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
NOTICE - Per the recommendation from OGAC that Malawi as an FY2008 Compact Country, submit a mini
-COP (i.e. program area level narratives only), this activity level narrative has not been updated prior to the
submission of the FY09 Full COP. The Malawi country team anticipates updating narratives upon
completion and final approval of the negotiated 5-year Compact between the United States Government
and the Government of Malawi.
With EP funding, The EGPAF program will provide comprehensive PMTCT services and referrals, linking
HIV-positive mothers, exposed infants, and children to HIV care and treatment services and training of
PMTCT service providers. Services provided in these clinics include: HIV/PMTCT education to
communities; routine counseling and testing (CT) for all pregnant women; CD4 testing for all HIV-positive
women; infant feeding counseling; provision of comprehensive antenatal, obstetrical, and post-natal care;
provision of antiretroviral prophylaxis to mother and infant pairs; cotrimoxazole prophylaxis for all exposed
children and their mothers; and the provision of social support for HIV-infected and lactating mothers
through clinic-based support groups.
In 2001, EGPAF began supporting PMTCT in Malawi with private funds and in 2002 partnered with the
Lilongwe Medical Relief Fund Trust/University of North Carolina-Chapel Hill to launch the implementation of
In FY 2008, EGPAF will manage a cohesive unified program with private and USAID funding contributing to
the common goal of scaling up PMTCT services in Malawi using FY 2007 Emergency Plan (EP) funding.
HIV-positive mothers receive their NVP dose at the initial ANC visit, which has helped to increase the
uptake of maternal ARVs; introducing CD4 testing at the initial visit for all HIV-positive mothers has
increased the number of pregnant women accessing HAART. The PMTCT program works to strengthen the
continuum of care for HIV-positive women and their families by accommodating their medical needs within
the ARV care clinic, thereby adapting a family-focused care model.
EGPAF's expertise allows for maximum impact at both the policy and program levels. The immediate
objectives are to increase access to services that will prevent the transmission of HIV from mother to child.
The long-term goal is to strengthen the capacity of in-country health care facilities and the counterpart
national systems so that they can assume increasing levels of responsibility to provide comprehensive
PMTCT services. The Foundation works to integrate PMTCT into existing programs through antenatal care,
labor, and delivery and postnatal services for mother and infant. EGPAF provides TA, training, support for
related equipment, commodities, facilitative supervision, and M and E. EGPAF actively engages in national
policy task forces and working groups to bring the latest scientific evidence and the best program
approaches into discussion. Service integration will continue to be a priority, as will greater emphasis on
providing access to complementary prevention, care, and treatment services and facilitating longitudinal
follow-up of HIV-exposed infants.
Through EGPAF's partnership with UNC, 100% of ANC clients are counseled, 99% are tested and get their
results and 99% of HIV-positive mothers receive ARV prophylaxis to provide comprehensive PMTCT
services within government antenatal and postnatal care clinics. All antenatal women who test HIV-positive
receive CD4 tests and those with CD4 counts less than 250 are referred for care and treatment. CD4 testing
has helped to increase the identification of more HIV -positive women eligible for HAART by 25%.
EGPAF leverages a considerable amount of private funds to support the Ministry of Health (MoH) in its
PMTCT scale up. FY 2008 USG funds will augment this by building on a base of technical expertise already
existing to expand PMTCT even further. EGPAF will coordinate PMTCT program scale up with the MoH's
nationwide scale up of PMTCT services and work to strengthen the MoH's capacity to provide PMTCT
services. FY 2008 funding will be used to provide TA within or outside Lilongwe, strengthen social support
for HIV-infected mothers through community- and clinic-based support groups, and allow the program to
participate actively in the formulation and updating of PMTCT guidelines, national guidelines, and
Activity 1: Strengthen PMTCT Services
In FY 2008, EGPAF will provide TA to their sub-grantees, UNC, and another partner (to be determined), to
strengthen ANC services at a minimum of six new sites (in high HIV prevalence areas) to integrate
comprehensive, high quality PMTCT services. EGPAF will coordinate with the MoH as they roll out PMTCT
services nationwide to reach underserved areas. Activities include support for provider-initiated and client-
initiated group pre-test counseling and testing using rapid test kits that enable clients to receive the results
on the same day. Post-test counseling will include maternal nutrition, infant feeding options, the importance
of postnatal care and family planning after delivery for both HIV-negative and positive women. For HIV-
positive pregnant women post-test counseling will include offering take-home NVP at the time of diagnosis.
The program encourages HIV-positive women to bring spouses/partners to be counseled and tested at
PMTCT sites to enhance support for wives/partners irrespective of the men's HIV status, reduce stigma,
and accord individuals/couples the opportunity to make informed decisions on accessing care and treatment
services. An emphasis is placed on male participation at the first ANC visit so that both partners can be
counseled and receive their results as a couple. This eases the pressure of partner HIV status disclosure
and thereby reduces the chance for gender based violence against women. Providers will continue to
counsel family planning clients, men, children, and other family members within PMTCT services as EGPAF
will be supporting the implementation of a family-centered care model using women as entry points to
Activity Narrative: EGPAF will strengthen PMTCT services in maternity wards where women in the first stage of labor with
unknown HIV status will be given the opportunity to be counseled and tested for HIV. The women will be
given the results and ARV prophylaxis if they are positive, and exposed infants will receive ARV prophylaxis
as well. Pregnant women with unknown HIV status in the second stage of labor will be offered counseling
and testing after delivery and infants will receive appropriate ARV prophylaxis. Maternity staff will be
supported to modify obstetric practices during labor and delivery to reduce the chance of HIV transmission.
EGPAF will continue to mentor health workers and traditional birth attendants to encourage women with
known and unknown HIV status who deliver at home to return to the facilities with their newborn infants
within 48 hours (72 hours is recommended but this timeframe can make babies miss the opportunity for
NVP depending on the time the infant was born) for the infant to receive ARV prophylaxis including
counseling and testing of mothers with unknown HIV status. EGPAF will strengthen efforts to follow-up
women and infants in MCH after delivery to strengthen the continuum of care for HIV-positive mothers and
exposed infants and will continue to support acceptable management of medical waste practices at all the
EGPAF will promote innovative approaches to support the follow-up of mother-infant pairs and linkages to
care and treatment. EGPAF will explore strategies to fast track pregnant women to treatment services
including the identification of a reference laboratory for each PMTCT site, provide CD4 count to all HIV-
positive pregnant women (this is new policy from the MoH), provide training for MCH providers in HIV care,
and provide routine CD4 analysis of HIV-positive mothers to increase efficiency of linkages to care (See Lab
summary and narrative on CD4 machines).
EGPAF will coordinate with the MoH's national PMTCT scale-up plan and with other partners providing
PMTCT services to ensure that services are complementary and work to avoid district and services
duplication. In coordination with the MoH, EGPAF will focus on sustainability by strengthening health care
worker skills through training and preceptorship activities in PMTCT services, and strengthening M&E skills
to enhance collection of quality data at the sites. EGPAF will support the sites to ensure that they provide
take home NVP tablets at the time of diagnosis.
EGPAF will support strengthening of a PMTCT M&E system with an emphasis on improving the quality of
data collection, data analysis and reporting.
New/Continuing Activity: Continuing Activity
Continuing Activity: 17127
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
17127 17127.08 U.S. Agency for Elizabeth Glaser 7664 7664.08 EGPAF $220,000
International Pediatric AIDS
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $74,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities