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.
Private Sector Program (Prevention AB)
This is a continuing activity in the following emphasis areas: AB, OP, CT and TB/HIV. This is a comprehensive ABC activity. In COP07, Abt Associates will expand services to most at risk populations. As of August 2006, the partner received 100% of COP06 funds and is on track according to workplan objectives.
COP06 Summary: The Private Sector Program (PSP), through large workplaces and private clinics, improves access to HIV prevention, care and treatment services for employees and family members.
PSP focuses on demand-driven programming to the business sector; a major focus is to ensure management/employee ownership of activities and establish cost-sharing arrangements. During COP06, PSP supported local companies to conduct interpersonal peer education programs with training, supportive supervision and senior management consultation. PSP integrated materials on ABC, cross generational sex and transactional sex, gender norms and the current HIV burden on women. PSP, utilizing the cross generational sex study results, developed posters and short mini-media focusing on male behaviors for use in interpersonal and interactive communication specifically on stigma/discrimination and also on cross generational sex. In addition, PSP adapted curricula for use by medium and long distance drivers. Peer educators, who are volunteers, received five days training on ABC and HIV care (i.e. VCT, TB, Positive Living) curricula. During that training, the participants were equipped with communication and counseling skills to support the effective implementation of programs and communication with family and community members. Participants were recognized through "Family Days" to celebrate the company's successes in addressing employee health and safety. Routine follow up and supervision were provided to each site.
PSP engaged several persons living with HIV/AIDS associations to participate in or lead trainings on HIV prevention. Because of the poor performance of these associations, PSP provided communication skills and technical training on HIV prevention ABC to improve consistency and quality of messages from these groups. Furthermore, PSP leveraged resources with the International Labour Organization to broaden implementation of HIV prevention programs in workplaces throughout the country. PSP engaged the Ethiopian Civil Service Agency (encompassing approximately 400,000 public employees) and the Ministry of Labour and Social Affairs to support reform and mainstreaming efforts to include HIV prevention and Solidarity Funds.
COP07 Proposed Activity: In COP07, Abt Associates and consortium partners Population Services International, IntraHealth International and Banyan Global will strategically expand to, at a minimum, 20 additional mid-large workplaces based on a recommendation from the USG prevention TA visit in July 2006. This will result in engagement with additional males in management, employees and family members residing or transiting in communities at risk (i.e. located in urban areas or contiguous to major transportation corridors) or higher risk industrial settings (i.e. trucking and transportation, hotels and tourism, remote construction projects and road building). Activities will be expanded from the current program footprint of 55 large workplaces. Expansion will be reviewed within the context of the ART health network and existing/new HIV prevention partners including the High Risk Corridor Initiative, the Targeted Condom Promotion activity, Health Communications Partnership and AIDS Resource Centers. PSP's focus will be to support intensive workplace peer-based interpersonal communication and education programs to reinforce positive behavioral norms focusing on mutual fidelity in marriage and on heightened self-risk perception in the context of cross generational sex for men with money/stature or mobility. Peer educators will continue to receive follow up trainings and supportive supervision to ensure consistency of messaging, improved communication skills and for motivation.
PSP activities will include a rapid assessment of HIV services, knowledge and behavior followed by a management orientation session with senior management, peer-based rollout of behavioral change sessions using 8 - 16 module-based trainings in the workplace over several months, family-oriented activities in recognition of employer/employee commitment to workplace activities and mass education AB messages for those in the community of operation. Additional elements of the program include
HIV/AIDS policy design, health committee capacity building, management orientation and SI activities serving to monitor programs to allow for the strategic use of resources (i.e. trained peers, IEC materials and referral linkages with civil society and the public health system).
Options will be developed for employees, their dependants and the community to improve their knowledge on basic HIV facts, personal risk assessment, HIV prevention strategy, Gender and HIV, Counseling and Testing (CT), HIV and Tuberculosis, positive living and care and support and developing communication skills based on the level of risk and exposure of the target group. PSP will also provide training to PLWHA members to involve them in the education process in a more productive and structured manner.
PSP's growing focus on males who work away from their families will lead to a revision of pre-existing peer education and BCC materials to support several options for transport workers and those with mobility that are unified with workplace activities.
PSP will collaborate with HIV prevention partners to utilize or adapt pre-existing audio and print materials to actively address male social norms and low self risk perception.
Current workplaces: Addis Ababa Abattoirs Enterprise; Agency for Rental Housing Enterprise; Akaki Textile Share Company; Bekelcha Transport Share Company; Commercial Bank of Ethiopia; COMET Transport Share Company; East Africa Group PLC; Ethio-Agri-Ceft PLC; Wush Wush Tea Farm Development; Ethiopian Crown Can and Cork Manufacturing Industry; Ethiopian Electric Power Corporation; Ethiopian Telecommunications Corporation; Ethiopian Airlines Share Company; Ethio Leather Industry PLC; Ethio Tannery Share Company; Ethiopian Insurance Company; Fincha Sugar Factory; Kombolcha Textile Share Company; Matador Addis Tyre Share Company; Matahara Sugar Factory; Meta Abo Brewery Share Company; MOHA Soft Drinks Industry PLC; Mugher Cement Factory; National Mining Corporation; National Tobacco Share Company; PHARMID; Wonchi Sugar Factory; Addis Ababa Hilton Hotel; Adey Abeba Yarn Factory; Agricultural Equipment and Technical Service Share Company; Ambo Mineral Water Factory; Arba Minch Textile Share Company; Artistic Printing; Awassa Tabor Ceramics Share Company; Awassa Textile Share Company; Ayeha Development Farm; Ayehu Zigini Farm Development; Birhan en Selam Printing; Birr Farm Development; Bahir Dar Edible Oil; Bure Kul Mineral Water; Dashen Brewery PLC; Das Cotton PLC; Debre Birhan Blanket Factory; Dire Dawa Textiles Share Company; Dire Dawa Cement (National Cement) Factory; Dire Dawa Food Complex; Dire Dawa Railway; ECAFCO; Edget Yarn and Sewing Enterprise; Emergency Relief Transport Enterprise; Ethiopian Grain Trade Enterprise; Ethiopian Postal Service; Ethiopian Road Authority; Fafa Food Share Company; Babile Mineral Water; Guder Food Complex; Harar Brewery; Meher Fiber Products Factory; MOHA Gondar; Addis Ababa Cement Factory; National Bank of Ethiopia; Sheraton Addis Ababa; Tana Transport; Upper Awash Agro Industry Enterprise; and Wabi Shebelle Hotel Enterprise.
Private Sector Program (Other Prevention and Condoms)
This is a continuing comprehensive ABC activity in the following areas: AB, OP, CT and TB/HIV. In COP07, Abt Associates will expand services to most at risk populations. As of August 2006 the partner received 100% of COP06 funds and is on track according to workplan objectives.
The Private Sector Program (PSP) improves access to HIV prevention, care and treatment services for employees and family members at large workplaces and private clinics. PSP focuses on demand-driven programming to the business sector; a major focus is to ensure management and employee ownership of activities and establish cost-sharing arrangements. During COP06, PSP supported local companies to conduct interpersonal peer education programs with training, supportive supervision and senior management consultation. PSP integrated materials on ABC, cross generational and transactional sex, gender norms and the current HIV burden on women. PSP, utilizing CGS study results, developed posters and short mini-media focusing on male behaviors specifically on stigma/discrimination and also on cross generational sex. PSP adapted curricula for use by medium and long distance drivers. Volunteer peer educators are received five days training on ABC and HIV care (VCT, TB, Positive Living). During the training the participants were taught communication and counseling skills to support effective program implementation and communication with family and community members. Participants were recognized through "Family Days" to celebrate the companies' successes in addressing employee health and safety. Routine follow-up and supervision were provided to each site.
PSP leveraged resources with the International Labour Organization to broaden implementation of HIV prevention programs in workplaces nationwide. PSP engaged the Ethiopian Civil Service Agency (encompassing approximately 400,000 public employees) and the Ministry of Labour and Social Affairs to support reform and mainstreaming efforts to include HIV prevention and Solidarity Funds.
COP07 Proposed Activities
The Private Sector Program (PSP), through large workplaces, is improving access to HIV prevention, care and treatment services for employees and family members. In FY07, Abt Associates and consortium partners PSI, IntraHealth and Banyan will expand technical assistance to 20 additional mid-large workplaces in communities at risk (i.e. located in urban areas or contiguous to major transportation corridors or in industrial sectors which play a large role in HIV transmission (i.e. trucking, hotel and resort tourism, remote construction projects and road building). These activities are in conjunction with existing programs in 65 workplaces in seven regions. Expansion will be reviewed within the context of the health network and existing HIV prevention partners including the High Risk Corridor Initiative, Targeted Condom Promotion activity, Health Communications Partnership and AIDS Resource Centers.
This activity concentrates on demand-driven programming to the business sector; a major emphasis is to ensure management/employee ownership of activities and establish cost-sharing arrangements. By September 2008, PSP will have activities in 20 additional workplaces and will provide technical assistance to workplaces and private clinics to have BC-based prevention among workers and most at risk communities surrounding the workplaces.
A major focus of the program will occur in biweekly or monthly peer interpersonal and educational sessions which will teach and encourage positive behaviors including correct consistent condom use, seeking STI treatment; accessing counseling and testing services> They will also address pertinent issues of stigma and self risk perception of males engaging in cross-generational, coercive or transactional sex. IEC/BCC materials and recognition events reinforce the positive behaviors achieved. In clinical setting, whether workplace or private, PSP will provide TA to support prevention for positives counseling utilizing pre-existing materials.
The growing concern about males who work away from their families will lead to a revision of pre-existing peer education and BCC materials to support several options for transport workers and mobile workers that are unified with workplace activities. This will
include emphasis on transactional sex, fidelity and condom use. Prevention emphasis will also target urban males of high educational and socioeconomic status in response to EDHS data indicating their high number of sexual partners. Together with cross-generational sexual networks with an existing sub population of girls age 15-24, this is a critical group. Self-reported condom use among urban males is 48% (EDHS 2005).
This activity will collaborate with HIV prevention partners to utilize or adapt pre-existing audio and print materials to address issues surrounding male social norms, low self risk perception and correct consistent condom use, specifically working with transportation corridor programs and targeted condom promotion programs to interrupt sexual networks.
Other prevention specific activities will include both clinical and non-clinical aspects to support access to most at risk populations with condom and STI programming. The contractor will promote 100% condom use in cross generational and transactional sex relationships.
Access to Home Water Treatment (HWT) and Basic Hygiene Counseling
This is a continuing activity from FY06 that received supplemental funding. The supplemental funding was recently obligated to the partner, which will soon initiate implementation. Funding has been augmented to increase safe water access for ART, pre-ART and PMTCT clients.
This activity is will be implemented in close coordination with the Care and Support Contract Palliative Care (5616); Care and Support Contract TB/HIV (5749), PMTCT/Health Centers and Communities (5586) and ART Service Expansion at Health Center Level, WFP- Food and Nutrition support and Promotion Positive Living and Self-Reliance (5774); HRCI (5600), JHU (5618), ITECH (5767), UCSD (5770), CU (5772) palliative care activities.
People living in resource-poor settings often have limited access to safe water and basic methods of hygiene and sanitation. The situation in Ethiopia is no different as only 35.9% of the population has access to a safe and adequate water supply, and only 29% has access to excretal disposal facilities. The government is currently addressing this issue through the health extension program where HEW and health promoters educate, mobilize, and support communities in constructing safe excreta disposals and teaching about safe water storage (an activity supported by USAID with non-PEPFAR funds).
PEPFAR Ethiopia will build on the government's safe water initiative to improve safe water access among PLWHA. This is important as there is ample evidence that simple safe water interventions radically improve the quality of life for PLWHA. For instance, a study of HIV+ persons and their families in Uganda showed that use of a simple, home-based safe water system reduced incidence of diarrhea episodes by 25%, and the cost was less than $5 per family per year.
This activity strongly supports a safe water program as an element of the preventive care package for PLWHA in adherence to OGAC guidance. This activity will work closely with PEPFAR Ethiopia partners operating at hospitals and health centers to build on their safe water efforts and strengthen their links with community-based initiatives and safe water outlets.
Thirty hospitals and ninety health centers providing ART, PMTCT and HIV/AIDS care services and their surrounding community networks will be targeted, with particular attention to high prevalence areas with poor water and sanitation services. It will include: distribution of a locally-produced point-of-use water treatment, WuhaAgar, which is a diluted sodium hypochlorite approved by Ethiopian authorities, at VCT, ART, PMTCT and postnatal clinics; inclusion of a voucher entitling HIV/AIDS-affected clients to receive free bottled water disinfectant at a nearby commercial outlet to avoid travel to the health facility just for the sake of getting WuhaAgar; training of health providers at hospitals and health centers on hygiene and safe water counseling; consistent supply of WuhaAgar to the facility-based service outlets; sensitization of commercial providers to the voucher approach; monitoring of the voucher program at commercial outlets primarily through stock monitoring; support of existing community-based education on hygiene and safe water by the health extension workers and community health promoters; assessment and revision of existing teaching materials; and the design of new IE/BCC resources for patient education at facilities and by community health extension workers and health promoters on personal hygiene, safe water storage, and home water treatment, including how to use WuhaAgar.
Abt Associates will coordinate with the MOH/HAPCO, Health Education Center, ARC, the USAID-supported ESHE project, and other relevant PEPFAR Ethiopia partners on designing the IEC materials.
Abt Associates will spearhead the social marketing of WuhaAgar through commercial market outlets in urban and peri-urban areas. It will work in partnership with other PEPFAR partners, including the US universities, CSC, IntraHealth, FHI, SCUSA, IOCC, WFP and SCMS, to distribute WuhaAgar to community and facility outlets providing HIV/AIDS care, treatment and PMTCT services.
Abt Associates will also ensure equity of availability for the product. Those not yet
benefiting from PEPFAR Ethiopia programs or not yet aware of their status will have access to the products at affordable prices in local markets.
Please note that PEPFAR Ethiopia will not fund Abt Associates social marketing activities except to cover the cost of WuhaAgar utilized by PLWHA at health facilities or at commercial outlets through the voucher system.
This market-assisted approach will support sustainability, increase availability of the product through commercial outlets and reduce possible stigmatization of purchasers. Moreover, Abt Associates will partner with other USG partners, including the Millennium Water Alliance, to work on safe water and health promotion to maximize impact of this particular intervention. The Point of Use Safe Water product, WuhaAgar, is approved by Ethiopian authorities.
PLUS UP: The project will produce and distribute packages of essential preventive care elements to pre-ART and ART clients through facility and community-based care programs. Distribution will be supplemented by the training and deployment of approximately 800 women living with HIV to counsel on using the prevention products and to sell items such as affordable home water treatment in the community to their peers living with HIV as well as the general community. This will create income generating activities for women living with HIV. Implementation will be as per national guidelines, will attempt to leverage existing MoH malaria and TB programs and will test various implementation models of delivery for cost and efficiency metrics. The Preventive Care Package includes a range of services and items to reduce morbidity such as TB, diarrhoea and malaria referral; home water treatment and locally available safe water storage vessels; oral rehydration salts; basic hygiene products including soap, bleach and antiseptic; multivitamins; antihelminthics; long-lasting insecticide treated nets (as required); and condoms for use by sexually active beneficiaries. The package will include behavioral change and IEC elements meeting low-literacy levels regarding products described above in simple, pictorial form, as well as information and referral advice on co-trimoxazole prophylaxis, family planning methods to prevent unwanted pregnancy among women living with HIV, leaflets about STI treatment, referral for counseling and testing among family members over 18 months to know their HIV status, and referral of HIV+ clients for TB screening. Packages will be delivered through selected health networks, including community based care, hospitals and health clinics across Ethiopia. Staff at community organizations or clinic sites will receive training to provide counseling on the use of the package products. Community services and clinics will be provided with BCC materials to facilitate displays that promote water purification, nutrition, adherence and hygiene. The package's effectiveness will be evaluated through three complementary methods: CDC/Ethiopia will work closely with CDC-Atlanta and a local public health institution to conduct a comprehensive evaluation of the BCP. PSI will conduct regular mapping surveys to track availability of retail elements of the package, and map these to measure proximity to ART clinics, and to networks of community agents that have been trained. Finally, PSI will conduct annual tracking surveys at the general population level to monitor the community's opportunities, ability and motivation to use water purification products and insecticide treated nets.
Private Sector Program
This activity is linked to Mobile and Private Sector Counseling and Testing Services (5718); Care and Support Contract TB/HIV (5749) Care and Support Contract Palliative Care (5616), Care and Support Contract counseling and testing (5654)community-level counseling and testing service support in Ethiopia; the High Risk Corridor Initiative (5719), and ART Service Expansion at Health Center Level.
This is a continuing activity from FY05 and FY06. To date, the partner received 100% of FY06 funds and is on track according to the original targets and workplan.
Building on COP06 activities, Abt Associates Private Sector Program (PSP)-Ethiopia will continue interventions in very large (1000+ employees) and large companies (500+ employees) in seven regions of Ethiopia to improve access to quality TB and TB/HIV activities for employees, dependants and surrounding communities. It will also initiate TB and TB/HIV services in selected private health facilities.
By September 2008, activities will be established in up to 75 workplaces and 35 private clinics to ensure the presence of or improved access to quality HIV and TB/HIV services including TB/HIV prevention, TB detection, active referral for TB diagnosis and DOTS therapy. This activity will also establish referral linkages with private and public health facilities including MOH and PEPFAR Ethiopia health network.
In COP07, this activity will educate the workforce, families and surrounding community about basic TB facts and prevention and its correlation with HIV. Access to TB/HIV services will be extended to more workplaces and private clinics.
This activity will continue to strengthen the capacity of workplace and private clinics by providing essential commodities and in-service training for clinical and non-clinical staff, including building strong referral linkages to CT and other services. Efforts to establish readiness will enable facilities to provide quality services for employees, dependants and the surrounding community. Activities to expand PPM- DOTS referral will be continued. Efforts will be made to support the MOH in establishment of sustainable financing mechanisms in collaboration with the Medical Association of Physicians in Private Practice. To achieve maximum TB and HIV detection, outreach activities will continue to extend to employees, dependants and members of the adjacent community. The activity will also provide technical support to selected workplaces to determine cost/benefit of TB/HIV services in collaboration with the Association of the Ethiopian Insurers (i.e. solidarity funds or insurance). PEPFAR Ethiopia will use the recommendations from the OGAC private sector TA to further strengthen public private sector partnership in the design and delivery of TB/HIV services.
Based on the above, of an estimated 3,125 TB patients expected to be diagnosed at the 75 work places and 50 private clinics in FY07, 80% will receive HIV counseling and testing over one year period. Additionally, of the estimated 1,500 HIV+ clients expected to receive palliative care services at the 75 workplaces and 50 private clinics, 50% will receive routine TB screening at least once. Screening will be based on sign/symptom review and AFB smear microscopy for patients with a history of productive cough of more than two weeks.
This activity will develop approaches to meet the needs of workplaces and private clinics concerning HIV and TB support services, including prophylaxis therapy, PMTCT, ART, VCT and TB/DOTS. TB Champions (.employees who volunteer to be DOT supporters to and/or CPT or IPT intake) of colleagues, community or family members will be promoted in each workplace. This will be achieved through a cost share arrangement with the business sector.
This activity will leverage peer education activities in HIV prevention to improve workplace, family and community outreach knowledge of TB and HIV. Additionally, private companies are now covering the cost of elements of the preventive care package in workplaces to employees and families living with HIV.
Mobile and Private Sector Counseling and Testing Services
This activity is linked to community-level counseling and testing service support in Ethiopia; the High Risk Corridor Initiative (5719), Care and Support Contract Palliative Care (5616), Care and Support Contract counseling and testing (5654), and ART Service Expansion at Health Center Level.
This is a continuing activity from FY06. As of June 2006, the partner received all FY06 funds except supplemental funding which was recently obligated. The partner is on track according to the original targets and workplan. Funding has been increased based on the achievements from FY05 and to date in FY06
This activity description is a combination of FY06 and FY06 supplemental activities "PC4-private sector program (5718)" and the activity "Mobile private sector counseling and testing services (6452).This activity is linked with four other COP activities (5647, 5667, 5718 and 5727) referred to as the National and Regional Support to Scale up Counseling and Testing services. It also has linkages to Strengthening National Model VCT sites in Addis Ababa city and rural Hot Spots.
PEPFAR Ethiopia will operate a high quality, youth-friendly mobile HIV Counseling and Testing (HCT) service in high prevalence urban and peri-urban areas. This will leverage the activities of the High Risk Corridor and Private Sector program to reach MARPS. Accessibility and quality of VCT remain problematic along the high risk corridors, as large numbers of MARPS and general population have limited access to VCT services in public facilities. There are many private facilities providing CT services with non-standardized practices, low quality counseling and lab services and inadequate follow up service. Abt Associates will expand mobile CT services in addition to support for workplace and private CT activities. At a minimum, 35 private clinics will be strengthened to have high-volume CT services. Additionally, innovative models that refer at risk clients appearing at pharmacies will be referred to CT. This mechanism will coordinate with activities ?10395 and ?10547 to expand mobile outreach VCT services along the four major high prevalence transportation corridors.
During COP07, the following activities will be undertaken:
Management of eight low-cost mobile HIV counseling and testing units along the high risk corridor, high prevalence and high demand areas. These units will: (1) Target girls 15-24 and men 29 years of age or older for CT service uptake in urban areas; (2) Design highly visible promotion teams utilizing multi-day HIV counseling and testing events in high prevalence areas along major transportation corridors and within the health network model; (3) Contract with indigenous commercial partners to operate VCT and TB counseling and testing services in the private sector; (4) Provide TA to indigenous organizations to standardize mobile unit services toward compliance with national guidelines, referral for care and treatment and extended hours for improved accessibility, utilization of simple techniques for sample collection (finger prick) and deployment of lay counselors; (5) Proficiency testing of technical skills counselors, laboratory technicians and management skills of facility administrators; (6) Standardization of data reporting to appropriate regulatory authorities; (7) Technical assistance to private facilities for improvements of quality, productivity and infrastructure to facilitate higher productivity of counselors and laboratory technicians; (8) Promotion of extended hours for VCT to facilitate improvements in access; and (9) Standardization of referral linkages to community and facility-based HIV/AIDS prevention, care and treatment services.
This activity will support community mobilization and service provision of CT services along transportation corridors, in markets, workplaces, public gathering and high demand areas within the health network model. Mass promotion will be coupled with service provision to improve uptake. This activity will implement a model of mobile, yet repetitive CT services driven by mass promotion, make CT services more attractive to MARPS and increase the efficiency and productivity of testing and support improved access. Utilization of the local
private sector to provide services will offload already burdened public health providers and build competency in local organizations to compete with international non-governmental organizations to provide high quality services.
The mobile services will contribute to the national strategy to rapidly scale up HCT services and reach underserved and marginalized populations. Current services are predominantly based in static centers situated in urban and peri-urban areas within government health centers and hospitals. The January 2006, draft Ministry of Health National HCT guidelines clearly indicated the need for outreach and mobile HCT service delivery model. The Private Sector Program (PSP) will continue implementation in very large (1000+ employees) and large companies (500+ employees) in seven regions of Ethiopia to ensure improved access to counseling and testing services.
By September 2008, this activity will be present in up to 75 workplaces and private health facilities throughout Ethiopia and will ensure the presence or improved access to quality HIV services, including counseling and testing. Two major foci of the private sector program will be to 1) ensure intensive workplace peer-based support for behavioral norms that support a greater uptake of TB and HIV services and 2) promote a "Know Your Status" interpersonal communication program that reinforces and models positive behavioral norms. The peer education program will increase the number of employees and dependants who come forward for VCT and for the subsequent clinical care and treatment service and support. Through both clinical and non-clinical interventions, CT that includes PICT will be supported by using blended approach such as the use of vouchers, mobile CT and onsite clinics through training of counselors, building quality assurance mechanisms, and establishing functional referral linkages for TB/HIV services with MOH and the PEPFAR health network.
This activity will educate the workforce and families about basic facts and the importance of CT in all 75 workplaces and reach families and the surrounding community with similar messages during mass educational events. This will be accomplished through the peer education component which will utilize eight modules on TB and HIV/AIDS delivered through small group discussions (45 min) on company time.
This activity will also work with employers on establishing HIV policies to protect HIV+ employees from stigma and discrimination.
In addition this activity will introduce CT franchising in workplaces and selected private health facilities for the provision of sustainable, high quality private sector services. It will work closely with MAPPP and other appropriate professional associations for the initiation and sustainability of these services.
Prioritizing Pregnant Women for Antiretroviral Therapy This is a continuing activity. To date, the partner has received 100% of FY06 funds and is on track according to the original targets and workplan. This activity is related to ART treatment service activities by US Universities and the Care and Support Contract (previously referred to as BERHAN). The contractor will also collaborate with IntraHealth, JHPIEGO and FBO to support increased community awareness of HIV clinical and non-clinical services with the ART health network. At present, 54% of ART clients are located in 11 ART hospitals. The majority of ART hospital and health center-based HIV services that provide CT, PMTCT and TB are underutilized, resulting in excess client capacity. This supplemental activity addresses the needs of a large number of HIV+ women living in peri-urban communities with few formal organizational entry points for interventions. Despite greater access to HIV/AIDS services in urban and peri-urban areas, efforts to prevent pediatric HIV infection have been hampered by low uptake of PMTCT, low perceived quality of ANC services by clients, low ANC attendance and lack of awareness of PMTCT and ART services.
Based on recommendations from the USG private sector TA visit in August 2006, PEPFAR Ethiopia is 1) expanding its approach to target strategically activities and audiences that may identify HIV+ persons and link them to care and 2) utilizing a broad range of private sector partners, including pharmacies and lower level clinics to identify pregnant women and direct them to treatment. According to the EDHS 2005, approximately 11 percent of deliveries in Addis Ababa occur in the private sector. Furthermore, 17 percent of all women (urban and rural) receive family planning services from the private sector. We anticipate this number to be heavily skewed to urban and peri-urban areas. Regional capitals and large towns such as Awassa, Bahir Dar, Dessie, Dire Dawa, Mekele and Nazareth are key centers to expand the ART health network to capture those living with HIV/AIDS that will not initially attend services at public facilities. In addition, several NGO facilities are present in these towns address MCH. These NGO facilities represent congregations of populations that are underserved by HIV services such as PMTCT and ART thereby providing access to target groups for services.
As of June 2006, several regional health bureaus, with active support from the MOH, are decentralizing ART to health centers. Based on this finding, we anticipate an expansion of ART services, in addition to other HIV services, to low client flow locations where excess capacity will continue to impact progress to targets. In addition, poor linkages between the ART and PMTCT programs have prevented eligible pregnant women from accessing ART. Furthermore, the activity engages urban-based private MCH services and pharmacies which are more widely used by women due to perceptions of convenience, quality and technology.
In response to the current experience, this activity will address community awareness through branding and franchising services to improve uptake of services, improve productivity in high client flow services and support additional improvements in progress to targets of pregnant women being enrolled in HAART.
The main thrust of the initiative is strengthening post-partum care, including initiation of ART for mothers and their new-borns. COP06 contains existing activities at the hospital level addressing IMCI and pediatric treatment. This activity will support linkages between health centers and hospitals supported in the COP06 supplemental activities. As the screening of infants with HIV/AIDS and pediatric ART are complex interventions, the involvement of USG universities is pivotal. Health centers will send mothers with complicated medical conditions and infants who need diagnostic work and possible initiation of ART to designated hospitals within the ART Health Network.
The following are proposed activities. 1) The activity will improve awareness of HIV services among pregnant women and address client perceptions of quality of services in order to increase uptake. The contractor will work with both public and private sector providers to: strengthen community awareness and involvement of HIV/AIDS care for pregnant women; increase counseling and testing of pregnant women with a target of 12,000 pregnant women getting CT services; improve the quality of care and support for HIV+ women; strengthen referral linkages for HIV+ pregnant women; strengthen the public-private partnerships to bring HIV+ pregnant women into the ART network; and integrate PMTCT and ART for
pregnant women into regular ANC services in selected high client flow public and private (NGO and for-profit) facilities with a target of referring 5,000 eligible pregnant women for ART. 2) The activity will ensure that facilities in the network target pregnant women for service. The contractor will prioritize assistance to facilities that reach this audience, such as providers of antenatal care and family planning. Utilization of the pre-existing Biruh Tesfa franchise network (i.e. 150 private providers) will broadly expand access to pregnant women through private clinics and pharmacies in urban areas. Members of the network will receive trainings focused on targeting pregnant women and ensuring quality of care. In addition, network members will conduct outreach, in partnership and cost-share with the USG, to target pregnant women. 3) The activity will support outreach communications to raise community awareness of the value of HIV/AIDS counseling and testing, care during and after pregnancy, and assisted delivery. Several pre-existing materials were developed with past PEPFAR Ethiopia investments. In addition, low level mobilization, (i.e. road shows during market days) will be conducted in areas where mass media has low penetration. Fractional franchising and branding of HIV services at network sites, including the use of nationally-accepted logos, will be leveraged with Abt Associates Mobile CT and TB activities to improve client awareness. 4) The activity will prioritize identification and enrollment of pregnant women on HAART at selected facilities. OPD and private clinics will receive assistance in identification and referral. Utilizing experienced clinical mentors from the private sector, the contractor will deploy these individuals to high client flow public health centers resulting in a greater capacity to identify and refer clients. In addition, utilizing ART and PMTCT guidelines, L&D based PMTCT will be enhanced. 5) This activity will improve data management, quality assurance and stewardship of regional health bureaus.
Once the mothers who are put on ART at hospital level become clinically stable, they will be referred back to health centers and referred to Mothers to Mother groups. Uptake of maternal health services, specifically ANC, remains a major impediment to PMTCT services uptake. Too few women are visiting hospitals and health centers for antenatal care services to be counseled and tested for HIV and to receive ARV prophylaxis or be enrolled in the ART program.
Community linkages with PLWHA groups and previously-implemented PMTCT community core teams will be extended and strengthened. This is a critical point of integration for the MTCT program and will lead to direct increases in the number of pregnant women receiving Care and Support and ART. This activity will accelerate the roll-out of PMTCT/ART in public and private facilities, support TBA, identify and mobilize families, and generate community demand for PMTCT and ART services.
Targets: (Note: As this partner will not implement ART services on its own, targets on number of individuals newly initiating and receiving ART by the end of the reporting period are not applicable)
Sustainable Financing for Institutions and the National ART Program
Building on COP06 activities, Abt Private Sector Program (PSP) will continue in seven regions to ensure improved access to high quality private sector HIV/TB services through fostering public-private sector partnerships.
PSP will assess and provide technical assistance for establishing and/or increasing management and sustainability of the AIDS fund (solidarity fund) in large workplaces, the civil service and national health accounts. Additionally, technical assistance will be provided to MOH/HAPCO and RHB in considering financing mechanisms for the National ART program using cost recovery, solidarity funds, private insurance and re-insurance. Currently work on cost-benefit analysis of HIV treatment has played an important role in mobilization of the private sector.
PSP will also work on risk pooling and sharing of costs with the Association of Ethiopian Insurers and individual insurance companies to ensure possibility of providing cover to the solidarity fund and HAART treatment based on a company specific study and/or the general health insurance market. Creating an enabling management environment for developing a matching fund and /or a cost sharing/financing scheme on ART treatment and care and support to increase number of users supported by the solidarity fund is another component of the intervention.
Furthermore, work with private providers through a "network" of pharmacies, higher clinics and educational institutes will strengthen administrative capacity of HIV/AIDS and TB service delivery and training...
PSP believes that the meaningful involvement of associations for persons living with HIV in program implementation will enhance program success to reduce stigma and discrimination, PSP will therefore build the capacities of these groups to deliver targeted messages, supporting the project level effort and to encourage a sense of professionalism in their approach or communication. To this effect members will receive training on delivery of messages and communication skill.