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.
Subdivisions of Program Areas, these track general higher level sub-classifications of expenditure.
Subdivisions of Major categories, these are the most detailed expenditure data.
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
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
In EGPAFs care and treatment program, palliative care includes the provision of patient and family centered
care throughout the continuum of illness. Providing a comprehensive care package includes the prevention,
diagnosis and treatment of opportunistic infections, pain management, linkage with home-based care and
other community support services, psychosocial and adherence support for the patients and his/her family.
In addition, it considers nutritional issues as they interact with health status and treatment success for the
patient as well as food insecurity for the whole family as a result of disease.
EGPAF wants to address these components by:
- building capacity in the health facility to prevent, diagnose and treat opportunistic infections and provide
comprehensive chronic HIV care, including the management of pain
- building capacity in the health facility to provide counseling and psychosocial support throughout the
continuum of illness
- collaborating with community-based organizations implementing HIV prevention activities and providing
additional psychosocial support services (individual and family counseling, support groups), home-based
care, nutritional support, and active tracing of patients lost to follow up (subgrants to cover part of these
- establish linkages with other (international) organizations providing support services to ensure provision of
bednets, clean water supplies, nutritional supplementation where feasible
Capacity building of health staff on palliative HIV care: In the health facilities, EGPAFs Clinical Advisors will
conduct training and on the job mentoring on OI management for health facility staff including physicians,
medical technicians, nurses, laboratory and pharmacy staff. Involvement of DPS and DDS staff in regular
supervision and mentoring will help build their capacity to develop formative supervision skills and provide
staff with necessary technical support. EGPAF will implement the QI and supervision tools that have been
developed during PY04 for the supervision of chronic HIV care.
In so far as some essential drugs for the treatment of OIs have not been available or with long stock
ruptures, EGPAF will procure and manage a buffer stock of essential drugs for the management of OIs.
Counseling and psychosocial support: In the health facilities additional counseling will primarily be provide
by lay counselors and peer educators. In addition, they will also, together with volunteers from CBOs,
provide counseling in the community and in support groups meetings. Training of lay counselors and peer
educators will focus on essential HIV knowledge, HIV care and treatment related knowledge including
treatment preparation, prevention with positives, nutrition, positive living with HIV as well as couple/family
counseling. Lay counselors and peer educators will work within the health facility but provide an important
linkage with the community and community-based services.
Community-based support: since 2006, EGPAF has provided small subgrants to an increasing number of
CBOs. Activities of these CBOs initially focused on HIV education, community mobilization for PMTCT and
psychosocial support for pregnant women in the PMTCT program. Since 2007, activities have expanded to
include community education on ART, treatment literacy, active tracing of HIV exposed infants and linking
them with ART services as well as active tracing of patients on treatment lost to follow up. CBOs have also
established support groups for people on treatment. EGPAF will continue to provide relevant training and
technical assistance to the CBOs, as well as support for coordination and exchange with other CBOs,
monitoring and evaluation and the documentation of lessons learned. In COP08 the number of CBOs with
which EGPAF will have a subgrant will increase. The goal is to have one CBO in the catchment area of
each treatment site to provide these additional support services. In each of the new districts, new CBOs will
be identified through a process of mapping and capacity assessment. In district where no capable
community-based organization exists, EGPAF will work with health facility staff and motivated beneficiaries
to establish support groups for PLHA. In some districts EGPAF has established MOUs with other
organizations providing home-based care, psychosocial support and support for OVC. EGPAF will expand
this and work to increase collaboration with other USG and other partners to increasingly provide a
comprehensive package of services. As EGPAF is not directly providing bednets, safe water supplies and
nutritional support, this support will only be provide through partnerships. Currently this includes the
provision of Plump'Nut to several malnourished infants and children. EGPAF will explore the possibly to
include several malnourished adults in this program as well as explore other possibilities to provide
nutritional support to patients on treatment.
To support both the counseling activities in the health facilities as well as HIV education and counseling
activities implemented by CBOs, EGPAF will reproduce and disseminate existing IEC/BCC materials.
The patient tracking system EGPAF has implemented in each of the care and treatment sites facilitates the
monitoring of quality of care provided to patients in care. As currently many patients enrolled but not yet in
need of treatment are lost to follow up, EGPAF in collaboration with the CBOs will work to recuperate these
patients and ensure that they receive clinical follow up care and are linked with support services.
This activity also relates to activity 8593 and OI logistics systems strengthening described in USAID activity
9136 elsewhere in this document.
The main component of this activity is to provide all HIV patients with a minimum package of quality clinical
care services at EGPAF's 17 ARV treatment sites. Patients will receive access to this minimum package of
care regardless of whether they have initiated ART. Key components of the care package will include:
1) Management of opportunistic infections (OIs) and other acute illnesses: including the prevention,
diagnosis and treatment of common oi as well as provision of cotrimoxazole prophylaxis, pain control,
facilitating the distribution of bed nets to prevent malaria, as well as site level support for the recording and
reporting of opportunistic infections through maintenance of good registers that keep track of a) HIV clinical
stage and prophylactic medicines prescribed, b) OIs diagnosed (TB, CM) c) record of adherence to
medication and clinic reviews d) specific psycho-social issues requiring follow-up and e) eligibility for ART
2) Provision of psychosocial and adherence support through working with community-based groups and
associations and recruitment and training of clinic staff to provide on-going counseling support
3) Assurances of continuity of care services beyond the clinical setting through referral to community-based
organizations that serve the respective health facilities. This may include referral to counseling and testing
4) Continued patient and family education about HIV disease, OIs, appropriate nutrition and HIV prevention
5) Continued monitoring and regular follow-up to determine readiness and eligibility for initiation of ARV
To ensure access to all five elements, EGPAF will develop a system for tracking the types of services
offered and delivered. Additionally, clinic nurses, clinical officers/medical technicians and pharmacy staff will
be trained in the provision of standard HIV care services. Training will include adult and pediatric HIV
management and will be provided in coordination with the Ministry of Health.
Through these activities, 13,132 adult and 2,456 children will be provided with clinic-based HIV-related care
services during FY07. Children will be identified for care through linkage with PMTCT services, postnatal
clinics, in- and out-patient child care services as well as child at risk consultation services. At least 22
community based organizations will be engaged to support referral networks and 300 individuals will be
trained in OI management.
Per guidance sent by CDC/GAP, this activity represents approximately 1/12 of the funding originally
allocated to EGPAF for this program area under activity 8595.08. Funding is provided to pay for that activity
from February 23 - April 1, 2009.
allocated to EGPAF for this program area under activity 8594.08. Funding is provided to pay for that activity
Expanding access to tuberculosis treatment, combined with introducing HIV testing and anti-retroviral (ARV)
delivery into TB programs, is essential to ensure the survival of HIV-positive people. Since up to half of
people living with HIV/AIDS (PLWHA) develop tuberculosis, and tuberculosis has an adverse effect on HIV
progression, EGPAF will work to ensure that tuberculosis care and prevention is a priority in its HIV care
and treatment program, and that HIV/AIDS prevention and care will be a priority in the TB program.
Mozambique is ranked 18th for TB incidence (447/100,000 pop./Y) worldwide and faces many serious
constraints in addressing the TB epidemic. TB notification related to case identification (Notification Rate:
168/100,000 pop./Y) and TB management translated into cure, treatment completion and death rates
(124/100,000 pop/Y) remain very poor. Within MOH, coordination between TB and HIV departments,
essential to develop an effective approach to address this associated HIV/TB epidemic (Source: WHO
MOH faces major challenges in improving access to and quality of care for TB and T/HIV co-infected
patients, including a lack of qualified staff, a lack of support to staff through supervision and on the job
training, poor diagnostic capacity, and weak linkages between TB and HIV care and treatment services.With
the expansion of C&TS, the MOH together with partners has worked to improve TB management and to link
and integrate TB and HIV care and treatment services.
During FY08 these funds are requested to implement a range of activities that include: integration of TB and
HIV care and treatment services, and improve the quality of services provided to TB/HIV co-infected
patients. EGPAFs general objectives focusing on improving access to and quality of service, ensuring
access to psychosocial and other support services, building institutional capacity within MOH to manage
the programs and ensuring monitoring and evaluation of services, will consider TB/HIV services as an
integral part of the program. Activities are aimed at 1) preventing HIV infection in TB patients, 2) preventing
occurence of TB disease in HIV patients, 3) providing comprehensive care for co-infected with TB and HIV
Under each of the 5 objectives, EGPAF will support specific activities:
Objective 1: Improve and reinforce care and treatment for adults and children co-infected with TB/HIV
i) Training of staff in the following; TB prevention and case detection in HIV patients, HIV counselling and
testing and clinical management of co-infection, both for adults and children (new sites) ii) continuous
training, supervision and clinical mentoring .iii) Ensure continued implementation of TB screening at all ART
facilities as well as assure for treatment those infected with TB through referral to TB programs iv) Support
to coordination and planning meetings to help establish effective linkages between and integration of TB
and HIV care and treatment services.
EGPAF target is to offer counselling and testing services to 4,571 TB patients, test 3,672 patient and to
enrol 1,836 TB/HIV co-infected patients into C&TS; additionall to ensure treatment of TB for 1,836 HIV
Objective 2: Build capacity of health staff and communities to provide psychosocial, nutritional and
adherence support to PLWHA and their family members and to sensitize the population on TB/HIV/AIDS.
This will be achieved through i) collaboration with CBOs to devlop programs for psychosocial, literacy
promoting and adherenc support activities to reach TB/HIV co-infected patients and improve the linkages
between commuity and health centre services. ii) train and organise sensitization campaigns targetting lay
counsellors, peer educators, community leaders and CBO members to increase community awareness
about the inter-relationships between TB and HIV and where to obtain care and treatment. ii) Provide
counselling training for health staff, lay counsellors, peer educators and CBO volunteers which includes TB
to ensure that TB is addressed within support groups and patients are well educated about TB case
Objective 3: Build institutional capacity of the MOH to plan, monitor and manage TB services
In addition, activities focusing on increasing DPS and DDS capacity to manage HIV care and treatment
programs that will benefit the TB program will be undertaken. these include, support pharmacy
management in relation to TB drugs and ensure joint supervision of TB/HIV services, implementation of
supervision tools and support DPS & DDS planning and coordination and in TB taskforce meetings and
nationa ART technical meetings provide technical inputs regarding TB/HIV management.
Additionally, EGPAF will within laboratory and clinical space rehabilitations ensure availabilty of a safe
environment for laboratory function and clinical managment of PLWHA with a view of infection control.
Objective 4: Improve monitoring and evaluation systems and implement quality assurance mechanisms to
enhance TB within C&TS
EGPAF support to monitoring and evaluation of HIV care and treatment program will also encompass
TB/HIV treatment services. EGPAF will ensure systematic monitoring of TB screening among HIV patients
within care and ttreatment and antenatal services sites ,as well as monitor HIV screening among TB
patients. The Patient tracking system (PTS) implemented at ART facilities includes a TB component which
facilitates monitoring of TB care provided to HIV patients. The PTS (computer based) will be rolled out to
other sites with implementation of a papaer based system at lower volume care and treatment sites.
EGPAF particpates in the HIVQUAL program whose implementation for the care and treatment program will
address quality of services as it relates to the screening for and management of TB/HIV co-infection in
adults and children.
allocated to EGPAF for this program area under activity 5182.08. Funding is provided to pay for that activity
The Help Expand Anti-Retroviral Therapy for Children and Families Project (project HEART/Mozambique),
is part of a five-country program, that started two years ago and has focused on expanding access to care
and treatment programs in the rural and remote areas of Mozambique, linking care and treatment programs
with existing PMTCT programs.
During the 3rd year of implementation, EGPAF will focus on implementing comprehensive, family-focused
care and treatment programs in 30 sites in 23 districts in 4 provinces of Mozambique:(Moçimboa de Praia,
Montepuez, Mueda, Muidumbe, Nangade, Palma, Pemba,/Cabo Delgado - Angoche, Ilha de Moçambique,
Nacala Velha, Meconta, Mogincual, Mogovolas, Monapo, Mossuril /Nampula - Chibuto, Bilene, Xai Xai,
Mabalane/Gaza - Boane, Marracuene, Moamba, Matutuine/Maputo)
EGPAFs approach is to support the MOH in the implementation of the national HIV/AIDS strategic plan and
initiate and strengthen HIV care and treatment services integrated into existing health services. The first
year focused on increasing human resource capacity to support the program and establish services while
the second year on gradually increasing the number of patients on treatment. The third year of program
implementation will have an increased focus on pediatric treatment, integration and linkages with TB and
HIV programs and other essential services, monitoring and improvement of the quality of services provided
to ensure a more comprehensive package of care for PLHA.
Activities to be implemented relate to 5 main program objectives.
1) Objective 1: Improve and expand care and treatment services for HIV-infected adults including pregnant
To ensure that human capacity to provide quality services are in place, EGPAF will continue supporting the
training of clinical staff (doctors, nurses, tecnicos de medicina), and pharmacy staff, as well as lay
counselors and other staff involved in HIV care and treatment services. This includes pre-service training
of tecnicos de medicina (physician assistants) at the Institute of Health Sciences (Instituto de Sciencias de
Saude) in Nampula province as well as in service and refresher training for all clinical staff. Specific training
includes training on provision of HIV care and ART for pregnant women.
Increased emphasis will be placed and more staff time allocated to regular case reviews and on-going
clinical mentoring of staff in HIV care and treatment. Implementation of supervision tools developed in the
second year will ensure that supervision is standardized and objective.
In addition, EGPAF will collaborate with the Federal University of Rio de Janeiro (FURJ) to support the
mentoring of laboratory staff; one week intensive mentoring at each site will help to improving the quality of
laboratory tests and adherence to SOPs. EGPAF will recruit through a pre-contracting mechanism,
additional health staff including counselors where this is needed.
EGPAF will support the District and Provincial Health Authorities in Gaza, Nampula and Cabo Delgado
provinces to hold HIV and ART coordination meetings with partners and implementing agents to ensure
coordination of activities, exchange experiences between sites and address problems in program
implementation and service quality. Efforts will be made to ensure that case reviews are included as part of
these meetings. EGPAF will provide technical support to facilitate these case reviews.
Objective 2: Improve and expand pediatric care and treatment services for HIV-exposed and infected
infants and children
To further expand access to pediatric treatment and to achieve EGPAFs objective to ensure that 15% of
people on ART are children, EGPAF will support similar activities as for adult treatment but focusing
specifically on pediatric treatment, i.e. (refresher) training of clinical staff at provincial and district levels, on
the job training, supervision and mentoring. Further training on IMCI/HIV/AIDS, early infant diagnosis and
DNA-PCR will be provided.
Through a collaborative relationship with Baylor, EGPAF will provide the opportunity to Mozambican
medical doctors and medical assistants (tecnicos de medicina) for two-week attachments in pediatric HIV
care and treatment, thus receiving much needed hands on training and intensive mentoring. These
attachments with Baylor/BIPAI have been very successful in improving skills to provide pediatric care and
treatment and boosting confidence of clinical staff to initiate infants and children on ART.
To expand access to pediatric treatment in the northern part of the country and increase capacity of
responsible Provincial and District Health Authority (DPS and DDS)staff to manage this program, EGPAF
will second a pediatric HIV/AIDS technical advisor to the DPS in Nampula. This person will work closely with
the pediatric treatment coordinator for the 3 Northern provinces, Dr. Zeferino and support provincial level
pediatric treatment scale up, monitoring and superivion in Nampula, Cabo Delgado and Niassa.
A significant proportion of children on treatment are adolescents. However, the special challenges these
children face in dealing with chronic illness and lifelong treatment, the special needs as they become
sexually active and challenges related to disclosure are currently hardly dealt with in the program. To
address this important gap, EGPAF, in collaboration with the Ministry of Health and other treatment
partners, will work to adapt, test and implement counseling and psychosocial support materials and
activities for adolescents and their families to be implemented within the health facilities and community-
Finally EGPAF will work to ensure linkages between existing OVC programs and the care and treatment
program, particularly in Gaza Province. Working through community-based and other organizations with
programs targeting OVC and their families, EGPAF will promote HIV counseling of OVC and ensure their
access to HIV care and treatment programs.
Objective 3: Build capacity of health facilities and community to provide psychosocial, nutritional and
educational support to PLWHA and their family members and to sensitize the population on HIV/AIDS
EGPAF will continue to train lay counselors and increase their role in providing counseling and psychosocial
support for patients enrolled in the care and treatment program. Activities will include developing
subagreements with CBOs to provide community-based education on HIV, PMTCT and treatment literacy;
establish support groups and conducted active tracing of defaulting patients. The number of CBO
subgrantees will increase to ensure that in each district the program is linked with community-based support
In addition specific activities targetting children and adolescents will be enhanced by providing training,
workshops, continuous technical assistance and the provision of counseling and IEC materials. EGPAF will
organize three-day Children's Camps to enable children to share with peers their experiences and problems
Activity Narrative: related to having to deal with a chronic disease requiring life-long treatment and affecting their lives and
relationships. Children will receive relevant HIV, adherence and positive living education and psychosocial
support through play, discussions, individual and groups counseling.
Objective 4: Build institutional capacity of the MOH to plan, monitor and manage the national ART program
EGPAF will increasingly focus on district level support and technical assistance to DPS to oversee and
manage the care and treatment programs. Involvement of province and district level staff in joint supervision
functions not only as a means to train and mentor site level staff, but also to train MOH supervisors in
formative supervision skills, the use of supervision tools and providing constructive feedback. EGPAF will
provide coordination support and technical assistance to the HIV and ART meetings at provincial and
district level as a forum to ensure coordination of activities, identify and address problems, and provide
technical inputs. EGPAF will also support proper forecasting and management with a focus to the
laboratory and pharmacy departments at provincial and district level.
EGPAF will continue to provide technical assistance at the national level by participation in central level
working groups to develop and update guidelines and training. Our specific focus will be on pediatric care
and treatment (National Pediatric ART Committe) including psychosocial support.
Funding will also be used to implement infrastructure and space improvements (treatment services,
pharmacy, laboratory) at sites where EGPAF plans to implement care and treatment programs.
Objective 5: Improve monitoring and evaluation systems and implement quality assurance mechanisms to
enhance care and treatment services
The implementation of the Patient Tracking system will be expanded to all supported sites; this will be an
important tool to monitor program progress and quality. EGPAF will continue working to support and expand
implementation of QI tools and processes (HIVQual) in the supported sites, ensuring that quality monitoring
becomes routine and staff is capacitated to assess program quality and adequately address problems as
well as document lessons learned. In addition, through district and provincial level support, EGPAF will
contribute to quality improvement within the ditrict that EGPAF supports treatment services by particpating
in supervision and program monitoring jointly with the MOH staff.