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.
na
Table 3.3.12: Program Planning Overview Program Area: Laboratory Infrastructure Budget Code: HLAB Program Area Code: 12 Total Planned Funding for Program Area: $ 4,730,540.00
Program Area Context:
USG supports Guyana's laboratory structure and core functions. PEPFAR funding has increased access to HIV testing and clinical monitoring for the HIV treatment program in-country. FY07 laboratory infrastructure plans build on laboratory activities from FY06 and will continue to rely on technical assistance from the Ministry of Health (MOH), Francois-Xavier Bagnoud Center (FXB), CDC, Supply Chain Management System (SCMS), and AIDSRelief. A laboratory-trained physician employed by the CDC office coordinates all PEPFAR laboratory activities in-country.
The current public laboratory system consists of five levels: health post, health center, district hospital laboratory, regional hospital laboratory, and tertiary laboratory. Smaller facilities perform only malaria smears and possibly hemoglobin, while district level facilities can perform basic testing such as hemoglobin, complete blood count (CBC), urinalysis, and blood glucose. No serology or microbiology studies are available except at the tertiary level, which includes only the Central Medical Laboratory (CML, a clinical facility) and the National Infectious Diseases Laboratory (which is not a physical laboratory, but instead is infectious disease testing done at the blood bank laboratory by blood bank staff). Currently, no laboratory can conduct testing for Pneumocystis Carinii pneumonia (PCP), Cryptococcus, Chlamydia, or Herpes Simplex Virus (HSV) infections, which are prevalent among HIV-positive patients. No institution has a mandate as a national laboratory reference center. Four of the five regional hospitals are old wooden structures in poor condition with chronic problems with utilities and maintenance. These regional hospitals, as well as the five geographic regions without a regional hospital, are completely dependent on the Georgetown facilities for all but the most basic testing, the setting of standards, storage of commodities, and training of staff. There is no single institution to carry out reporting on diseases of public health significance. Establishing sound laboratory infrastructure in Guyana will require a national reference laboratory with capacity to build systems and standards into the greater public health system while providing essential support to the expanding HIV/AIDS program.
Establishing a public health reference laboratory remains a key element of the Guyana PEPFAR program. Not only will it provide a new level of infrastructure for labs in Guyana, but it will provide crucial support to the HIV care and treatment programs. When completed the NPHRL will provide reference laboratory capacity in Guyana and serve as a base for improving laboratory services throughout the health system. The NPHRL will serve as an incentive to encourage needed healthcare professionals to stay and work in Guyana. The new HIV treatment center housed in the first floor of the structure will provide a patient-friendly venue with greater privacy, improved flow, and enhanced pharmacy space to facilitate ARV services. The new lab represents the fulfillment of the joint commitment by the USG and the Government of Guyana to upgrade the healthcare system.
A PEPFAR-funded structure housing the HIV clinic and the National Public Health Reference Laboratory (NPHRL) has been under discussion with the Guyana MOH since 2003. Design commenced in 2005 and the US Department of State Regional Procurement Support Office in Florida (RPSO) will be managing the construction. Stakeholders are negotiating specifics of the construction so that the laboratory will be equipped as a Biological Safety Level II facility at a cost that is compatible with the overall context of the Guyana PEPFAR program. The funds obligated in FY05 and FY06 (US$750,000) will be used to commence construction and funds will be added in FY07 to complete the construction. The Global Fund in Guyana has expressed an interest in participating in equipping the laboratory and we will leverage these and other funds as available.
CDC continues to fund laboratory support to all care and treatment programs in-country in coordination with FXB and AIDSRelief. CD4 testing is available for all treatment sites but is conducted at the Central Medical Laboratory. In 2006, FXB began extending CD4 capacity to two regional hospital laboratories (Linden and New Amsterdam). A Global Fund grant purchased the equipment and CDC/FXB will provide
technical oversight and reagents. Other treatment centers will continue to transfer specimens to Georgetown through the existing specimen transport system. AIDSRelief implemented CD4 testing at St. Joseph Mercy Hospital and will be extending this capacity to Bartica Hospital in FY07. CDC, in collaboration with MOH, will establish Quality Assurance/Quality Control (QA/QC) programs for all laboratories. The NPHRL will eventually coordinate all of these functions. In FY07, CDC will ensure the dissemination of Standard Operating Procedures (SOP) and QA/QC measures to each site to begin a uniform laboratory QA/QC program. Through a partnership with I-TECH, FXB, MOH, the European Union (EU) and the American Society for Clinical Pathology (ASCP), CDC will begin training programs and seminars for laboratory staff in quality assurance. CDC will work with the MOH to establish a site, outside of the National Blood Transfusion Service (NBTS), in which to conduct ELISA testing for dried blood spots for quality assurance of the HIV rapid test program.
Hematology and chemistry profiles needed for the monitoring of patients on ARV are readily available at the CML. CDC will continue to provide 25% of these reagents to CML to support the HIV care and treatment program. This routine monitoring is hampered at the regional hospital laboratories due to the lack of reliable equipment, insufficient equipment maintenance protocols, and recurrent shortages of reagents. CDC will work with SCMS to ensure a better procurement system for these reagents and other laboratory supplies during 2007. Global Fund will purchase hematology equipment to be installed at the laboratories at Linden and New Amsterdam Hospitals. CDC will develop a mechanism to provide reagent support to these regional laboratories and, in collaboration with ASCP, will provide training in chemistry and hematology testing.
USG works closely with other agencies in Guyana to support and coordinate laboratory services. The Canadian Society for International Health (CSIH) has implemented TB culturing at the CML and TB smears at all regional laboratories. MOH, FXB, CDC, and AIDSRelief will determine the role of viral load technology for clinical monitoring in Guyana's national HIV/AIDS program. This group will also compare costs for purchasing DNA polymerase chain reaction (PCR) capacity for infant testing versus establishing a system for sending samples outside of Guyana for testing. Any virologic technology purchased for the MOH will be accessible to patients from all care and treatment sites in the non-profit sector. These specialized services will all eventually occur under the control of the NPHRL to ensure uniform coverage, minimize duplication, and enforce strong QA/QC standards.
Human resource shortages remain a primary limitation for implementation and sustainability of programs in Guyana. USG will work closely with MOH on strategies for staff retention. Through both a new technologically advanced physical structure and a clear institutional vision and plan, the NPHRL will serve as an incentive for laboratory staff to stay and work in Guyana. USG will advocate for efforts to link the University of Guyana laboratory programs to the new national laboratory in order to enhance pre-service training and create segues to the public health laboratory system that will aid in recruitment of new graduates and provide opportunities for professional advancement in Guyana as an alternative to emigration.
Program Area Target: Number of tests performed at USG-supported laboratories during the 6,000 reporting period: 1) HIV testing, 2) TB diagnostics, 3) syphilis testing, and 4) HIV disease monitoring Number of laboratories with capacity to perform 1) HIV tests and 2) CD4 tests 7 and/or lymphocyte tests Number of individuals trained in the provision of laboratory-related activities 75
Table 3.3.12:
