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.
This is a continuing activity from FY 2007.
EGPAF began providing basic palliative care to 6,469 PLHIV at 33 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, EGPAF 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, EGPAF, 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, EGPAF 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, EGPAF will expand its services to provide palliative care for 6,469 existing patients and add an
additional 3,661 new patients at 33 existing sites and four new sites, including 26 ART sites and 37
palliative care 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
with the national nutrition guidelines. EGPAF 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. In addition, EGPAF will collaborate
with TWUBAKANE ensure provision of Family planning services; 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
EGPAF-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. EGPAF will support 37 facilities
to train, equip, and supervise 20 community health leads per health facility, along with other health care
workers, reaching a total of 808 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
In order to ensure continuum of HIV care, EGPAF 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. EGPAF-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. EGPAF 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. EGPAF will support health
facilities to refer HIV-infected children to OVC programming for access to education, medical, social and
legal services. EGPAF 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, EGPAF 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. EGPAF will strengthen the capacity of five DHTs to coordinate an effective
network of palliative care and other HIV/AIDS services. The basic package of financial and technical
Activity Narrative: support includes staff for oversight and implementation, transportation, communication, training of
providers, and other support to carry out key responsibilities.
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 EGPAF began implementing the national TB/HIV policy and guidelines at their 24 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 those who are co-infected receive cotrimoxazole and
100% of all eligible patients receive ART. In addition at EGPAF-supported PMTCT and HIV care and
treatment sites, 100% of 10,130 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 EGPAF 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, this EP partner 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, EGPAF 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 EGPAF will continue to support 26 existing sites and add 11 new sites for the implementation of
the TB/HIV component of the clinical package of HIV care.
These 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.