12
months (at least 6 weeks after cessation of breastfeeding) by DNA PCR using dried blood spot specimens
at all PMTCT sites and immunization clinics. This will be achieved by:
- Transferring DNA PCR technology using DBS to three central laboratories (CeDreS, IPCI, CIRBA)
- Providing test kits and supplies for testing up to 10,000 HIV-exposed infants
- Collaborating with the MOH to review and change policies on early infant diagnosis to reduce the need for
costly DNA PCR testing by performing early HIV rapid testing on infants before 12 months.
6. Provide TA to build appropriate reference testing capabilities and facilities within the LNSP. This will
include providing assistance for the coordination of an external quality assessment program for HIV
serology in collaboration with ASCP for the development of a laboratory quality system.
7. Providing TA to the national TB program for the provision of HIV CT at all TB centers. This will include
training of CAT and CDT staff on HIV testing and QA/QC and training and coaching of TB supervisors for on
-site supervision of CT services.
8. Supporting ART clinical laboratory monitoring for HIV-infected patients at the infectious diseases
department (SMIT) and outpatient clinic (USAC) of the university teaching hospital of Treichville, Mèdecins
Sans Frontières (MSF), and other treatment sites according to national guidelines by providing lab services
for: full blood count (FBC), CD4 + T-cell count, full chemistry including but not restricted to liver enzymes
(transaminases), renal function test (creatinine), glucose, lipids, amylase and serum electrolytes, HIV RNA
viral load, Hepatitis B and C virus serology.
Technical assistance in laboratory quality assurance by:
1. Monitoring the performance of laboratory sites for the accuracy of HIV testing and ART clinical laboratory
- Continue TA for an initial assessment of laboratory staff at new PEPFAR-supported sites and periodic on-
site supervision at all sites with progressive transfer of competencies to the regional and district levels
- Organize an external quality assurance (EQA) program for HIV serology through a two-year cooperative
agreement with the national reference laboratory (LNSP)
- Support the EQA/PT program for CD4 testing in collaboration with LNSP and CeDReS
- Identify, with LNSP, and support a suitable partner to establish and pilot a QA program (including
EQA/PT) for hematology and clinical chemistry
2. Transferring competencies for and decentralizing supervision of HIV testing sites to regional supervisors
by creating a national pool of supervisors; implementing a national guide for supervision, related
standardized supervision forms, and checklists
3. Providing TA to develop the overall QA program, including but not limited to the definition of QA
standards for all laboratory categories.
Activity Narrative: Provide training by:
1. Continuing to support the improvement of pre-service training institutions, including updating curricula,
provision of lab equipment and supplies, and training of staff
2. Continuing to support the national HIV and TB programs for in-service trainings (HIV and CD4 testing,
laboratory quality management, and maintenance of basic equipment)
3. Supporting the implementation and rollout of standardized training materials, including the
comprehensive WHO/CDC HIV rapid-testing training package and the WHO/CDC/IUATLD/APHL/RIT direct
TB smear microscopy training package.
1. Continue to support the lab component of strategic information activities, including evaluating the national
care and treatment program for emerging ARV drug resistance in patients at 12 months of treatment to
assess the effectiveness of current ARV drug regimens
2. Implement a threshold survey for transmitted drug resistance among pregnant women at selected ANC
3. Validate new HIV incidence surveys and targeted evaluation studies to:
- Validate simple and easy-to-use new technologies for CD4 testing +/- complete blood count (Auricare
NOW, FACSCount CD4Abs/CD4%) to evaluate their appropriateness in laboratory programs.
- Validate rapid nucleic acid technologies for quantification of viral load (real time PCR)
- Assess the feasibility of new methodologies (dried tube serum) for EQA for HIV serology.
- Assess the suitability of newly available commercial cell stabilizers for CD4 count and full blood count
- Assess the residual risk of window-period HIV infections using nucleic acid techniques (NAT) and pooling
strategies (cross-referenced CNTS mechanism 4933)
4. Apply to be a WHO regional HIV Drug Resistance Collaborative Center. This will enable RETRO-CI to
provide TA to other PEPFAR and regional countries with limited resources for implementing drug-resistance
5. Collaborate with ASCP and CLSI in evaluating, developing, improving, and maintaining their laboratory
quality management system (managerial and technical) in compliance with CAP and ISO 15189
requirements with the goal of accreditation. This will be two- to three-year process. RETRO-CI will serve as
an advisory body for supporting the accreditation of national and regional laboratories, thus evolving its role
at the national and regional level as a center of excellence for training and QA.
6. Collaborate with the National Public Pharmacy (PSP), the Supply Chain Management System (SCMS),
and PEPFAR implementing partners to improve the supply-chain system
7. Provide TA for training of staff on inventory and stock management.
Laboratory commodities and equipment will be purchased directly and are projected to total $1,526,765;
staff salaries and administrative costs to support 26 RETRO-CI laboratory affiliated positions make up the
With significant Emergency Plan financial and technical support, the government of Cote d'Ivoire is
improving national capacity to respond to the HIV/AIDS epidemic throughout the country. In the realm of
strategic information, the primary technical contribution of the USG is implemented by the strategic
information staff of Project RETRO-CI, which is a collaborative organization created jointly by the Ministry of
Health (MOH) and the CDC. RETRO-CI is a critical partner in the development of the Three Ones principle
of a unified national monitoring and evaluation system promoting coherent health management information
systems (HMIS) and HIV/AIDS surveillance.
During the past three years, the RETRO-CI SI team has assisted EP partners to develop, implement, and
coordinate comprehensive SI activities providing key data for decision-making in the fight against HIV/AIDS.
RETRO-CI continues to provide HMIS and surveillance assistance to the Ministry of Health (MOH) and the
Ministry for the Fight Against AIDS (MLS), including support for the development of a nationwide
harmonized longitudinal patient-monitoring system. RETRO-CI has conducted annual ANC HIV surveillance
surveys and helped conduct the 2005 National AIDS Indicator Survey. In addition, the RETRO-CI SI team
has participated, under the coordination of JSI/Measure Evaluation, in the harmonization of national
HIV/AIDS indicators and the development of national data-collection tools for the tracking of facility-based
and community-based activities.
With FY08 funds, the SI branch at RETRO-CI will continue to provide technical assistance to support the
building and strengthening of a unified national M&E system and the conversion of HIV/AIDS data to useful
information through the three components of strategic information — monitoring and evaluation, health
management information systems, and surveillance.
Monitoring and Evaluation
RETRO-CI SI M&E activities will aim to collect and aggregate data to provide information to support the
management of the EP program in Cote d'Ivoire. RETRO-CI has developed an SI strategy for PEPFAR
Cote d'Ivoire and will provide technical assistance to EP-funded implementing partners to ensure that they
have the capacity to meet EP reporting requirements and to use data effectively for program improvement.
This activity will include the provision of French-language SI materials and training, the preparation of
reports aggregating program data of EP implementing partners, and the presentation of written and oral
reports to national partners and stakeholders. The USG will also begin the data-quality audit (DQA)
process, including onsite supervision and partner-performance evaluation.
The national M&E system lacks expertise in health information systems. The RETRO-CI SI team will
provide continued technical assistance to the MLS, the MOH, the Ministry of Education, the Ministry of
Family and Social Affairs, and other EP partners to implement a fully functional M&E system that will
improve routine data reporting and data use. This will include support for revision, dissemination, and
implementation of national strategies in strategic information. With CDC HQ technical assistance, Project
RETRO-CI will assist in:
- Implementing a national-scale ART patient-monitoring system using adapted WHO ART patient-monitoring
forms and an electronic ART monitoring tool.
- Designing or adapting software, databases, and computer applications that support specific HIV/AIDS
program activities (CT, PMTCT, OVC, etc.).
- Designing a national data repository on HIV/AIDS. This secure data repository will respect WHO privacy
and confidentiality guidelines and will aim to be a one-stop provider of HIV/AIDS data at the individual and
- Supporting ongoing adaptation and scaling up of the national-level Training Information and Management
System (TIMS) software to track the coverage of human resources providing HIV/AIDS-related services
- Addressing confidentiality, privacy, and security in the management of data related to HIV-infected
individuals. This will include the development of a national unique identifier.
- Promoting the use of data for decision-making by using data visualization and building GIS core
competencies that address EP and national needs.
- Improving HIV-related data quality and use by developing national policies and guidelines, by training
government and implementing partner personnel, and by supervising data collection and management
- Providing all EP-funded partners with data-management software (MESI) for data storage and decision-
making, with Solutions technical assistance.
In addition, the RETRO-CI SI team will provide support in informatics to a variety of government actors,
NGOs, and other organizations. Specific activities will include:
- Training in the use of data-management and statistical software packages, such as Epi Info, CRIS, MESI,
- Assisting the MOH with its next-generation national health management information system, which
integrates HIV indicators with other health-outcome measures.
- Assisting with the development and implementation of a national M&E system while supporting the
achievement of EP prevention, care, and treatment goals. This assistance will include the translation of
software programs and training materials, supervision, and development of quality-assurance guidelines.
- Working with the national SI technical working group to develop recommendations for facilitating the
integration of data collection in the field, with the aim of reinforcing linkages between different HIV-related
services. This technical assistance will complement SI activities funded through cooperative agreements
with the MLS, the MOH, and other partners in support of creating a functional national M&E system.
Surveillance and Surveys
For the past two decades, RETRO-CI surveillance activities have been the main source of country-level
HIV/AIDS data in Cote d'Ivoire. Within the framework of knowledge transfer to the host government,
RETRO-CI will support the MOH and MLS (ministries in charge of the country's HIV/AIDS surveillance
system) and other EP partners by:
1. Providing technical and logistical assistance to the MOH to support the development and execution of a
dissemination plan for the 2007 national antenatal HIV surveillance survey (ANS). With FY07 funds, 100
health personnel were trained, blood samples were collected at 30 urban and 12 rural sites and tested at
Project RETRO-CI's laboratory, and data was entered into a database.
Activity Narrative: 2. Informing programmatic decision-making by conducting further analyses of available surveillance and
program data (CT, PMTCT, ART) through a data-triangulation exercise, with the aim of describing the
patterns that drive the HIV epidemic in Cote d'Ivoire as well as the impact of the national response.
Technical assistance for protocol development and implementation will be provided by CDC headquarters.
3. Providing technical and logistical assistance to the MLS to carry out a population-based HIV survey
(either a Behavioral Surveillance Survey or a Demographic and Health Survey) to assess the impact of
prevention, care, and treatment interventions. Assistance will support sample collection for anonymous HIV
testing at selected sites, transport of samples, testing at the RETRO-CI laboratory, data management and
analysis, a written report, and dissemination of the results through a variety of media (paper reports, CD-
ROM, Web site).
4. Providing technical and logistical assistance to the MOH and to Abt Associates, in collaboration with the
WHO and other partners, to complete dissemination of the findings of a recent service provision
assessment (SPA) through a workshop, training, written reports, and a CD-ROM (started in FY07).
5. Providing technical assistance as needed to support a variety of in-country partners with the
implementation of public health evaluations (PHEs) and targeted evaluations. Assistance will include
support for the evaluation of HIV drug resistance, the investigation of recent HIV infections, and the
evaluation of nutrition and food support strategies (breastfeeding, OVC food support, nutrition as part of
palliative care). RETRO-CI will procure laboratory and study supplies, collect samples at peripheral sites,
transport specimens for testing at the RETRO-CI laboratory, manage and analyze data, and disseminate
results through a communication plan. Technical assistance will be sought from CDC HQ for conducting
initial assessments, developing protocols and guidelines, and planning activities.
RETRO-CI will collaborate with other francophone African countries to support the development of their
strategic information capacities. Building on two decades' experience in SI (including translation into French
of Epi Info and TIMS software), RETRO-CI continues to manage data related to tens of thousand of patients
that has supported the publication of more than 300 peer-reviewed articles. RETRO-CI will take advantage
of this extensive experience to assist other francophone countries by:
1- Organizing regional SI workshops and trainings in French.
2- Supporting the development and implementation of health information systems in French.
3- Providing French-speaking experts to other countries for technical assistance in strategic information.
Despite the cost containment measures on the part of ICASS management as well as agency-specific
efforts, Cote d'Ivoire has one of the highest ICASS costs in the African Region. This is partly due to the high
cost of doing business in Abidjan, Cote d'Ivoire and the expense of operating a newly constructed embassy
compound inaugurated in 2005. The operating costs of the new Embassy have increased due to building
construction failures and the cost of fuel to run two generators to produce electricity rather than running
directly off the national power grid. The need to generate power on site using diesel generators was
necessitated by the frequent power surges placed sensitive embassy communications and other equipment
at risk. To offset the increased costs of operating the embassy, there was a reduction in force of 12 LES this
year, along with other cost saving measures.
Although Cote d'Ivoire is emerging from a lengthy politico-military crisis, agencies at post remain
significantly downsized. CDC is one of the few agencies that has remained and bears a significant burden
of the cost sharing of operating one of the largest embassies in West Africa, as well as paying for the actual
space in the embassy used in support of the interagency PEPFAR team.
Along with growth in the PEPFAR program in Cote d'Ivoire, the CDC portion of ICASS costs will increase as
a direct result of the need for increased office space (and workstations) at the NEC, as well as increasing
demands in support of the PEPFAR program for Embassy services with associated ICASS charges.
$1,400,000 is projected for total ICASS charges for FY08. The ICASS services which are used frequently
include HR processing, procurement, contracts, financial and other activities needed to support the
interagency PEPFAR program at post.
OBO costs in FY07 were paid from country budget allocations and this will continue in FY 08. The OBO
charges (projected to be $280,000 in FY08) apply to the total number of existing authorized positions for
each US agency including both filled and vacant positions (includes all "persons" employed by the agency,
FTEs, LES, PSCs and temporary appointees). The fully integrated interagency PEPFAR staff currently
numbers 91, including 23 staff associated with the RETRO-CI laboratory; and the team anticipates hiring 15
additional staff in FY08. The OBO charges are rated per person and based on the type of office space
allocated to each position. Currently, CDC supports the PEPFAR coordinator, the USAID focal point and
four members of its management and support staff in the NEC space. The majority of PEPFAR staff will
continue to be located at the Ministry of Health/RETRO-CI site in Treichville. However, office space there is
currently at capacity and expansion at this site is not an option due to limitations on construction authority
for CDC. With the available space at the embassy, the interagency team will plan to locate 8-10 additional
staff at the embassy in FY08.
As CDC overseas operations have rapidly expanded, CDC HQ has found it difficult to keep up with the need
to provide support to the field. Support for PEPFAR-CI Information Technology requirements continue to be
challenging in country as a result of satellite limitations, electrical power outages, and a growing need to
offer IT support to increased staff without an increase in IT support staff. In a much needed effort to address
the growing IT needs for CDC operations overseas, in FY08 the CDC HQ based Information Technology
Services Office (ITSO) will establish an annual support cost of $3250 dollars per workstation and laptop at
each location [projected to be $341,250 for the PEPFAR Cote d'Ivoire interagency program] to cover the
cost of Information Technology Infrastructure Services and Support provided by HQ. This cost will include
funding to provide a base level of connectivity for the primary CDC office located in each country to the
CDC Global Network, keeping the IT equipment located at these offices refreshed or updated on a regular 3
-4 year cycle, financial resources for expanding the ITSO Global Activities Team in Atlanta as well as fully
implementing the ITSO Regional Technology Services Executives in the field. This is a structured cost
model that represents what is considered as the "cost of doing business" for each location.