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.
New/Continuing Activity: New Activity
Continuing Activity:
Table 3.3.03:
Program Budget Code: 14 - HVCT Prevention: Counseling and Testing
Total Planned Funding for Program Budget Code: $500,000
Total Planned Funding for Program Budget Code: $0
Program Area Narrative:
OVERVIEW
In Ghana, testing services are available in at least 400 public PMTCT sites, 210 of which also provide stand-alone C&T. Several
dozen private sites are known to provide C&T but no information on client load is available. The military has VCT sites in all seven
garrisons. Most testing centers use rapid tests for initial and confirmatory testing and provide the test results within an hour.
During FY 08 almost 400,000 accessed public C&T services. The main barrier to accessing C&T services is the high level of
stigma and discrimination against those found to be HIV positive. Presently, there are few links between C&T and TB services.
Utilization of C&T services by persons engaged in high-risk behaviors, such as FSW, MSM and partners of PLHA, is still low
mainly due to stigma issues.
The military voluntarily test approximately 1,000 persons in a year, and an additional 5,000 military personnel are tested on a
mandatory basis annually through new recruit and pre-deployment testing. Typically, the C&T counselors are military personnel or
other health educators who have other responsibilities and can only provide counseling services on a part-time basis.
KEY INTERVENTIONS
USG Ghana, through USAID partner Quality Health Partners (QHP), focuses on testing, palliative care and ART, and supports the
provision of quality C&T at 25 Global Fund-supported sites. The USG Ghana also supports the integration of C&T services STI
sites and drop-in centers that target persons engaged in high-risk behaviors. Intensive efforts are underway to scale up couples
counseling through referrals and education at PLHA support groups. DOD uses PEPFAR funds to enhance the Ghanaian
military's C&T infrastructure. USG Ghana also supports efforts to ensure C&T commodities are available and accounted for
nationwide.
CURRENT USG SUPPORT
The USG is supporting 47 counseling and testing centers, 35 of which are "MARP-friendly" with trained staff in health issues
pertaining to sex workers and/or MSM. These include ten private sites. During FY 08, 1,530 female sex workers, 972 MSM and 83
partners of sex workers received counseling and testing services.
In the beginning of the year, the USAID Strengthening HIV/AIDS Partnerships (SHARP) Project supported STI treatment in 22
clinics targeting at-risk populations. However, due to transparency and governance issues, the sub-agreement ended midway this
year. Rapid test C&T services are available in 5 drop-in centers providing services to FSW and MSM. However, the grant to one
center ended due to non-performance. Referral systems are operational between MSM and CSW communities and MSM/CSW-
friendly counseling and testing sites promote acceptance and receipt of testing. There are reports that more clinics develop
accepting attitudes towards female sex workers, and some also to MSM, when staff from trained sites is transferred there.
PLHA discordant model couples are active in couple-to-couple counseling and family counseling to encourage disclosure and
testing of partners as part of the Positive Living Tool Kit that is used in 175 PLHA support groups. As an integrated activity jointly
carried out by USAID implementers SHARP and QHP, referrals for C&T are closely linked to the "Prevention with Positives"
intervention at ART facilities and STI clinics and also through the PLHA support groups (according to the DHS 2003, two out of
three couples with HIV-infection are discordant in Ghana).
QHP support is focused on applying quality assurance methods to improve the quality of counseling and to ensure appropriate
referral to other essential services. The COPE quality improvement process is being used to review the practice of counseling and
testing at the ART sites to identify changes needed, and to develop action plans to address the necessary changes. Follow-up
review meetings on the action plans are scheduled at 3 to 6 months intervals for re-evaluation and problem-solving.
The DOD program tested 6,350 individuals for HIV including 4,500 troops preparing for peace keeping operations. The USAID
pilot of two urban private sector C&T sites to learn programmatic lessons and evaluate the model for potential scale-up was not
successful. Cost as compared to the public sector and lack of a sufficient volume of demand were the main obstacles. USAID's
logistics partner, JSI/DELIVER, supports the nationwide logistics management information system for HIV/AIDS test kits. Data
collected is used for forecasting the quantification, procurement planning and pipeline monitoring of the commodities. The system
is operational in all sites using test kits and all relevant staff is trained on commodities security and logistics.
USG FY09 USG SUPPORT
QHP will take on 5 additional sites in each of the next two years with its quality assurance for a total of 40 USG-supported Global
Fund sites. QHP will provide the same package of services described above. In addition, because of the success in previous
years the focus on strengthening contacts between sites and high-risk groups will be intensified. Facility-based providers will pay
visit to client groups, e.g. PLHA group meetings, assisting them with topics on testing, disclosure, stigma and accessing services.
In addition, QHP will support bi-annual facility-community dialogue meetings with PLHA and high-risk groups in order to facilitate
linkages and uptake of services. Support for orienting/training providers at DOTS centers on national policy and guidelines for
testing TB clients for HIV will also contribute to the uptake of C&T services.
Through QHP and the National AIDS Control Program, FSW/MSM-friendly STI sites and drop-in centers will be closely monitored
for performance in C&T. The "Call Me-Chat Me-Text Me" that was prepared and tested in 2008 will be rapidly expanded in FY09
to promote the use of C&T services among high-risk groups. The SHARP program will be ending in FY09 but follow-on activities
will continue the MARP prevention, care and support program. PLHA couples trained in couple-to-couple counseling and family
counseling to encourage disclosure and testing of partners will be supported to counsel, help partners to disclose HIV positive
status, refer 500 partners of PLHIV for counseling and testing, and promote prevention interventions for PLHA.
Within the military, DOD will support 2 full-time counselors and train additional part- time counselors. The national two-week
training for counseling will be utilized.
DELIVER will continue to support the national scale up of VCT /PMTCT sites by putting in place the national logistics systems in
all new sites.
LEVERAGING AND COORDINATION
The Global Fund supports training, infrastructure development and test kit procurement at its sites. The USG provides
comprehensive test kits logistics support to reinforce these efforts. The USG also reinforces the Global Fund's investment by
ensuring the quality provision of C&T at Global Fund sites. The GOG and other donors target C&T for the general population;
therefore, the USG complements these efforts by supporting C&T targeted toward high-risk groups through specialized clinics and
using specialized telecommunications campaigns for MARPS.
EXPANSION OF PROGRAM WITH ADDITIONAL COMPACT FUNDING
Expansion using Compact funds will be along the lines of the expansion of QA support to Global-Fund supported sites. The "Call
Me-Chat Me-Text Me" will be expanded nationally. Training to become a MARP-friendly service provider will be expanded
nationally as well.
PRODUCTS/RESULTS
* Improved C&T services at 40 Global Fund-supported C&T/PMTCT/ART sites, with 20 additional staff trained and 20,000
individuals receiving C&T and their test results
* MARP follow-on activities will refer 5,000 individuals for C&T
* The Ghana Armed Forces will support 7,000 HIV tests of the military, families and civilians tested
* 500 partners of PLHA referred for HIV testing
Table 3.3.14:
Table 3.3.19:
