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: 2010
JHPIEGO is being funded directly to provide technical assistance in three distinct areas, each drawing on the partner's international expertise and Cote d'Ivoire advantages:
- Cervical cancer prevention and care: - Quality improvement in PMTCT services - Task shifting to improve ART service delivery
In addition, JHPIEGO works as a subpartner to Social Sector Development Strategies (SSDS), under the AIDSTAR mechanism, to provide technical assistance to improve pre-service and in-service training curricula and systems.
As a prime partner, JHPIEGO will continue and build on FY 2009-funded activities in:
1. Cervical cancer prevention and care: Cervical cancer is a major public health problem for women in CI. It is the leading cause of cancer deaths in women, even though it is highly preventable when precancerous lesions are detected and treated. In countries that have developed and implemented high-quality, organized cervical cancer prevention programs, the incidence of cervical cancer has decreased by 70% to 90%. CI has no national cervical cancer prevention program. Existing services are characterized by low coverage rates, poorly targeted services, lack of coordination and linkages of screening and treatment components, and inadequate tracking of patients for follow-up. Services among HIV- infected women are almost nonexistent.
Invasive cervical cancer is an AIDS indicator condition (WHO Stage IV), and per WHO's Human Papilloma Virus (HPV) Center, women in West Africa have higher rates of HPV infection, the primary cause of cervical cancer, than the worldwide rate (16.5% vs. 10%). Moreover, HIV-infected women have higher incidence, greater prevalence, and longer persistence of HPV infection; are at higher risk of developing precancerous lesions of the cervix; and may have more rapid progression to cancer than non-HIV-infected women. Unlike other opportunistic infections, HPV and cervical dysplasia are not effectively prevented, nor do they reliably regress with ART. Therefore, with increasing access to ART in low-resource settings, HIV-positive women may live longer, but may also be at increased risk for development of cervical cancer.
Given the high burden of HIV in CI and corresponding potential for AIDS-related malignancies, particularly the high incidence of cervical dysplasia among HIV-infected women, a crucial gap exists for screening and treatment of AIDS-related cancers, especially cervical cancer. HIV and its influence on the development of cervical cancer pose significant risks for women's health, as well as the well-being of their families and communities. As a result, HIV-infected women should receive cervical cancer prevention services as part of their routine HIV care and treatment.
In FY 2009, the USG team began funding JHPIEGO to help address this need, with pilot activities at 10 high-volume, high-capacity care and treatment hospitals. JHPIEGO has been a leader in global cervical cancer prevention efforts in low-resource settings (Ghana, Guyana, Indonesia, Malawi, Peru, Philippines, South Africa, Thailand). JHPIEGO is building upon this experience to help introduce a cervical cancer prevention program targeting HIV-infected women in CI. JHPIEGO is introducing screening for cervical pre-cancer lesions using visual inspection with dilute acetic acid (VIA) and providing cryotherapy for those who screen positive in a single visit approach (SVA). The SVA is a recognized alternative for low-resource settings to cytology-based screening for cervical dysplasia. This approach also links testing with the offer of treatment or other management options, during the same visit. This linkage is not only clinically important but also cost-effective in ensuring VIA-positive women are taken care of at the earliest possible time.
With FY 2010 funds, JHPIEGO will continue and expand current activities to three additional sites, to be selected with the PNPEC and the PEPFAR team. While preparing the selected sites for SVA services, JHPIEGO will work with the MOH to establish a national Technical Advisory Group to advocate for a comprehensive cervical cancer prevention and control policy that incorporates the SVA and to adapt service delivery guidelines and training materials. As this foundation is being developed, JHPIEGO will help prepare selected sites to provide SVA through training of providers; procurement of equipment/supplies; incorporation of cervical cancer and STI prevention messages; establishment of a data collection system; and implementation of quality assurance measures, such as performance standards and supervisory visits. Services will be made available to HIV-infected women, will be integrated with HIV testing and counseling as well as care and treatment services, and will be linked to a referral system for treatment of women who have lesions not amenable to cryotherapy or who are found to have invasive cervical cancer.
Specific objectives are to:
Establish strategy, policy, and guidelines for cervical cancer prevention services for HIV-infected women. Provide cervical cancer prevention services with appropriate follow-up as part of routine care for HIV-infected women at hospital sites, reaching at least 3,000 HIV-infected women. Increase HIV-infected women's awareness and acceptance of cervical cancer prevention services through behavior change communication (BCC) messages and activities. Develop and implement a referral system for treatment of women who have lesions not amenable to cryotherapy or for those found to have invasive cervical cancer. Develop a monitoring and supervision system for quality assurance of cervical cancer prevention services and activities. Develop a cervical cancer prevention model for other health facilities in subsequent years.
2. Quality improvement in PMTCT services PEPFAR CI's main partner focusing on quality improvement across technical areas is the University Research Co. (URC), which in 2010 will scale up its "collaborative" approach from 41 to 120 ART and PMTCT sites.
In addition, the USG team is funding JHPIEGO to work closely with URC and the National HIV/AIDS Care and Treatment Program (PNPEC) to continue quality-improvement work in PMTCT to 1) continue supporting sites where it is currently working, 2) contribute to rapid scale-up and coverage of quality-improvement efforts, and 3) allow for comparison of the partners' approaches and a variety of lessons to improve programming.
JHPIEGO's SBM-R (Standards-Based Management and Recognition) approach involves setting comprehensive, verifiable standards for care and empowering facility staff to identify gaps and develop interventions to address these gaps. A recognition system rewards facilities when a predetermined level of quality is reached.
In Cote d'Ivoire, JPIEGO has helped in-country experts adapt and adopt performance standards in PMTCT and HIV testing and counseling and is helping implement the SBM-R approach at 25 sites. FY 2010 funding will be used to continue supporting those sites and expand activities to five additional sites supported by PEPFAR clinical partners.
By improving the quality of PMTCT services, this activity contributes to the key issues of safe motherhood and child survival.
3. Task-shifting Using FY 2009 funds, JHPIEGO is working in collaboration with ICAP-Columbia University to support the Ministry of Health in developing policy and practical frameworks for task-shifting to strengthen HIV/AIDS care and treatment. The initial focus is on facilitating the transfer of tasks in ART service delivery from physicians to nurses to help address gaps caused by inadequate and poorly distributed (especially in rural areas and in the conflict-affected North and West of the country) human resources. With FY 2010 funds, JHPIEGO will work with ICAP and the MOH to implement task-shifting activities at 13 HIV/AIDS care and treatment sites outside Abidjan, with the necessary training and supervision.
For HIV/AIDS programs in Cote d'Ivoire to achieve desired clinical outcomes and contribute to reaching national uptake targets, improvement in service quality is critical. PEPFAR CI's main partner focusing on quality improvement is the University Research Co. (URC), which in 2010 will scale up its "collaborative" approach from 41 to 120 ART and PMTCT sites.
In addition, the USG team is funding JHPIEGO to continue quality-improvement work in PMTCT to 1) continue supporting sites where it is currently working, 2) contribute to rapid scale-up and coverage of quality-improvement efforts, and 3) allow for comparison of the partners' approaches and a variety of lessons to improve programming.
JHPIEGO implements a simple, low-tech, and practical approach to improving the quality of HIV/AIDS services. The SBM-R (Standards-Based Management and Recognition) approach involves setting comprehensive, verifiable standards for care; conducting a participatory assessment of baseline at the facility level; empowering facility staff to identify gaps and develop interventions to address these gaps using root-cause analysis; and following up using internal and external assessment to continuously evaluate and improve the quality of care. A complementary recognition system rewards facilities when a predetermined level of quality is reached, forming the basis for a credentialing system for a more sustained emphasis on high-quality services.
In Cote d'Ivoire, JPIEGO has helped in-country experts adapt and adopt performance standards in PMTCT and HIV testing and counseling and has led a series of advocacy meetings regarding this approach with PEPFAR and Government of Cote d'Ivoire partners to achieve buy-in. JHPIEGO is helping implement the SBM-R approach at 25 sites; some sites have reported improvement of up to 20% over a six-month period in attainment of performance standards. FY 2010 funding will be used to continue supporting those sites and expand activities to five additional sites supported by PEPFAR clinical partners.
JHPIEGO will work in coordination and collaboration with URC, under the guidance of the National HIV/AIDS Care and Treatment Program (PNPEC) and the PEPFAR team, to achieve synergies and avoid duplication.