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
Columbia University International Center for AIDS Care and Treatment Program (ICAP) will use FY 2008
funding to apply its PMTCT capacity building activities in 30 sites located in Limpopo, Northwest, Gauteng,
Mpumalanga, Northern Cape, and Western Cape provinces. ICAP's capacity building model is based on its
support of the South-to-South Partnership for Comprehensive Pediatric HIV and AIDS Care and Treatment
Training Initiative (S2S) in the Western Cape, which emphasizes site level training; namely, continuous and
supportive onsite presence, onsite dynamic skills-building events such as on-the-job training, clinical
mentoring, modeling and site implementation workshops and case-based learning. The core activity for FY
2008 involves designing and implementing PMTCT performance action plans and establishing long-term
monitoring systems so that increased quality of service delivery can be sustained over the long term. This
activity will be implemented in collaboration with the Foundation for Professional Development (FPD),
BroadReach Healthcare and Right to Care.
A main focus of ICAP support on the site level is to build provider and system capacity with a focus on
continuous quality improvement. Shortages of health care workers are exacerbated by the gap between the
knowledge and skills required to provide HIV and AIDS services. Additionally, poor design of facility
systems and services, lack of patient scheduling systems, inefficient provider placement and scheduling
and irregular supervision by senior management continue to weaken already stressed HIV services. ICAP's
site level support is dynamic and continuously customized to consider site attributes and existing resources.
During FY 2008 this capacity building model will support the continuation and expansion of the S2S
Partnership with Tygerberg Children's Hospital-Stellenbosch University in the Western Cape. The S2S
program, experiences and materials will support the activities within this initiative aimed at supporting
pediatric HIV and AIDS.
ACTIVITIES and EXPECTED RESULTS:
ACTIVITY 1: Basic Capacity Building Model
While the technical support and capacity building focus varies according to site attributes, all sites benefit
from ICAP support to: (1) jointly develop or review/revise existing site specific work-plans (with clear
benchmarks, targets, and activities) to outline action steps on how to achieve related goals, including setting
site specific benchmarks and targets (in close collaboration with USAID-SA partners); (2) leverage and
maximize efficiency of existing site and regional level human and commodity resources; (3) deliver a quality
package of PMTCT-Plus and family-centered HIV services to clients; (4) implement active referrals and
linkage systems; (5) efficiently operate with an integrated approach to caring for the HIV-infected pregnant
woman/mother and her family; (6) facilitate and lead site level system improvements that improve quality of
care, support optimal patient flow, and decrease patient wait time; and (7) initiate a multidisciplinary
approach to service delivery.
ACTIVITY 2: Exposed Infant Follow-up/Care and Pediatric HIV Care and Treatment
ICAP will continue to support pediatric activities in close collaboration with the S2S program to rapidly
expand access to HIV care and treatment for infants and children. Through its basic capacity building model
ICAP will support the implementation of comprehensive care services for the HIV-exposed child at all sites,
including growth monitoring, neuro-developmental screening, and cotrimoxazole prophylaxis. ICAP will
capitalize on IMCI, EPI, and under-5 services to identify infants at peripheral sites that should be referred for
HIV testing, and use aggressive pediatric case finding by supporting clinical/immunological presumptive
diagnosis and/or early infant diagnosis services. The ICAP model will be used when appropriate to expand
provider-initiated in-patient testing in pediatric wards, and to assist in the implementation of routine
pediatric psychosocial assessments to appraise readiness and support needs prior to initiating treatment.
ACTIVITY 3: Expansion of Early Infant Diagnosis (EID)
The ICAP capacity building approach will support implementation and expansion of EID services. This
includes the improvement of follow-up services, including improving counseling to ensure that caregivers
understand the importance of returning for services and developing mechanisms to identify and trace
caregivers who have not returned for follow-up and test results.
ACTIVITY 4: HIV-infected Women of Childbearing Age and their Partners
ICAP plans to strengthen the quality of the clinical and psychosocial services available to women of
childbearing age and males (especially partners) enrolled in care and treatment services. This activity
Includes supporting facilities to offer services and referrals to counsel HIV-infected women and partners,
specifically on family planning.
By strengthening PMTCT services, these activities contribute to PEPFAR 2-7-10 goals, averting new
infections among infants exposed to HIV as well as increasing access to treatment care and support for HIV
-infected women and their infants.
PEPFAR funds were allocated to Columbia University for OVC activities during the final FY 2007
reprogramming round. In actuality, however, this is a treatment activity so USAID will reprogram the FY
2007 funds for OVC to the treatment services program area. Therefore there is no need to fund this activity
with FY 2008 COP funds.
This is a new activity in FY 2008.
Columbia University is a Track 1 care and treatment partner in South Africa, implementing site-level
activities in the Eastern Cape and KwaZulu-Natal with CDC funding. Since FY 2007, Columbia University's
office in Western Cape has received funding from USAID to support treatment partners in Limpopo, North
West, Gauteng, Mpumalanga and Western Cape to improve linkages with prevention of mother-to-child
transmission (PMTCT) and pediatric antiretroviral treatment (ART). This is achieved by providing technical
assistance, training, and mentoring in public and non-governmental (NGO) facilities. The emphasis areas
are human capacity development and local organization capacity building.
FY 2008 funds will support the continuation and expansion of the South-to-South Partnership for
Comprehensive Pediatric HIV/AIDS Care and Treatment Training Initiative (S2S), a pediatric HIV and AIDS
training program implemented in partnership with Tygerberg Children's Hospital and the Stellenbosch
University in the Western Cape. The S2S program's experience and materials will support the activities
within this initiative.
Columbia University's International Center for AIDS Care and Treatment Program (ICAP) supports sites to
build provider and system capacity with a focus on continuous quality improvement. Poor facility
systems/services design, lack of patient scheduling systems, inefficient provider placement/scheduling and
irregular supervision by senior management continue to weaken already stressed HIV services. ICAP's site
level support is dynamic and continuously customized to consider site attributes and existing resources.
While the technical support and capacity-building activities vary according to site attribute, all sites benefit
from ICAP support, including assistance to (1) jointly develop or revise existing site specific work plans to
outline action steps on how to achieve PMTCT and pediatric ART goals, including setting site specific
benchmarks and targets (in close collaboration with USAID-SA partners); (2) leverage and maximize
efficiency of existing site and regional human and commodity resources; (3) deliver a quality package of
PMTCT and family-centered HIV services to clients; (4) implement active referrals and linkage systems; (e)
operate efficiently with an integrated approach to caring for the HIV-infected pregnant woman/mother and
her family; (5) facilitate and lead site level system improvements that improve quality of care, support
optimal patient flow, and decreases patient wait time; and (6) initiate a multidisciplinary approach to service
Site level systems improvement and skills-building activities will be conducted routinely on an individual and
group basis to introduce new competencies and activities as well as to reinforce specific areas of need with
emphasis on the skills providers' and teams' need for appropriate care of families. All improvement activities
are conducted on the site level and are generally targeted towards rapidly enhancing site performance and
strengthening program implementation and include a blend of didactic, modeling, clinical
implementation/preceptorship, negotiation and case study activities. ICAP will support stakeholders to (1)
assess and identify missing service components, performance gaps, and systems failures to providing
quality care and treatment services; (2) identify action steps and activities to support root causes of
problems; and (3) support the management team to monitor the resulting affect and ensure positive
enabling factors to improve or initiate that service component.
ACTIVITY 1: On-site Skills Building, Task Shifting and Clinical Mentoring
The critical conduits for system implementation are the healthcare workers. ICAP will work with site staff
and partners to implement a supportive supervision model that combines capacity-building elements such
as (1) supportive and regular on-site presence; (2) on-site dynamic skills-building events that directly link to
implementation and program improvement such as (a) clinical mentoring and modeling to promote the rapid
application of in-service learning to the clinical settings and to improve the quality of clinical care and patient
outcomes; and (b) on-the-job training to provide necessary knowledge and hands-on practice of skills
needed to perform job tasks; and (3) structured training interventions that employ multiple skills building and
transfer of learning strategies to reinforce and emphasize key PMTCT and pediatric ART content. Training
interventions include instructional (didactic) activities that include case-based learning, group-discussions,
problem solving exercises; one-on-one and small team clinical mentoring activities (across/within cadre)
with responsive/dynamic coaching and modeling activities; and case study activities.
ACTIVITY 2: Utilize a Multidisciplinary Approach
ICAP will promote the strengthening of a comprehensive approach to patient care at each facility. This
includes instituting distinct clinical reasoning skills among cadres, emphasizing collaborative decision
making and recognizing the important contributions of all members of the team. Activities to support this will
include routine and regular management meetings to discuss service delivery and patient cases, onsite
skills building activities and implementation workshops.
ACTIVITY 3: Performance Support
ICAP will provide technical support to partners and site staff to develop content for simple tools, resources,
and performance aids that will help providers to correctly perform tasks and make decisions. This includes
the development of protocols, decision trees, flip charts and posters for clinical and counseling related
ACTIVITY 4: Improve Service Quality and Standards of Care
ICAP will support the adaptation and implementation of a simple standards of care (SOC) tool designed to
help the staff rapidly monitor the quality and depth of PMTCT, pediatric and adult ART services being
offered at a facility level. ICAP will do so in collaboration with facility staff and partners.
The approaches noted above will be applied to focus areas outlined below.
(1) Prioritizing ART for eligible pregnant woman: ICAP will build on existing PMTCT services to ensure that
all HIV-infected pregnant women are assessed for ART eligibility. Eligible women will be fast-tracked to
initiate ART regardless of point of entry. Depending on site attributes, ICAP will work with sites and partners
to ensure the following: (a) HIV-infected pregnant women receive CD4 testing the same day they receive
their HIV test results; (b) women accessing maternal and child health (MCH) services initiate ART at the
nearest ART site and be given coordinated visits to ensure that both MCH and HIV and AIDS needs are
met; and (c) development of additional service models that increase access to care and treatment services
for families including family days at care and treatment clinics, weekend and afternoon care and treatment
(2) HIV-infected women of childbearing age and their partners: ICAP will continue to strengthen the quality
of the clinical and psychosocial services available to HIV-infected women of childbearing age and males
(especially partners) enrolled in care and treatment services. This includes supporting facilities to offer
services and referrals to counsel HIV-infected women and partners intending to become pregnant.
(3) Ongoing support for PMTCT clients on ART: ICAP will support sites to improve clinical management of
pregnant women and families on ART. The support will include assessing (a) clients for treatment failure;
(b) ARV contraindication and adverse reaction; and (c) administration of appropriate drug substitution or
(4) Psychosocial and Adherence Support (P&AS): Quality adherence and psychosocial support is the
cornerstone of successful HIV care and treatment services and having healthier HIV-infected pregnant
woman. ICAP will provide individual P&AS through (a) developing and routine implementation of
psychosocial assessments to assess ART readiness during pregnancy and post-natal period; and (b)
establishing support groups at sites to initiate or strengthen support groups for PMTCT clients. ICAP will
also strengthen the roles of the Implementation Team to support P&AS programs. The Implementation
Team will include pharmacists and nurses. This activity aims to ensure that facility staff understand the roles
and responsibilities of each cadre and acquire the necessary skills to provide those services as part of the
(5) Patient Follow-up: ICAP will develop a mechanism to track and trace patients that have discontinued
services or missed appointments. Specifically, this includes (a) setting up a system for tracking no-shows
and discontinuers; (b) implementing a follow-up system to reach out to clients soon after they fail to return to
the clinic; and (c) developing strong linkages with community-based organizations and community health
workers to support patients who have discontinued services.