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.
The Cote d'Ivoire Ministry of Health's current sole-source CDC cooperative agreement (Mechanism #9652) ends in 2010. This TBD mechanism is for a sole-source follow-on award to the MOH to continue and build on planning, coordination, and monitoring and evaluation activities supported in previous years. Overall funding is not increasing from FY 2009; the exception is in the HVTB budget code, where a narrative is provided.
None
Despite setbacks due to the political-military crisis, with TB sites initially closed in the North and West, the National TB Program (PNLT) of the Ministry of Health (MOH) continues to decentralize TB diagnostic and treatment services, with support from the Global Fund (rounds 3 and 6), the Global Drug Facility, and PEPFAR. The PNLT plans to increase from 96 to 110 the number of health facilities nationwide with the capacity to diagnose and treat TB cases using the DOTS strategy.
With USG funding, the PNLT has taken the lead in the response to TB/HIV co-infection, along with the National HIV/AIDS Care and Treatment Program (PNPEC) and the Institut Pasteur of Côte d'Ivoire. The PNLT's response to the TB/HIV epidemic is focused on policies and guidelines promoting the development of a TB/HIV collaborative framework, improvement in diagnosis of TB among people living with HIV/AIDS (PLWHA), provision of routine HIV testing and counseling (TC) of TB patients, and integration of HIV care and support in all TB clinics.
The PNLT coordinates long-term technical assistance from the USG/CDC, International Union Against Tuberculosis and Lung Disease (IUATLD), WHO, FIND/UNITAID, PEPFAR implementing partners, and other experts to promote a synergistic approach to strengthening diagnosis and care of TB and of HIV/TB co-infection.
With PEPFAR support, the TB program is implementing routine provider-initiated opt-out HIV testing and counseling (PITC). The program is also training health care workers in monitoring and management of TB/HIV co-infection. In coordination with the National HIV Care and Treatment Program (PNPEC), PEPFAR-funded cotrimoxazole and ART are available in 93 TB diagnostic and treatment centers (September 2009), with links to HIV treatment sites following completion of TB treatment. The USG is supporting free "opt-out" testing programs at all 11 national TB specialist centers and 82 integrated TB diagnostic and treatment centers (17 other TB care and treatment sites still need to implement routine PITC), resulting in HIV testing of 15,150 TB patients and identification of 4,848 TB patients co-infected with HIV in 2008. PEPFAR-supported sites are on track to provide HIV tests and results to at least 19,200 TB patients with FY 2009 funds.
The number of sputum smear microscopy centers will be increased from 116 (September 2009) to 120 centers by September 2010.
Through PEPFAR partners, the PNLT is also expanding TB screening at HIV care clinics, and wraparound linkages have been created with the World Food Program to provide nutritional assistance to TB/HIV co-infected patients. With the support of the USG and implementing partners, the PNLT is working to make the referral system more efficient and the tracking of patients more accurate. During FY 2009, the PNLT continued the integration of a clinical TB symptom screening questionnaire at all HIV clinics. The PNLT and PEPFAR partners are also piloting the integration of TB diagnosis and treatment in 10 HIV care and treatment sites. The strategy is to supply the selected HIV sites with materials to collect sputum samples on suspected TB patients, to transfer those samples to nearby TB centers for diagnosis, and then to offer on-site TB treatment when appropriate. This strategy aims to increase TB diagnosis and treatment among HIV patients by reducing loss to follow-up between TB and ART sites.
The PNLT is working to improve TB diagnosis capabilities by strengthening the capacities of TB reference centers to perform TB culture using liquid media. In FY 2009, the USG supported improved smear microscopy through adaptation and roll-out of the CDC/WHO smear microscopy training package and support for increased use of fluorescent LED microscopy (with maintenance of both existing and new microscopes) as part of an effort to increase TB case finding. The USG also continued to support the PNLT to improve the quality of sputum smear microscopy through external quality assessment by blinded rechecking. Newly renovated labs at the Institut Pasteur and CeDReS are awaiting equipment installation. In addition, six TB diagnosis and treatment centers (the CATs Abobo, Koumassi, Bouaké, San Pedro, and Daloa and the CDT Bouaflé) were renovated with USG support.
To improve TB infection control, the PNLT developed a draft infection control policy and guidelines, to be validated and piloted in 20 sites in 2010. To improve coordination of TB/HIV activities, the PNLT created a national TB/HIV joint committee with TB and HIV program partners, which conducts quarterly meetings to assess progress and improve implementation of TB/HIV activities.
Implementing partners are working with the PNLT and other programs to integrate HIV indicators within the national health system and at specialized TB centers and integrated peripheral sites, and job aids and training tools for counselors and other professionals are being adapted.
With FY 2010 funding, the PNLT will work to:
1. Expand coverage and improve uptake and quality of HIV testing among TB patients and TB diagnosis among HIV-infected patients. With PEPFAR support, the PNLT aims to integrate HIV testing, care and treatment in 17 more TB centers, for a total of 110 supported TB/HIV sites. PEPFAR will directly support the PNLT in training health care workers at TB and HIV care sites in comprehensive TB/HIV co-management and program implementation. PEPFAR will support the PNLT in scaling up the routine opt-out PITC strategy at all TB clinics, with a target of HIV testing for 80% of TB patients (approximately 20,000) by September 2010 and an ultimate goal of 100% (about 25,000). An emphasis will be put on strengthening TB diagnosis among children under 5.
USG partners will continue to work with the PNLT to incorporate a clinical TB symptom screening tool into the national HIV patient encounter form, to be used at registration and at each follow-up visit for intensified TB case finding among HIV-infected patients. The PNLT will continue to pursue improvement of the quality of sputum smear microscopy at central, regional, and district health centers by strengthening the quality-assurance system through external quality assessment and on-site supervision. To improve accuracy and speed of TB smear microscopy, fluorescent LED microscopy will be introduced and supported at 15-20 sites in FY 2010.
The PNLT will also use USG support to continue development and decentralization of rapid TB liquid culture capability using MGIT technology to strengthen intensified TB case finding among HIV-infected persons, diagnosis of smear-negative TB, and culture and drug susceptibility testing for TB cases failing primary treatment. USG support will also facilitate the continued development, with financial and technical support from FIND and UNITAID, of molecular diagnostic capacity (at IPCI-Cocody, CeDreS, and RetroCI, and later at CAT Adjame) for TB diagnosis and drug susceptibility testing of smear-positive specimens. Referral of specimens to the central laboratories will be facilitated by continued development and strengthening of a TB laboratory network and specimen transport system that will support all TB diagnostic and treatment centers.
In support of improved TB diagnostic imaging, the PNLT will coordinate a pilot to introduce digital chest X-ray imaging capacity (with improved image capability, computer-assisted interpretation, improved external quality control via computer and expert remote radiographic interpretation of images transferred across the cell phone network, and elimination of the need for continued procurement of X-ray film) at the largest TB treatment center (CAT Adjame) and will pilot a mobile digital chest X-ray system to serve five to 10 TB/HIV treatment centers on a regular basis.
2. Improve infection control. The PNLT will implement stronger infection control measures (including renovation and training) in 20 pilot sites and equip CATs with X-ray rooms and some TB center labs with air extractors and masks.
3. Improve policy development and strengthen monitoring and evaluation of joint TB/HIV activities. National TB recording and reporting tools revised by the PNTL to include HIV variables will be used by all PEPFAR-supported sites for TB/HIV surveillance. The Electronic TB Register (ETR.net) will be piloted in selected TB centers. The USG will also support the PNLT and the National HIV/AIDS Care and Treatment Program (PNPEC) to implement an updated national TB infection-control policy at all TB and HIV care and treatment sites in an effort to minimize nosocomial infections. With technical assistance from implementing partners, the PNLT will work to incorporate relevant approaches into national policies and guidelines. The USG team will work with the PNLT and PNPEC to develop a national policy related to isoniazide preventive therapy (IPT) and will support its implementation.
4. Strengthen coordination and sustainability of joint TB/HIV activities. The PNLT will work to reinforce activities of the new national TB/HIV joint committee and to create decentralized joint TB/HIV collaborative committees at the district level with joint TB/HIV supervision plans.
