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: 2007
This is a continuing activity from FY 2007. No narrative required.
Sex workers are often one of the groups with the highest HIV prevalence due to their high-risk sexual
behavior and their limited access (due to stigma, discrimination, and marginalization) to services for HIV
prevention, treatment, and care. A high prevalence of HIV in sex workers is a concern both for members of
these subpopulations and for the general population, as sexual mixing can facilitate transmission of HIV
from high-prevalence to low-prevalence groups.
Among EP focus and other bilateral countries, there is considerable variability in the proportion of HIV
attributable to sex workers. Country-level responses to HIV prevention among these groups is also
variable, and in some instances inadequate. In Kenya, South Africa, and Tanzania, where HIV is spread
mainly through generalized, heterosexual transmission, there is increasing evidence of HIV transmission
among sex workers, with potential for rapid spread among them. In Tanzania, Mozambique, and several
other countries, in addition to sex workers, HIV is occurring among individuals involved in "transactional
sex" (the exchange of sex for money and/or other goods with concurrent sexual partners) who are both
vulnerable to HIV and likely to be a bridge group to the general population.
In FY 2008, FHI will work closely with the OGAC prevention technical working group to define, implement,
and evaluate programming for prevention of HIV in Persons Engaged in High-Risk Behaviors (PEHRB).
Specifically, multiple TA visits will result in collaboration with FHI to define and implement a package of
services for sex workers, including community-based outreach, TC, condom programming, STI screening
and treatment, referral to PMTCT and HIV treatment and care for those who are HIV-infected. In addition,
the TWG and FHI will work together to determine policy, training, procurement and data needs to facilitate
comprehensive HIV prevention programs for national coverage in Rwanda, and prepare tools that can
assist all partners in implementing and expanding such programs.
Currently, FHI is providing STI services for sex workers at two clinical sites in Kigali. This funding will be
used to support STI services for sex workers in two additional sites, one in Kigali and one in Gitarama,
where HIV/AIDS care and treatment services are also available. These locations are EP-supported sites
and are selected based on the sex worker and truck driver populations in the area. FHI will collaborate with
the TWG on evaluation of these services for the purpose of developing best practices and evidence-based
prevention programming in high-risk groups. Funding will also be used for at least one regional visit to
another EP country in order to learn about and/or share best practices in this area.
This is a continuing activity from FY 2007.
FHI began providing basic palliative care to 17,807 PLHIV at 59 sites. 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 OIs and other HIV-related illnesses, including OI diagnosis and treatment, and
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, FHI will continue to provide psychosocial
counseling including counseling and referrals for HIV-infected female victims of domestic violence. To
ensure comprehensive services across a continuum, FHI, 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, FHI 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-related commodities.
In FY 2008, FHI will expand its services to provide palliative care to 17,807 existing patients in care and add
6,373 new patients at 59 existing sites, including 32 ART sites and 49 TC/PMTCT sites. Expanded services
will emphasize on 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, and 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 national nutrition guidelines. FHI 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 health education
on hygiene. In addition family planning education, counseling and methods will be provided to PLHIV and
their spouses. This service will be located within the counseling unit of the site to reduce need for referrals.
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 FHI-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. FHI will support 59 facilities to
train, equip, and supervise 20 community health leads per health facility reaching a total of 1,370 lead
health workers trained. These community health workers will organize periodic meetings to ensure quality
and coverage of community-based HIV services and linkages between community and facilities. The facility-
based case managers, community health leads and community based services providers constitute an
effective system that ensures continuum, coverage and quality of palliative care.
In order to ensure continuum of HIV care, FHI 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 referrals slips to ensure timely enrollment in care and treatment for children diagnosed with
HIV/AIDS. FHI -supported sites will assess individual PLHIV needs, organize monthly clinic-wide case
management meetings to minimize follow-up losses 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. FHI will work with CHAMP to
develop effective referral systems between clinical care providers and psycho-social 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.
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. FHI will support health
facilities to refer HIV-infected children to OVC programming for access to education, medical, social and
legal services. FHI 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-
risk behaviors. 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 ones taken to HIV care and treatment
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, FHI 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.
In the context of decentralization, DHTs now play a critical role in the oversight and management of clinical
and community service delivery. FHI will strengthen the capacity of four 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.
Activity Narrative: This activity addresses the key legislative areas of gender, wrap around for food, microfinance and other
activities, and stigma and discrimination through increased community participation in care and support of
In FY 2007, FHI began implementing the national TB/HIV policy and guidelines at their 59 supported sites.
The program's achievements include an improvement in the percentage of TB patients tested for HIV from
less than 70% to 95% and improving 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 eligible patients receive cotrimoxazole and 100% of those who are
eligible receive ART. In addition, at 59 FHI-supported PMTCT and HIV care and treatment sites, 100 % of
16,642 patients enrolled in HIV care are routinely screened for TB. However, lower than expected numbers
of PLWHA in care and treatment are diagnosed and treated for TB. The priority in FY 2008 will be to
expand implementation of regular TB screening and for all PLHIV, and for those with suspect TB, ensuring
adequate diagnosis and complete treatment with DOTS.
In FY 2007, FHI 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, FHI 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 of the six
supported districts underwent initial respiratory infection control training and have begun drafting infection
control plans which is being implemented in one hospital.
HIV services are not yet available at all facilities in Rwanda. In order to ensure effective integration of TB
and HIV, FHI is supporting integrated planning and TB/HIV training to both HIV services providers and TB
services providers. This EP partner 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 FHI will continue to support 59 existing sites for the implementation of the TB/HIV component of
the clinical package of HIV care.
In addition to TB/HIV activities at their supported sites, FHI will recruit three TB/HIV focal points in FY 2008.
These focal points will be provided with extensive TB/HIV training and transportation. These staff located at
FHI office will join those located at AIDSRelief, Columbia University, PNILT and TRAC and decentralization
unit at Minisante to compose the national core team of supervisors for TB/HIV integration. The team will
ensure the functioning of the national TB/HIV working group, conduct monthly regular supervision to district
and feedback sites on the improvement and achievements for TB/HIV activities. 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.
This activity is continuning from FY 2007. No new narrative is required.