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.
In COP08, Pro Health International (PHI) provided counseling and testing to 1,200 pregnant women with
training of 10 healthcare workers (HCWs). In addition, at least 80 traditional birth attendants (TBAs) were
trained. In COP09 PHI will provide a comprehensive package of PMTCT services in Rivers and Cross River
states of Nigeria, through the HARPIN program (HIV/AIDS Reduction Program In the Niger-Delta). Through
effective mobilization of resources, community participation and stakeholder involvement, PHI will carry out
this multifaceted program by building local capacity and strengthening existing healthcare delivery systems
to achieve Prevention of Mother to Child Transmission. In view of this pursuit, PHI will support 4 selected
health facilities (with the view of establishing a hub and spoke design of comprehensive treatment) in
providing the minimum package of PMTCT - these four facilities will be selected based on strategic
capacity to create the most meaningful impact on the long term, provide testing and counseling services to
3,700 pregnant women, of which 3,556 will receive their results; provide ARV prophylaxis to an estimated
104 positive pregnant women and providing training in PMTCT to 25 healthcare delivery staff especially
ANC, labor and delivery staff (five from each of the four facilities) while ensuring that national standards are
adhered to at the minimum.
In the PHI PMTCT program a ‘top to bottom' approach to advocacy will be employed during which
stakeholders will be identified and engaged appropriately to ensure a hitch free program execution and also
to build a basis for program sustainability. These stakeholders include the community leaders, traditional
leaders, religious leaders, policy makers, TBA and youth group leaders, association leaders, and age group
leaders. Visits will be made to the State Ministry of Health to introduce and gain support for the program
from the ministry. Similar visits will be made to the respective local government councils, SACA, SASCAP,
LACA etc., for the same reasons. Other state level committees that are involved in PMTCT will also be
visited and intimated on the HARPIN program as a means of integrating the program into already existing
HIV/AIDS frameworks. Of particular interest will be the PMTCT/Pediatrics committee. The HARPIN program
will also be involved in state HIV/AIDS activities. Facility level advocacy will be aimed at key hospital staff in
a bid to gain their support and acceptance of the program. This will translate to a means of achieving target
as other staff within the same facility will be encouraged to refer pregnant women to the proper unit where
they will access testing and counseling and early enrollment into the program with linkages to treatment and
care if found positive. Facility level advocacy to nearby facilities without PMTCT services will further
accomplish this objective. Since gender disparities like gender-based violence, female coercion, trans-
generational sex, and inequitable gender roles are known drivers of MTCT, community gatherings, women
group meetings, support group meetings, local government staff meetings, and other gatherings will be
used as an avenue to address these gender disparities and disseminate gender-based messages that
affect PMTCT, as well as avenues to encourage the practice of infant male circumcision. These are with the
aims of reducing HIV transmission, reducing stigma, and making the stakeholders gain acceptance of the
program down to the grassroots level.
The most cost-effective health facilities will be used and this will be achieved by selecting secondary health
facilities where there is high traffic of patients, especially pregnant women. Where these are not available
the most viable PHCs will be utilized. These health facilities will be supported to provide counseling and
testing for pregnant women, ARV prophylaxis to prevent MTCT, counseling and support for safe infant
feeding practices, and finally family planning counseling or referral. These will be in accordance with the
national guidelines. A viable network of comprehensive prevention, treatment, care and support will be
established between these health facilities and other providers of HIV/AIDS care, treatment and support
services to facilitate patient referral and linkage to other services that may not be available at the supported
health facilities. Health facilities will be supported to provide basic laboratory services by providing technical
assistance with donation of laboratory materials from the free healthcare program in the Niger Delta. Of
particular interest would be establishing a ‘hub and spoke' design of ARV treatment and PMTCT services,
should more funds be available as a means of creating a complete continuum of diagnosis and treatment
for those who are positive and to prevent client loss.
Both formal and hands-on training will be provided to both lay counselors and the health facility staff
(especially labor and delivery staff) with emphasis on the former so as to avoid over-burdening the local
health workforce, should that be the case. Attempts will be made to mostly use PLWHAs as the lay
counselors. They will provide counseling and testing for all ANC, labor and delivery clients using the
provider-initiated opt-out approach while ensuring that patients' right to refusal are guarded. Post-test
counseling will include an assessment of the mother's risk of infection as well as information on reduction of
and the risks of MTCT. Partner testing with partner focused counseling techniques will be utilized while
ensuring that test results will be made available on the same day using the serial algorithm. In addition to
the regular post test counseling, clients that test positive will be linked to the prevention with positives
program as a means of preventing further transmission or re-infection leading to increased viral load.
Clients that test negative will be counseled to stay negative. Infants of mothers that test positive will be
referred for early infant diagnosis (EID). This will enable prompt referral for pediatric treatment, care and
support facilities including the OVCs.
In the PMTCT program PHI will identify and provide a complete course of ARV prophylaxis to 104 positive
pregnant women with their babies of the 3,556 that will receive HCT results. Following confirmatory tests,
CD4 estimation and subsequent staging at designated referral sites will be carried out. All positive pregnant
women will be given sdNVP to take home at their first visit. HIV positive pregnant women will be
categorized into those needing HAART and those requiring conventional prophylaxis. Client with high CD4
counts (above 350) will receive ARV prophylaxis, while those with low CD4 counts (below 350) will often
require HAART and will be linked to a referral ARV center. The other two-thirds who will require
conventional ARV prophylaxis will then be commenced on the current WHO recommended short course
ARV prophylaxis which will include ZDV from 28 weeks, intrapartum NVP, and a 7 day ZDV/3TC post-
partum tail. Alternatively, a regimen consisting of combivir with nevirapine will be given at 36 weeks or
during labor. Following delivery, all HIV-positive women will be linked to comprehensive treatment, care,
and support sites especially where pediatric and adult services are co-located and long term follow-up
instituted. Infant prophylaxis will be according to the Nigeria National PMTCT Guidelines, which recommend
a single dose of NVP with ZDV for 6 weeks and will be accessed at referral sites. All exposed infants with
their mothers will be linked with care and treatment services including providers of cotrimoxazole
Activity Narrative: suspension pending a negative virologic diagnosis after EID testing.
Training will be provided to healthcare workers on counseling and support for safe infant feeding, which will
be provided at the 4 supported health facilities. HIV-positive women will be counseled pre/postnatally on
breastfeeding using the WHO/UNICEF curriculum adapted for Nigeria. Positive mothers will be counseled
and supported on the use of exclusive breastfeeding with early weaning as one option. They will also be
intimated on the pros and cons of other options like the exclusive use of breast milk substitute (BMS) and
allowed to make an informed choice, in accordance with the national program. Linkages will be established
with proximal OVC programs for the provision of safe weaning nutritional supplements, provision of water
guard, bed nets and other home-based care materials. Also, linkages will be established with support
groups that will provide education and ongoing support around infant feeding choices and prevention with
positives. PHI will consider the affordability, feasibility, acceptability, sustainability and safety of each of the
services offered. Direct training for a total of 25 HCWs including community based health workers will be
provided using the National PMTCT Training curriculum. These HCWs will also be provided with follow up
and mentoring by PHI PMTCT specialists to ensure proper and adequate use of knowledge and skills
acquired during training. PHI will conduct referrals and linkages for family planning to accessible centers
while group counseling will be provided in other areas like nutrition and general prevention of HIV/AIDS.
The HARPIN PMTCT program will be closely monitored by the PHI strategic information unit headed by the
strategic information officer. National PMTCT registers and summary sheets will be provided to the
supported facilities. Training, in addition to monitoring and evaluation, will be provided on proper data
collection and entry methods as the means to data quality assurance. Site data will be collated and
collected weekly following which it will be entered into the master data sheets and analyzed for reporting
and action. Qualitative assessments will also be carried out by regular site visits by PHIr staff and external
assessors. As the need arises, PHI will also provide assistance to the state committee for site visits.
Monthly reports will be sent to PHI headquarters in Jos while quarterly reports will be sent to USAID and the
GON (NACA and NASCAP).
Partnerships will be developed with other USG and non-USG implementing partners to build PHI's capacity
by way of adopting best practices; leveraging on laboratory and testing services like CD4 count and PCR
estimation for EID; capacity building and mentoring, etc. These will help to boost PHI's capacity in the
program year as well as adding value to its PMTCT service delivery.
The emphasis areas for this program are building of local capacity and network/linkage formation. Local
health workers that reside within the target communities will be given priority during selection to ensure an
increase in the local pool of human capacity. Linkages and referral paths will be created with other IPs,
FBOs, CBOs and CSOs as a means of ensuring that clients and patients do have easy access to needed
services promptly.
PHI will hold a two-day training for traditional birth attendants with a view to building the requisite community
framework for the mobilization and referral of pregnant women within the community. The TBA training is
aimed at improving access to PMTCT services especially in the rural regions where TBA services are
preferably patronized.
New/Continuing Activity: New Activity
Continuing Activity:
Emphasis Areas
Health-related Wraparound Programs
* Child Survival Activities
* Family Planning
* Safe Motherhood
Human Capacity Development
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
Rivers and Cross River are two out of six states within the south-south geo-political region of Nigeria with
high oil exploration and tourism activities. The south south geo-political region is most negatively impacted
by the HIV/AIDS pandemic. The National AIDS and Reproductive Health Survey (NARHS 2005) revealed
that this region had the highest prevalence of transactional sex and multiple sexual relationships with
marital and non-marital partners. This region also had the highest number of individuals who had sex with
non marital partners in 12 months preceding the survey. Two-thirds of women located in this region had
more than one sexual partner in 12 months preceding the survey. The south-south region also had the
highest rate of non-marital non-cohabiting sexual relationship in the country, including both heterosexual
relationships and men who have sex with men (MSM). In addition, the south-south region has the worst
stigma and discrimination national figures for family and non-family members who are living with HIV/AIDS.
In the Nigerian Sentinel Survey of 2005, the south-south region had the second highest rate of HIV
prevalence (following the north-central region).
Drivers of the HIV epidemic in the south-south region include high levels of transactional sex, poverty, cross
generational sex, multiple partnering, oil glut and attendant liquidity, tourism, social insecurity, high cost of
living, and cultural practices and festivals that encourage casual unprotected sex (e.g., the New Yam
Festival). Secondary school-based studies in the region indicate that 22.6% of sexually active female
adolescents had multiple sexual partners, with age at sexual debut at 14 years. Cross River State, with its
rapid emergence of tourist spots (the TINAPA free trade zone and resort, for example) is likely to show
increased sexual networking. In Rivers state, only 6.2% of sexually active individuals consistently and
correctly use condoms with their partners. High risk behaviors have been found in the Niger Delta region,
with about half of 15 to 22 years engaged in casual sex with commercial sex workers (CSWs) without
condom. Peer pressure influence to engage in sex, unfavorable socio-cultural factors, gender norms, and
low socioeconomic status are identified risk factors for early sexual debut, multiple partnerships and cross
generational sexual activity in this region. Early sexual debut was common among uneducated female rural
dwellers.
In view of the above, Pro Health International (PHI) seeks to establish sustainable behavior change among
the target population of youth (15 - 25 years of age) in Rivers and Cross River states of the south-south
region. Specific targeted behaviors include: delayed sexual debut untill marriage; being faithful to one
partner; and correct and consistent use of condoms. This will be done through messages on abstinence and
fidelity in addition to facilitating increased knowledge of HIV/AIDS, risky sexual behaviors and risk
personalization, and also through instituting interventions that encourage community-based normative
changes to provide a congenial environment needed for sustained behavior change.
The behavior change objectives will be achieved using the minimum package intervention strategies of peer
education, community- and school-based HIV clubs, and interpersonal communications targeting out-of-
school and in-school youth with abstinence/be faithful (AB) messaging. Small group discussions, rallies and
advocacy interventions at the community level and the formation of community based organizations will be
used to address normative changes to support behavior change.
Pro Health's condoms and other protection (C&OP) strategy for COP09 is a peer-led, containment strategy
targeted at PLWHAs within the community based on the premise that preventing a positive person from
transmitting the virus is the most effective way to avert new infections through sexual transmission. The
HARPIN sexual prevention program for COP 09 will have 4 intervention components; peer education plus
(PEP); interpersonal communication; formation of community based HIV clubs; and community awareness
campaigns/rallies targeting out-of-school in line with the minimum package as recommended by the
National Prevention Plan. Peer education trainers (PETs) will be identified and trained with the Society for
Family Health (SFH) PEP manual for out-of-school youth. Other in house trainings on volunteer
management, advocacy and communication for social change, adolescent psychology, cultural and social
studies, financial and administrative management will complement the PEP training. These trainings are
geared towards building peer education specialists who will train additional peer educators (PE) and build
the requisite environmental framework for achieving sustainable behavior change through the minimum
package for sexual prevention. PETs will select 5 out of school peer education groups (PEG) in each LGA
using a participatory approach at open community meetings. The out of school PEGs will be trained for a
period of 6 months and then be required to reach their peers.
Peer educators will organize small discussion groups of their peers to discuss topics related to personal life
and experiences. These discussion groups will be branded ‘Club ABC' and develop later into community
based organizations (CBOs). Peers will be reached individually with interpersonal communication as well.
Local CBOs already involved in HIV/AIDS prevention will also be engaged in reaching the community.
The second component is peer education for in-school youth. They will be reached with the UNICEF Peer
Education training manual, small group discussions, and school based HIV/AIDS clubs. 5 schools in each
LGA will engage in the peer education program. Support from the State Ministry of Education will ensure
that schools with ongoing interventions are prioritized. PETs will train PEs who will reach peers with AB
messages. In addition, peers will be required to form small discussion groups around HIV/AIDS topics and
issues relating to personal life and experiences. At about the sixth month of the program, the in-school
peers and peer educators will then form a school based club branded as ‘High Flyers Club'. In all, one
thousand (1000) peer educators will be trained to reach twenty seven thousand two hundred and seventy
three (27,273) of their peers (13,637 males and 13,636 females).
The third component involves advocacy for community level normative change, community participation and
stigma reduction, with the consent and participation of relevant stakeholders. The state ministries of health,
education, youth and sport, and social welfare will be informed and their consent and support sought to
engender acceptability and participation. The local government councils will be visited to advocate support,
commitment and eventual ownership of the program. Traditional leaders will be visited to canvas their
support and permission to reach people with the programs. Other stakeholders in the community will be
visited to rally their support and seek avenues through which the whole community can be reached.
Activity Narrative: Two advocacy officers (AOs) will utilize avenues, such as town meetings, trade union meetings, church
services and gatherings, youth meetings, women groups, interest groups and other meetings within the
community to facilitate discussions about stigma and discrimination against people living with HIV/AIDS
(PLWHAs). These meetings will provide an atmosphere for open discussions on HIV/AIDS in the
communities. The AOs will provide information on the magnitude of the HIV/AIDS problem and the
community's ability to fight it. The AOs will additionally stimulate community discussions on cultural issues
that fuel the HIV pandemic (e.g., sexual coercion, cross-generational sex, transactional sex and sexual
abuse) through focused discussion group sessions, interpersonal communications, and other mechanisms.
These meetings will target communities that are in close proximity to Pro Health International's (PHI)
service provision points.
The fourth component will foster behavior change among PLWHAs to avert new infections. PLWHAs will be
supported to adopt safer sexual behaviors as part of a comprehensive prevention approach. HARPIN will
target PLWHAs and other youth in their communities with awareness campaigns that include rallies and
interpersonal communication, peer education models using PLWA peer groups and age appropriate
balanced ABC messaging and referrals to medical services. PLWHAs will be trained as PEs to provide
information on various topics, including positive living, nutrition education, treatment education and
adherence, sexually-transmitted infection (STI) counseling, and referrals to medical services, including HIV
counseling and testing, PMTCT services and management of opportunistic infections. Trained PLWHA will
reach other PLWHA/high risk persons with messages. There will be rallies in collaboration with other
support groups aimed at reducing stigma and discrimination associated with HIV/AIDS. Advocacy visits will
be made to relevant stakeholders and opinion leaders to introduce and solicit their support for the project. A
total of 9,697 PLWHA (4,849 males and 4,848 females) will be reached through 100 trained PLWHAs.
Recognizing that HIV/AIDS care and treatment settings serve as strategic entry points for reaching large
numbers of HIV-infected people, the HARPIN project will continue to engender linkages between
community based prevention efforts targeting PLWHA and clinic-based, provider-delivered intervention to
help prevent the spread of HIV and also protect the health of PLWHA. Training will be provided to
healthcare providers in selected sites to provide routine care and treatment to HIV-positive patients and
deliver important health information and preventive medical care, including treatment and/or referrals for
STIs and family planning services. Health care providers will be supported to assess patients' risk and
provide targeted prevention recommendations, which encourage sex partners to get tested, disclose HIV
status to sex partners, abstain from sex or reduce the number of sex partners or maintain fidelity to one
partner, use of condoms during each sex act and appreciate the consequences of having sex without a
condom, and understand the relationship between alcohol use and how it affects adherence and increased
risky behavior. Cross referrals will be provided between facility based interventions and the community
based interventions to provide a continuum of care for PLWHA, expand program reach, and, encourage and
sustain behavior change. One condom outlet for PLWHAs will be established for each of the six local
government areas where this intervention will be implemented.
Contribution to overall program area:
The HARPIN Project's activities will address specific behaviors among youth with the aim of attaining
positive and sustained behavior change in terms of primary/secondary abstinence practice, faithfulness to
partners and correct and consistent use of condoms. The AB program will specifically provide knowledge of
abstinence skills amongst youth, while prevention with positives interventions will contribute to containment
of the disease by reducing transmission, re-infection or increased viral load among PLWHA. This will
contribute to strengthening and expanding the capacity of the GON's response to HIV/AIDS epidemic and
achievement of PERFAR goals of preventing 1,145,545 new infections.
Population being targeted:
Two primary population groups will be targeted in these sexual prevention activities. The first group will
include young men and women (15-24 years old) while their corresponding figures-of-influence (parents,
teachers and religious leaders) will be our secondary target. The second primary target group consists of
PLWHAs, while their discordant sexual partners will be the secondary target audience in this category.
Emphasis area:
The emphasis areas for this program area are human capacity building and gender balance. Emphasis will
be on building local capacity to ensure sustainability. CBOs within the community will be involved in
programs to improve their knowledge and exposure in program design and implementation.
Key legislative issues:
Key legislative issues addressed include stigma and gender, with an emphasis on community norms that
discourage stigma on PLWHA and enhanse women's ability to access and utilize information on HIV/AIDS.
Link To Other Activities
The AB and C&OP activities carried out under PHI are linked with the organization's PMTCT activities and
free healthcare efforts (with other funding).
Gender
* Addressing male norms and behaviors
* Increasing gender equity in HIV/AIDS programs
Table 3.3.02:
Table 3.3.03:
