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
Noted April 24, 2008: With these additional funds CRS in collaboration with TRAC will purchase vehicles
and fuel and recruit drivers to carry supervisors recruited by TRAC to initiate and scale-up quality
performance measurement of PMTCT program in Rwanda.
This is a continuing activity from FY 2007. No narrative required.
This is a continuing activity from FY 2007.
CRS began providing basic palliative care to 5,300 PLHIV at 14 sites in FY 2007. Palliative care services in
FY 2008 will continue including clinical staging and baseline CD4 count for all patients; follow-up CD4 every
six months; management of OI, STIs, and other HIV-related illnesses; routine provision of CTX prophylaxis
for eligible adults, children and exposed infants based on national guidelines; basic nutritional counseling
and support; positive living and risk reduction counseling; pain and symptom management; and end-of-life
care. In addition, CRS will continue to provide psychosocial counseling including counseling and referrals
for HIV-positive female victims of domestic violence. To ensure comprehensive services across a
continuum, CRS through the partnership with CHAMP and other community services providers, refers
patients enrolled in care to community-based palliative care services based on their individual need,
including adherence counseling, spiritual support, stigma reducing activities, OVC support, IGA activities,
and HBC services for end-of-life care. Through SCMS, CRS will provide diagnostic kits, CD4 tests, and
other exams for clinical monitoring, and will work with SCMS for the appropriate storage, stock
management, and reporting of all OI and STI-related commodities.
In FY 2008, CRS will expand its services to provide palliative care for 5,300 existing patients and an
additional 3,672 new patients at 14 existing sites and five new sites including two ART sites and three
TC/PMTCT sites. Expanded services will emphasize quality of care, continuum of care through operational
partnerships, and sustainability of services through PBF. Strengthened nutritional services through training
and provision of nutritional care will include counseling; nutritional assessments using anthropometric
indicators; management of malnutrition through provision of micronutrient and multivitamin supplements;
and links to Title II food support for clinically eligible PLHIV and children in line with national nutrition
guidelines. CRS will also support referrals for all PLHIV and their families for malaria prevention services,
including for the provision of LLITNs, in collaboration with CHAMP, GFATM, and PMI; and referral of PLHIV
and their families to CHAMP CBOs and other community-service providers for distribution of water
purification kits and hygiene health education. Strengthened psychological and spiritual support services for
PLHIV at clinic and community levels will be done through expanded TRAC training in psychological
support for all CRS-supported health facilities and community-based providers, including GBV counseling,
positive living, and counseling on PFPs.
In addition, the MOH will implement a new community health policy in FY 2008. The policy calls for the
election of male and female leaders for every 100 households to lead community health activities, organize
other community volunteers into associations and supervise their activities. With the assumption of 20
community health leaders per each health facility, CRS will support 19 facilities to train, equip, and
supervise 380 community health leads. They will also organize periodic meetings to ensure quality and
coverage of community-based HIV services and linkages between communities and facilities. In addition to
these health community leads, CRS will also train 130 health care workers.The facility-based case
managers, health community leads, health care workers, and community-based volunteers constitute an
effective system that ensures continuum, coverage and quality of palliative care.
In order to ensure a continuum of HIV care, CRS, in collaboration with CHAMP, will recruit case managers
at each of the supported sites. These case managers, with training in HIV patient follow-up, will ensure
referrals to care services for pediatric patients identified through PMTCT programs, PLHIV associations,
malnutrition centers, and OVC programs. To do this, the case managers will have planning sessions with
facilities and community-based service providers and OVC services providers for more efficient use of
patient referral slips to ensure timely enrollment in care and treatment for children diagnosed with HIV/AIDS.
Case managers will conduct regular case reviews with other partners included in the referral system to
review the effectiveness of the system, identify challenges and design common strategies to overcome any
barrier to pediatric patients routing between services. In addition, adult patients enrolled in care will be
encouraged to have their children tested and infected persons taken to HIV care and treatment sites.
CRS-supported sites will assess individual PLHIV needs, organize monthly clinic-wide case management
meetings to minimize follow-up loss of patients, and provide direct oversight of community volunteers. The
community volunteers will be organized in associations motivated through community PBF based on the
number of patients they assist and quality of services provided. CRS will work with CHAMP to develop
effective referral systems between clinical care providers and psychosocial and livelihood support services,
through the use of patient routing slips for referrals and counter referrals from community to facilities and
vice versa. Depending on the needs of individuals and families, health facilities will refer PLHIV to
community-based HBC services, adherence counseling, spiritual support through church-based programs,
stigma reducing activities, CHAMP-funded OVC support, IGA activities (particularly for PLHIV female- and
child-headed households), legal support services, and community-based pain management and end-of-life
care in line with national palliative care guidelines.
PBF is a major component of the Rwanda EP strategy for ensuring long-term sustainability and maximizing
performance and quality of services. In coordination with the HIV PBF project, CRS will shift some of their
support from input to output financing based on sites' performance in improving key national HIV
performance and quality indicators. Full or partially reduced payment of palliative care and other indicators
is contingent upon the quality of general health services as measured by the score obtained using the
standardized national Quality Supervision tool. DHTs now play a critical role in the oversight and
management of clinical and community service delivery. CRS will strengthen the capacity of two DHTs to
coordinate an effective network of palliative care and other HIV/AIDS services. The basic package of
financial and technical support includes staff for oversight and implementation, transportation,
communication, training of providers, and other support to carry out key responsibilities.
Increasing pediatric patient enrollment is a major priority for all EP clinical partners in FY 2008. To expand
quality pediatric care, Rwanda's few available pediatricians will train other clinical providers, using the
innovative model developed in FY 2006 and continuing in FY 2007 and FY 2008. CRS will support health
facilities to refer HIV-positive children to OVC programming for access to education, medical, social and
legal services. CRS will also support sites to identify and support women who may be vulnerable when
disclosing their status to their partner, and include in counseling the role of alcohol in contributing to high-
This activity addresses the key legislative areas of gender, wrap around for food, microfinance and other
Activity Narrative: activities, and stigma and discrimination through increased community participation in care and support of
In FY 2007, CRS began to implement the national TB/HIV policy and guidelines at their 14 supported sites.
The program's achievements include an improvement in the percentage of TB patients tested for HIV and
improving the HIV-infected TB patient's access to HIV care and treatment (increased proportion of patients
accessing cotrimoxazole and ART). In FY 2008, the goal is to ensure at least 95 % of all TB patients are
HIV tested, 100% of co-infected patients receive cotrimoxazole and 100% of those eligible receive ART at
14 AIDSRelief supported ART sites. At five AIDSRelief-supported PMTCT and HIV care and treatment
sites, 70-80% of 5,300 patients enrolled in HIV care are routinely screened for TB. However, lower than
expected numbers of PLHIV in care and treatment are diagnosed and treated for TB. The priority in FY
2008 will be to expand implementation of regular TB screening for all PLHIV, and for those with suspect TB,
ensuring adequate diagnosis and complete treatment with DOTS.
In FY2007, CRS supported sites with materials and training in routine recording and reporting for the
national TB/HIV programmatic indicators. Initial uptake and quality of services has been variable at different
sites. In FY 2008, CRS will support individual sites to both collect quality data, and to report and review
these data in order to understand and improve their program and support integration of TB and HIV services
at the patient and facility level, per national guidelines. Additionally, in FY 2007 two staff from each district
underwent initial respiratory infection control training and have begun drafting infection control plans.
HIV services are not yet available at all facilities in Rwanda. In order to ensure effective integration of TB
and HIV, CRS is supporting integrated planning and TB/HIV training to both HIV service providers and TB
service providers. CRS also plans to increase support to integrate diagnostic services, including
coordinating specimen transport for both programs, and patient transport for appropriate diagnostic services
(such as chest radiography and diagnostics required for extrapulmonary TB) to referral centers and
In FY 2008 This EP implementing partner will continue to support 14 existing sites and add five new sites
for the implementation of the TB/HIV component of the clinical package of HIV care.
Besides site level TB/HIV support activities, in FY 2007 CRS also supported in a senior TB/HIV staff
position to participate in TB/HIV programming implementation and monitoring at national level in
collaboration with PNILT and TRAC and other EP partners. In addition, this EP implementing partner
provided TA, training and materials to Butare University and Kigali national hospital pathology labs for the
diagnosis of smear negative and extrapulmonary TB. Physicians were trained in lymph node aspiration,
while lab technicians were trained in specimen processing. In FY 2008, CRS will continue supporting this
staff position, and support two laboratories trainings, and provide additional training to five other regional
laboratories in pathology specimen processing. The materials and supplies for these three laboratories are
purchased under SCMS. This activity reflects the ideas presented in the Rwanda EP five-year strategy and
the Rwandan National Prevention Plan by advancing the integration of TB/HIV services through the
operationalization of policies and increased coordination of prevention, counseling and testing and care and
treatment services. Lessons learned from integrating TB and HIV will serve in integrating HIV into the
primary healthcare system.
This activity is continuning from FY 2007. No new narrative is required.
Noted April 24, 2008: With these new funds CRs through its consortium member Institute of Human
Virology ( IHV) will support district hospitals in Rwanda for quality performance measurement at those
facilities and also at decentralised health centers. A set of indicators is being developped by Ministry of
Health and the national PBF program to measure the quality of HIV services. As part of the quality
improvement activity IHV will provide technical assistance to TRAC and hospital staff to improve their
services delievery filling the gaps identified by the quality indicators on patitent retention, data recording at
site, ontime CD4 count, TB screening in HIV patients, etc...This activity will improve the quality of HIV
service in Rwanda.
This is a continuing activity in FY 2008. However there is a new component in which CRS/AIDS Relief,
through the Institute of Human Virology (IHV), will build clinical capacity in Rwanda to ensure quality of HIV
services -including a significant emphasis on timely CD4 count, viral load and shifting to second line
regimen, prevention services, PITC--and continuity of care. In order to assure appropriate emphasis on
testing and prevention services, expertise will be used from CDC, WHO, or other organizations as
appropriate. Mentoring for a broader range of providers than those who treat HIV positive individuals,
including those who come into contact with untested HIV patients in outpatient or inpatient settings, will be
an essential component of this program.
Unprecedented HIV treatment scale-up is occurring in resource challenged health facilities in Rwanda,
where there is limited technical support and minimal local experience in providing continuity of care. Local
providers need additional support to provide quality care, increase clinical judgment and clinical decision
making, and to assure that testing and prevention services are given the same importance by clinicians as
treatment. However, this will not be accomplished through the prevailing didactic training model alone.
Significant challenges include: (1) it is difficult to apply classroom style didactic training to clinical practice;
(2) the sheer number of patients that require treatment and prevention services makes classroom training
difficult; (3) there are few local providers with ART or prevention expertise; and (4) the limited use of
evidence-based data in the different targeted populations to guide the clinical decision making process.
This makes the need for a new model of resident in-service training even more acute.
EP will support, through AIDSRelief, a national-level intensive mentoring and quality improvement program
in partnership with TRAC PLUS and the MOH. The primary goal is to build HIV care, treatment and
prevention expertise within the Ministry's clinical staff and local mentoring teams comprised of physicians
and ancillary health care providers and those with prevention expertise. The clinical mentoring teams will
support HIV prevention, care, and treatment programs at all levels of the national health care system
through an interdisciplinary team approach.
The focus will be on: encouraging and training health care clinical staff in implementing provider-initiated
HIV testing and counseling (PITC); prevention for positives (PFP); patient medical management with
emphasis on HIV care, treatment, and prevention; management of complex patient issues; in-patient
medical management with emphasis on accurate diagnosis and appropriate treatment of opportunistic
infections; community adherence and treatment support; laboratory and radiographic infectious disease
diagnostics; outpatient health care management and HIV care management; and addressing clinical
challenges in different aspects of health care delivery. Moreover, the mentoring teams will not only provide
front line providers with greater clinical and prevention skills, but they will also identify best practices and
develop initiatives to improve the overall quality of care and prevention through better clinic management
decisions, mainstreaming and integration of HIV testing and prevention services into clinical care, clinical
flow, and overall clinical program benchmarking—including explicitly measuring performance in PITC and
prevention for positives.
A key component of this activity will be on encouraging and training health care clinical staff in provider-
initiated testing and counseling and prevention for positives activities. This activity will include continuing to
work with the GOR to establish policies and protocols for provider-initiated testing and counseling and
developing training tools for health workers. It will also address reducing institutional or other barriers to
testing and making PITC a standard of good care. Provider-initiated HIV testing and counseling is endorsed
by WHO and UNAIDS and presents an opportunity to ensure that HIV is more systematically diagnosed in
health care facilities in order to facilitate patient access to needed HIV prevention, treatment, care and
support services. PITC must become the standard of care which is taught and practiced by clinicians.
AIDSRelief activities in this area will be in alignment with the WHO Guidance on provider-initiated HIV
testing and counseling in health facilities, and will take into account the current environment and capacity of
the GOR and the health care facilities. An initial needs assessment that assesses removal of barriers to
routine PITC and PFP will provide a baseline evaluation and help develop and introduce a harmonized and
supportive system within each health facility. This activity will also link directly with the Rwandan EP
programs priority of making Prevention for Positives the standard of care in all treatment settings.
These activities will also emphasize building advanced HIV treatment knowledge particularly in the areas of
side effects, resistance, durable treatment response and the latest HIV information and data,
implementation of continuity of care systems and long term follow-up, and quality improvement. At the
community provider level, the emphasis will be on enhancing basic clinical skills and site level capacity for
developing treatment and adherence programs. HIV/ARV treatment education competence will be
enhanced through training of trainers, teaching community focused curricula and development of training
materials. Training will also focus on improving competence for community adherence staff, community
counselors, nurses, and volunteers. In the field, preceptors will assist community workers with identifying
side effects to treatment and developing specific follow-up plans for new patients starting ARVs. In the clinic
preceptors will provide training for the counseling and education of patients who are preparing for ARV and
problem solving techniques for addressing specific adherence problems. At the district hospital, the
preceptors will also provide general clinical care guidance to district medical officers who are often young
This activity will support nationwide coordination of treatment, care, and prevention quality improvement
activities, integration of existing systems and national standards into the mentoring, coordination of key
stakeholders and implementing partners, data analysis and dissemination, performance monitoring of the
project, and supervision of the mentoring teams. The training will be followed with on-site mentoring and
technical assistance, semi-annual refresher trainings and introduction of new tools and technologies. The
mentoring team and the site providers will perform together continuous chart reviews, disease specific chart
Activity Narrative: reviews, mortality rounds and case studies (including studies focused on prevention services). By reviewing
specific clinical problems, the mentors will improve clinical practice and provision of care and prevention
The initial plan is to form four mentoring teams stationed at four regional district hospitals, but the final
number of mentoring teams necessary will be determined in coordination with TRAC PLUS. These teams
will be hired and trained on models of comprehensive care, treatment, prevention and evaluation. They will
build on their skills and improve techniques to form an effective mentoring and quality improvement program
team at the decentralized level. Each team will be comprised of at least one physician, one nurse educator,
one adherence and community prevention specialist, and one laboratory technician. Each team will be
responsible for at least 5-8 sites in an initial phase until these sites have reached capacity and implemented
improvement activities. The portfolio of the mentoring teams will increase gradually as new sites are
phased in for capacity development and participation. One highly experienced antiretroviral treatment expert
(Preceptor) will be paired with 2-5 less experienced providers (Mentors) per region. The mentors and the
preceptor will work as a team within a selected district hospital, seeing patients together two to three days a
week. Seeing patients in follow-up together is critical for clinical decision making, to see progression of the
disease, confirm diagnosis, witness the outcomes of a shared decision making process, and monitor that
appropriate prevention services are provided to the patient. This interaction will lead to highly experienced
local experts/mentors who are taught the process of HIV continuity of care, efficient outpatient clinic
management, quality improvement techniques, as well as clinical decision making.
The goal is to build local clinical capacity to manage complexities associated with HIV/AIDS and to make
sound programmatic and clinical judgments to improve the quality and depth of health care services,
including prevention services provided to the local communities.