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.
Years of mechanism: 2007
The PATH prevention of mother-to-child transmission (PMTCT) project will improve the quality, availability,
and uptake of comprehensive PMTCT services in Eastern Cape by strengthening systems that support the
delivery of high-quality, comprehensive PMTCT services, building the capacity of health facilities and staff to
provide comprehensive PMTCT services, and increasing community engagement and leadership in
promoting, supporting, and utilizing PMTCT services. Emphasis areas include training and community
mobilization/participation, with minor emphasis on quality assurance and supportive supervision. Primary
target populations include people living with HIV (PLHIV), pregnant women, HIV-exposed and infected
infants, South African-based volunteers and nurses, and provincial and district HIV and PMTCT
With FY 2007 funding, PATH in collaboration with the Eastern Cape Department of Health (ECDOH)
initiated a PMTCT program in Amatole, OR Tambo and Cacadu districts. The PATH PMTCT program
supports the South African Government's HIV/AIDS/STI Strategic Plan for 2007-2011, the Eastern Cape's
Comprehensive HIV/AIDS/STI/TB Program, and the Strategic Plan for US-SA Cooperation. PATH, the
prime partner, provides technical, programmatic, and financial leadership. The ECDOH, provides all the
facilities, systems, and local personnel. Health Information Systems Program (HISP) is responsible for
monitoring and evaluation. South African Partners, an NGO, leads the community support and mobilization
interventions. There is also a small grants program for community-based organizations. PATH will address
the root causes of gender inequity by examining values and norms. The project provides information and
support for infant feeding choices and helps clients assess their needs, considering issues such as the risk
of stigma and discrimination associated with not breastfeeding. The project provides holistic psychosocial
support to HIV-infected women. Community mobilization is led by PLHIV leaders--the majority of whom are
women, to increase knowledge about PMTCT, promote understanding of PMTCT as the equal responsibility
of men and the community, and work toward transforming current norms, stigma and discrimination that
hold women solely responsible for having HIV and transmitting HIV to children.
ACTIVITIES AND EXPECTED RESULTS:
This program will strengthen the ability of current PMTCT facilities to provide a minimum package of
services, enable the ECDOH to expand PMTCT services by training and supporting providers such that
they can provide comprehensive services, and raise awareness of and support for PMTCT service use
within communities. The project is focused on the public sector and dependent communities only.
ACTIVITY 1: Systems strengthening
Building on FY 2007 activities, FY 2008 resources will be used to ensure continuity of system strengthening
activities. One set of interventions will strengthen human resource capacity: training existing but untrained
facility staff (e.g., nurses, midwives, lay counselors) to provide PMTCT services, reinforcing the skills of
current PMTCT staff, and orienting other staff (e.g., child/wellness clinic nurses, community health workers)
who help ensure a continuum of care. Training will focus on HIV counseling and testing, measuring CD4 cell
counts, clinical staging, psychosocial support, antiretroviral treatment (ART), and follow up and care for the
exposed child, including piloting polymerase chain reaction (PCR) testing. A second set of interventions will
ensure that monitoring and supervision systems are fully operational at all levels (district, local service area,
facility), providing on-site technical support as needed. A third set of interventions will strengthen ECDOH
data and logistic systems, improving the quality of data recorded, collected, reported, and used at all levels.
The project will also work with the ECDOH to address specific policy and guideline issues that directly affect
PMTCT services. Finally, the project will improve referral systems, especially referral of pregnant or
postpartum women and their children to antiretroviral (ARV) care and treatment sites and pediatric centers.
ACTIVITY 2: Capacity building
The project works at all levels of service delivery to strengthen the provision of high-quality, comprehensive
PMTCT services. The project will focus on priority hospitals and select feeder-community health centers
and clinics to ensure that women have access to the full continuum of PMTCT services, from the first
antenatal care visit through follow-up of the mother and baby after birth. The package of interventions will
be tailored to each facility's needs and may include training in essential PMTCT skills, monitoring and
supervision to maintain high-quality services and/or upgrade staff skills, data management for ongoing
corrections and decision-making, integration of services to give women and babies necessary care and
treatment, and linkages to the community so that PMTCT is accepted and used widely.
ACTIVITY 3: Increasing community engagement and leadership
One of ECDOH's priorities is to broaden the role of the community in promoting, supporting, and utilizing
PMTCT services. This includes providing health education, reducing stigma, generating demand for
services, working with the partners and families of HIV-infected women to increase support for PMTCT,
developing community networks for client follow-up, and strengthening tangible links between the
community and the facility. Underlying these interventions is the need to build capacity of community
networks and organizations to implement and monitor programs. Interventions will strengthen HIV
prevention programs, provide PMTCT information, and reduce stigma in the community; strengthen peer
support for HIV-infected pregnant women to increase demand for and adherence to PMTCT and ARV
regimens; and improve community-facility collaboration to increase local ownership and utilization of
services. The ECDOH is the driving force of this project and all of the investments in human capital will
benefit their workers and the communities. Human capacity development is at the center of this project as
described in the training and systems strengthening activities above.
ACTIVITY 4. Preparing for a transition to dual therapy for PMTCT
The new HIV & AIDS and STI Strategic Plan for South Africa calls for a new policy on the drug regimen
used in PMTCT, suggesting that the policy should be updated according to the WHO Guidelines. The
purpose of this activity is to conduct an assessment to assist ECDOH in planning for the implementation of
Activity Narrative: the policy change and to suggest a set of criteria to inform how and when the introduction of dual therapy
should be introduced at the facility level. The assessment will look at the critical components of the health
system including policy, financing, human resources, training, supply systems, service management and
referrals, and information and monitoring systems to establish what will be needed to implement the
pending policy. PATH will also establish a pilot project in six sites in the EC (upon ECDOH approval) and
implement dual therapy services to establish a "better practice" model. This will be rolled out to other
districts and facilities. In addition, PATH will work with the ECDOH to strengthen referral systems for HIV-
infected pregnant women ensuring that all treatment eligible pregnant women are fast- tracked to treatment
ACTIVITY 5: Maternal nutrition and infant feeding job aids and materials
In FY 2007 PATH developed a series of job aids and print materials for both health workers and mothers
such as handouts on feeding options, flip charts and/counseling cards for infant feeding counselors on
feeding options, AFASS, lactation and breastfeeding, etc., basic maternal nutrition guidance, a wall chart
linking each antiretroviral drug with a statement on its implications for food intake at the time when it is
taken, etc. FY 2008 activities will focus on dissemination and utilization of these materials.
FY 2008 COP activities will be expanded to include:
ACTIVITY 6. Creating Linkages between Reproductive Health (RH) and PMTCT
This activity will effectively link prevention of HIV and prevention of unintended pregnancies into PMTCT
settings in the EC. The work will provide evidence-based information and recommendations for decision-
makers and program managers to improve policy and practice for integrating RH services into PMTCT
settings. Current integration policy and practices will be explored, as will client fertility intentions and
desires. The community will be consulted on what services should be integrated and to strengthen
community ownership of service delivery and to increase demand for RH services. The PMTCT continuum
will be analyzed to determine when clients are most likely to want internalize information that could
influence their uptake of services. Lay counselors and professional nurses will be trained and community
mobilization will be expanded to improve access to and utilization of RH services.
ACTIVITY 7. Preparing nurse/midwives to expand their role in HIV and AIDS prevention and treatment
This activity targets professional nurses from maternity wards and expand their roles and responsibilities in
terms of HIV prevention and treatment. The focus will be on hospitals where the need for task shifting is
greatest. Activities will improve attitudes, motivation, knowledge and skills. Participatory training approaches
will be used to work with this cadre to define the problems and to create solutions to ensure quality
The PATH PMTCT project contributes to the PEPFAR 2- 7-10 goals by strengthening PMTCT services
hence preventing vertical transmission of HIV.