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.
Years of mechanism: 2008
1. ACTIVITY DESCRIPTION & EMPHASIS AREAS
Basic Program Evaluation: What are the social and economic determinants of sexual vulnerability among
adolescent OVC? Which interventions are most effective in preventing or mitigating this vulnerability?
Given the lack of information on the impact of care and support strategies for orphans and vulnerable
children (OVC), and their HIV risk, there is an urgent need to learn how to improve the effectiveness of
program efforts. Growing evidence highlights the elevated risk of adolescent orphans for acquiring HIV
infection and sexually transmitted diseases (Gregson et al., 2005; Kang et al., 2008). While all youth within
Kenya are at sexual risk, adolescent orphans are an underserved and higher risk group due to earlier age of
sexual onset and higher likelihood for teenage pregnancy and engagement in transactional sex (Gregson et
al., 2005; Juma et al., 2007; Nyamukapa et al., 2008; Thurman et al., 2006). Increased understanding of
the multi-faceted needs of adolescent OVC and identification of interventions effective in addressing these
needs are critical. Since adolescents comprise the majority of the OVC population (United Nations
Children's Fund [UNICEF], 2006); however, evidence suggests that the bulk of OVC programs only reach
younger youth (Osborn, 2007; Ruland et al., 2005). OVC programs generally tend to neglect the particular
psychosocial, educational, reproductive health, and livelihood needs of adolescent orphans (Schueller et al.,
2006). In spite of the growing evidence highlighting sexual risk behaviors among adolescent orphans, they
may also lack sufficient access to HIV prevention messages (Juma et al., 2007). Given that the vast
majority of prevention and life skills programs operate within schools (Gallant & Maticka-Tyndale, 2004),
and that orphans consistently have lower school enrollment rates (UNICEF, 2006), many OVC may not be
reached by these services. It is also unknown how many OVC are reached with prevention messages
through out of school programs (Juma et al., 2007). Further, considering the complex psychosocial
challenges facing orphans, it is clear that programs should not focus on HIV education alone.
Comprehensive care and protection packages are necessary to reduce the sexual risk of adolescent OVC
so as to decrease HIV infection among this generation of youth (Thurman et al., 2006). To achieve this end,
a holistic understanding of the situation of adolescent OVC and identification of best practices is imperative.
Considering the scarcity of data in this area, this activity will conduct a basic program evaluation to help
identify which interventions are most effective in mitigating the vulnerability of adolescent OVC. The activity
will identify two EP supported OVC programs within two programs within three unique sites: one operating
within an urban environment, one within a peri-urban setting and one that is operating within a rural setting.
Urban and rural areas have varying HIV rates and adolescents within these environments have different
sexual behavioral patterns and face varying cultural and contextual issues that affect program design and
success. Thus, including a range of models across diverse settings provides valuable insight on the varying
factors and circumstances that affect the well-being of adolescent OVC. The scale-up of services for OVC
is desperately needed, though program design and resource allocation should be grounded in an evidence
base. To fully implement National Plans of Action for OVC, governments, donors and program managers
need comprehensive information on how to reach more OVC with services that improve their well-being.
Information on these topics is very limited and has not been well disseminated. Program implementers,
policymakers, and donors require data on (1) how best to develop and deliver age appropriate programs
and (2) what kinds of programs will have the most impact on improving the quality of life and promoting a
promising future among OVC (reducing their HIV risk). More information about the various types of
interventions, lessons learned from program implementation to date, priority needs of OVC and best
practices for meeting those needs and reducing the impact of HIV on adolescent OVC can ultimately
increase the quality and effectiveness of interventions. Assessments would be conducted to identify key
program priorities and best practices for serving adolescent OVC, reducing their HIV risk, and helping them
achieve their full potential. Assessments will focus on existing EP funded OVC programs working with
underserved, high risk group—adolescent OVC. Within the proposed three settings, including urban, peri-
urban and rural environments, quantitative and qualitative data will be collected at two different times,
yielding data on determinants of quality throughout the three year project period. Child participatory
approaches will be used to ensure feedback from adolescent OVC is incorporated in this activity. The
activity will also incorporate dissemination mechanisms to ensure that policy makers, EP funded partners
are kept abreast of emerging best practices as will have been identified during the course of this evaluation.
The scale-up of services for adolescent OVC is desperately needed, though program design and resource
allocation should be grounded in an evidence base. Program implementers, policy makers, and donors
require data on how best to develop and deliver age appropriate programs and what kinds of programs will
have the most impact on improving the quality of life and promoting a promising future among adolescent
OVC. The emphasis area is Strategic Information (M&E, HMIS, Survey/Surveillance, Reporting).
2. CONTRIBUTIONS TO OVERALL PROGRAM AREA
The study is strongly committed to ensuring that the information from these evaluations is disseminated and
will work with local partners and stakeholders at all levels to encourage the use of the data at the program
and policy levels as well as ensuring that best practices in programming for adolescents are identified and
well documented to facilitate replication and scale up.
3. LINKS TO OTHER ACTIVITIES
This activity will link to APHIA II programs in the country (#9029, #9041, #9048, #9053, #9056, #9067,
#9071, #9073) which are specifically targeting orphans and vulnerable children.
4. POPULATIONS BEING TARGETED
This activity specifically targets orphans and vulnerable children as well as build the capacity of EP partners
in identifying best practices for delivering essential services to adolescent OVC.
5. SECONDARY CROSS-CUTTING BUDGET ATTRIBUTIONS
This activity will contribute $15,000 towards support to education activities for adolescent OVC as well as
attribute $9,000 towards economic strengthening of households for adolescent OVC.
New/Continuing Activity: New Activity
* Addressing male norms and behaviors
* Increasing gender equity in HIV/AIDS programs
* Increasing women's access to income and productive resources
* Increasing women's legal rights
* Reducing violence and coercion
Health-related Wraparound Programs
* Child Survival Activities
* Malaria (PMI)
Human Capacity Development
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Estimated amount of funding that is planned for Economic Strengthening $9,000
Estimated amount of funding that is planned for Education $15,000
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS FROM COP 2008:
+ Alcohol/ substance abuse risk among out-of-school slum-dwelling youth in Nairobi
+ Integrating alcohol risk reduction in HIV counseling and testing
1. LIST OF RELATED ACTIVITIES
This activity relates to activities in AB and OP.
2. ACTIVITY DESCRIPTION
In 2009, Population Council will:
a) Expand activities to integrate counseling and testing services into existing family planning (FP) service
outlets. Integration of CT into FP offers an opportunity for increasing availability and access to CT services
since FP clients will conveniently be offered opportunities for CT. The Population Council will support the
integration of CT into 30 FP Clinics and train 80 FP providers with a target to provide CT to 8,000 clients.
The Population Council will monitor cost effectiveness of this integration to guide decision regarding further
scale up. The proposal to integrate CT into FP is based on feasibility assessment that was conducted by the
Kenya government in partnership a number of partners including JHPIEGO, CDC and FHI. Provision of CT
services in FP outlets will be guided by national standards for CT service delivery and quality assurance.
The program has intense social mobilization to inform potential FP clients about availability and benefits of
CT services at FP sites.
b) Alcohol is an associated known co-factor for HIV acquisition especially among women, but is largely
overlooked in HIV counseling and testing. During COP 06, Population Council tested an alcohol risk-
reduction model involving building the capacity of VCT counselors to advice clients on alcohol use. Because
most VCT clients who consume alcohol do so at hazardous levels (based on WHO AUDIT scale), and
because alcohol consumptions is associated with 3-7-fold increases in sexual risk taking and violence, it is
important that alcohol risk reduction be integrated into VCT, as part of comprehensive risk reduction. It may
also be important to explore alcohol risk reduction in other CT options now available in Kenya including
Provider Initiated Counseling and Testing (PICT), PMTCT, and integrated family planning.
During COP 09, Population Council will work with study partners Liverpool VCT as well as NASCOP to
expand this initiative to 15 additional sites, including expanding into district hospitals in Nairobi and Coast
provinces. During COP9, further expansion into 15 more sites will be undertaken, including a nested study
to examine how alcohol risk reduction can be incorporated into PICT. The results of this study will be used
to develop an in-service training module for use by NASCOP and others. Technical assistance will also be
provided to NASCOP and to pre-service training institutions, such as the MTC, in developing training
resources that could be integrated into existing pre-service training curricula for medical staff to enable them
to routinely include such issues in their counseling. In addition, technical assistance will be provided to
APHIA II and other partners to introduce the in-service counseling model into other service delivery sites.
Technical assistance will also be given to HIV counselor training organizations interested in integrating
alcohol risk reduction into their routine counseling. Anticipated outcomes of COP 09 activities:
• Technical assistance provided to the MOH and other partners to develop policy guidelines concerning
inclusion of alcohol risk reduction in HIV counseling.
• Model introduced into 15 service delivery sites.
• Technical assistance provided to APHIA II partners and HIV counselor training organizations to integrate
alcohol risk reduction in their counseling programs.
• Pre-service training resources developed and adapted for use by key pre-service training organizations.
c) The association between alcohol or substance abuse and sexual risk behaviors which put people at risk
of HIV, is well documented. The use of alcohol and drugs has been shown to be associated with
unprotected sex and having higher numbers of sexual partners, albeit a number of psychosocial factors are
also correlated with these factors. In Africa, HIV risk behaviors and their relationships to alcohol abuse has
been outlined in a number of recent studies. Recent research conducted in Kibera and other informal
settlements in the area of Nairobi, Kenya found that youth who live in these slums are more likely than
youth in the general population to have used alcohol or drugs, especially young boys and men. Alcohol and
substance abusing youth are also more likely to be out of school, to have been involved in both consensual
and forced sexual relationships.
Given this evidence, we propose to implement an intervention study among out-of-school youth living in
Kibera during COP 08. The aims of this study will be: to conduct a baseline assessment of the
characteristics, sexual behaviors, and alcohol and substance use of these youth via a representative
household survey; to identify factors associated with drug use and hazardous, harmful, and dependent
drinking as defined by the WHO; to refer youth identified during the survey as dependent drinkers for
counseling and/or treatment; inform a new youth-targeted intervention which will be developed by the
Support for Addictions Prevention and Treatment in Africa Trust (SAPTA) Centre in Kibera; and to conduct
an endline evaluation after a one-year period to assess the effectiveness of the intervention. During COP 09
we plan to disseminate the outcomes of this study to APHIA II partners and to GOK partners through
dissemination meetings and printing and wide distribution of the report. Anticipated outcomes:
• Adoption and scale up of alcohol and drug counseling prevention and treatment for youth program by
APHIA II partners
• Lessons learned communicated to other APHIA II and relevant GOK partners.
3. CONTRIBUTIONS TO OVERALL PROGAM AREA
This activity will contribute to the result of increased access to voluntary counseling and testing services.
This activity also supports the National Strategy of the Ministry of Health to expand integrated HIV/FP
services in Kenya. The target groups will be trained in counseling to inform clients about issues of HIV/AIDS
and the need for knowing their status.
4. LINKS TO OTHER ACTIVITIES
The activity creates demand for VCT services and will link to the CT services. More information will be given
to clients and the community during community meetings with the local administration so that more
messages and activities are conveyed through this community channel. The activity will also be linked to
Activity Narrative: other Population Council activities in AB and OP.
5. POPULATIONS BEING TARGETED
General population will be targeted who will attend the facility for family planning services and also health
facility staff, family planning clients and providers, doctors, clinical officers and nurses. These included men,
women, adolescents and the community at large. Activities will be coordinated with National AIDS control
program staff as well as with community based groups.
6. KEY LEGISLATIVE ISSUES ADDRESSED
This activity will work towards addressing the issue of stigma and discrimination faced by individuals with
HIV/AIDS and their families.
7. EMPHASIS AREAS
Major emphasis will be training and minor emphasis will be information, education and communication
materials which will be used as a part of community mobilization to raise awareness of knowing your HIV
New/Continuing Activity: Continuing Activity
Continuing Activity: 14974
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
14974 4204.08 U.S. Agency for Population Council 6991 384.08 Frontiers in $300,000
7023 4204.07 U.S. Agency for Population Council 4274 384.07 Frontiers in $200,000
4204 4204.06 U.S. Agency for Population Council 3241 384.06 Frontiers in $220,000
* Addressing male norms and behaviors
* Family Planning