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
University Research Co., LLC (URC) works with the national and provincial Departments of Health in South
Africa to expand access to and uptake of HIV testing and counseling. URC's major strategy is to assist
NDOH/PDOHs in implementing provider-initiated HIV testing, with the option to opt-out, to reduce missed
opportunities for HIV identification and further spread of HIV in the country. URC will use a collaborative
approach for rapidly expanding the HIV testing services. The approach will include integrating HIV testing
with antenatal care, sexually transmitted infections (STI), tuberculosis (TB), family planning (FP) and
general clinical service areas. Training of program managers and healthcare providers in strategies to
expand uptake of HIV testing and counseling rapidly will be a focus. URC will place temporary clinical staff
to provide HIV testing in high volume facilities where current staff are unable to meet the demand for
testing, thus ensuring that HIV clients are referred for onward treatment and support services. Finally URC
will strength supervision and monitoring systems to ensure provision of high quality HIV testing. Support will
also be provided to improve recording and reporting systems for HIV testing at all levels. The major
emphasis area is local organization capacity development, with minor emphasis on quality assurance and
supportive supervision, network/linkages/referral systems, and training. The activity targets public health
workers, community-based organizations (CBOs) and faith-based organizations (FBOs), program managers
and community volunteers, youth and adults, and STI, TB, and general clinic attendees.
Uptake of HIV testing remains low due to limited provision of this service at most facilities, staff shortages
as well as stigma and perceptions about poor follow-up and treatment options available for people with HIV
and AIDS. Since 2006, URC has been working through a CDC-funded program to expand uptake of HIV
testing at healthcare facilities in five provinces (Mpumalanga, KwaZulu-Natal, Limpopo, North West, and
Eastern Cape) to increase uptake of HIV testing. The basic strategy is to help healthcare facilities introduce
provider-initiated HIV testing and counseling as referred to in the HIV & AIDS and STI Strategic Plan for
South Africa, 2007-2011. This is being achieved by integrating provider-initiated HIV testing, with the option
to opt-out, with TB, STI, FP, antenatal care and other general clinical services targeting both adults and
youth. In FY 2008, URC will continue using the district-based HIV testing expansion model whereby public
healthcare facilities will be assisted to increase uptake of HIV testing through direct provision of high quality
provider-initiated services as well as through referrals to CT where direct HIV testing provision is not
possible. In clinics that lack the requisite number of staff or the existing staff do not have the appropriate
skills for initiating HIV testing; URC will place temporary staff (counselors and testers) to roll out the HIV
testing services. The maximum duration of temporary staff assignments to a facility will not exceed six
months. URC will develop the capacity of healthcare workers in their ability to provide high quality provider-
initiated CT services, including post-test counseling for HIV-infected and uninfected persons.
ACTIVITIES AND EXPECTED RESULTS:
URC will carry out eight separate activities in FY 2008.
ACTIVITY 1: Assist NDOH to Streamline Policies and Develop Guidelines on Provider-initiated HIV Testing
URC will work with the National Department of Health (NDOH) to develop a policy framework to streamline
the integration of provider-initiated HIV testing in clinical settings. URC will support policy dialogue
workshops at national and provincial levels to expedite the development of the policy framework as well as
ACTIVITY 2: Develop District-based HIV Testing Expansion Strategy
URC, in consultation with provincial health offices, will identify target districts for HIV testing rollout. All
facilities in a district will be covered under URC's HIV testing expansion program. URC will assist each
focus district in developing a strategy for increasing uptake of provider-initiated HIV testing services. A
typical strategy will include the following elements: (a) training facility staff in provision of HIV testing
services; (b) monitoring key performance indicators (number of people trained; number of people who
receive the HIV testing services, number of HIV-infected people referred for onward treatment and support
services percent of providers who follow national guidelines for HIV testing and counseling; quality of testing
services); (c) maintaining a training schedule (who will be trained, when will they be trained); and (d)
supervising and mentoring (who will be responsible for providing supervision and mentoring to facilities to
ensure the HIV testing is being integrated and the quality of services are per national standards, etc.). Each
district will establish a HIV testing expansion team representing HIV, maternal and child health, TB, and STI
directorates. These teams will be responsible for reviewing results every three months to determine if HIV
expansion strategies are producing desired results.
ACTIVITY 3: Establish Baseline HIV Testing and Counseling Uptake Levels in Each New Facility
URC staff will review clinic logs and patient records to establish baseline HIV testing uptake, and referrals
for antiretroviral treatment (ART) in various clinical settings (TB, STI, antenatal health clinic, etc.). These
assessments will help the facility teams identify clinical services that are offering CT as well as the levels of
uptake. The rapid assessments will also examine the quality of services that may be affecting the CT
uptake. The assessments will target both service providers and CT clients (those who accept and those
who opt-out). Observations, chart and record reviews, and interviews are some of the approaches that will
be used for data collection.
ACTIVITY 4: Training
URC will work with the departments of health to train clinic staff (doctors, nurses, midwives, counselors, and
testers) in provider-initiated HIV testing and counseling. Training will focus on how to provide basic pre-test
information and how to provide post-test counseling to HIV-infected and uninfected persons. The training
will also include a module on the management of provider-initiated HIV testing, which covers logistics,
recording and reporting, referral systems for HIV testing (for sites that are unable to provide testing within
their sites) and ART. Specific case studies will be presented and participants will work in groups to identify
Activity Narrative: gaps in CT services and suggest possible solutions. URC will provide job-aids, wall charts, and other
needed materials to improve compliance with clinical and counseling guidelines.
ACTIVITY 5: Referrals and Linkages
Not all service providers or facilities will be able to offer HIV testing within their facilities. In such instances,
URC will work with provincial and district departments of health to develop referral linkages to ensure that
clients have easy access to services. URC will also develop linkages between CT sites and sites offering
ACTIVITY 6: Community Linkages
URC will assist each participating healthcare facility to develop community linkages to increase awareness
as well as uptake of HIV testing services. This will be done through building partnerships with local
community- and faith-based organizations working in the catchments areas of clinics.
ACTIVITY 7: Compliance Audits
URC will conduct annual compliance assessments in a sample of participating facilities to assess whether
the staff complies with the national HIV testing and counseling guidelines. These assessments will also
examine the quality of performance data reported to the program.
ACTIVITY 8: Strengthening Quality Assurance and Supervision System
URC will train district and facility-level supervisors in quality assurance and quality improvement methods
and facilitative supervision techniques for improving the quality of CT services. These activities are
expected to increase uptake of HIV CT in 150 healthcare facilities (100 current and 50 new facilities) by
assisting them to rapidly expand CT services. Facilities receiving URC assistance will provide HIV testing
results to 100,000 men and women as a result of the integration of HIV CT with other high volume health
services. URC will train 1,400 healthcare workers in CT integrated with antenatal care, TB, STI and general
health services. By focusing on promoting the uptake of counseling and testing through community
structures and increasing local capacity, URC will contribute to the PEPFAR goals of 10 million people in
care and 7 million infections averted.