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
TB Care Association's activities will be carried out to increase TB and HIV case finding and case holding
through community peer supporters as well as to support facility-based integration of prevention of mother-
to-child transmission (PMTCT) with TB/HIV and antiretroviral treatment (ART) services. The TB CARE
Association PMTCT project emphasizes gender issues by increasing access to PMTCT, TB/HIV and ART
services for women and their partners. A second emphasis area is in-service training. The target
populations for this activity include children under the age of five years, pregnant women, discordant
couples, people living with HIV and AIDS, families. The emphasis area for this program include gender, by
addressing gender equity in HIV and AIDS programs, human capacity development by providing in-service
training and local organization capacity building.
Although TB CARE Association is a new FY 2008 PMTCT partner, this is an ongoing activity. TB Care
Association was founded in March 1929 as a social support group for TB sufferers in Cape Town. The core
role of TB Care has remained largely unchanged in the intervening 70+ years. TB Care provides a
comprehensive, developmental social support service to TB sufferers and their families in the City of Cape
Town. TB care operates from the community health centres which patients to take their daily treatment on
the street where they live under the supervision of specially trained community treatment supporters. In
FY07, TB CARE Association partnered with the Medical Research Council in FY 2007 and was a sub-
partner implementing these PMTCT activities. In FY 2008 PEPFAR funding will be coordinated by TB Care
Association and the Medical Research Council will be a sub-partner. The activity will be coordinated with
the provincial and district Departments of Health. TB CARE Association partnered with the Medical
Research Council in FY 2007 and was a sub-partner implementing this activity. FY 2008 PEPFAR funding
will be coordinated by TB Care Association and the Medical Research Council will be a sub-partner. The
activity will be coordinated with the provincial and district Departments of Health.
ACTIVITIES AND EXPECTED RESULTS
ACTIVITY 1: Community TB/HIV Case Finding and Case Holding Among Women Participating in PMTCT
The Good Start Community Intervention Project (PEPFAR-funded since FY 2005) has trained and
employed community peer supporters to provide household-level support to improve postnatal care of
mothers served by PMTCT programs. In the TB/HIV component of the Community Intervention Project,
community peer supporters will identify suspected TB cases in the households of pregnant mothers and
refer them to the health services for TB diagnosis. They will encourage pregnant women, their partners and
HIV-exposed infants to be tested for HIV and to access health services for appropriate prophylaxis and
antiretroviral therapy (ART). They will also provide adherence support for household members on
prophylaxis or treatment related to TB or HIV.
ACTIVITY 2: Integration of PMTCT with TB/HIV and ART Services
This project will support a comprehensive best-practice approach to integrate PMTCT into TB/HIV care in
Sisonke District in KwaZulu-Natal. The project will improve screening of pregnant women for TB and HIV as
part of antenatal care. HIV-infected pregnant women will routinely have CD4 counts assessed and be
screened for full antiretroviral treatment. HIV-infected mothers will also be screened for prophylaxis
(isoniazid preventive therapy and cotrimoxazole prophylaxis). HIV-exposed infants will receive
cotrimoxazole prophylaxis and will have a PCR test at their six week immunization visit. PCR-positive
infants will have a CD4% test to determine their eligibility for ART. The project will establish a best practice
approach to integrated TB/HIV prevention and care in PMTCT services and will provide training to PMTCT
health care providers on integrated TB/HIV care. Project results and lessons learned will be shared with the
national and provincial Departments of Health to inform existing policies and guidelines on TB/HIV care. TB
patients and PLHIV are the principal target populations and include pregnant women (referred to PMTCT
services) and children (receiving ARVs if indicated).
These activities will contribute to PEPFAR's 2-7-10 prevention goals by reducing mother-to-child HIV
transmission. The prevention outcomes are also in line with the USG goal of integrating TB and HIV
services within primary care systems in South Africa.
Activities will be carried out to screen people for TB in non-clinical counseling and testing (CT) and in
clinical sites and to ensure referral for care. The project will support care and treatment services at three
hospital-based clinics and eight primary health clinics (PHC). Clinical training and mentorship will be
provided to screen HIV-infected people for TB, provide appropriate TB treatment, and to screen for isoniazid
preventive therapy (IPT) to prevent TB. Community health workers (CHWs) will educate community
members about the symptoms of TB and the importance of seeking care and completing TB treatment.
They will screen community members for TB symptoms of TB and STIs and refer symptomatic people to
health services. Community adherence support will be provided by CHWs for TB treatment, for prophylaxis
(IPT and cotrimoxazole) and for antiretroviral therapy (ART). The adherence support model used for ART
will be piloted with TB patients.
TB Care Association (TBCA) will implement this activity in collaboration with provincial and district
departments of health. TBCA has been providing community-based counseling, emergency material relief
and TB treatment support in the Western Cape since 1992. The Western Cape province has requested
support from TBCA for the West Coast Winelands district because the burden of TB with HIV coinfection is
high. TBCA is exploring the possibility of expanding activities to the Northern Cape province as well.
ACTIVITIES AND EXPECTED RESULTS:
ACTIVITY 1: TB and STI Case Finding Linked to VCT
VCT will be provided in non-clinical sites including workplaces. During CT, counselors will routinely screen
for TB and STIs, utilizing a questionnaire. Clients who have TB symptoms will be given 2 sputum containers
by the nurse counselor and a referral letter to go immediately to their nearest health facility. Clients with STI
symptoms will also be given a referral letter to their nearest health facility. The CT register will have
additional columns to indicate if clients have TB or STI symptoms as well as a column to determine if the
patient presents at the health facility to which they are referred.
PEPFAR funds will be used to employ one data capturer for each supported health facility to assist with
recording laboratory results and to trace people with positive TB smears to ensure that they are initiated on
treatment. The data capturer will also be responsible for informing the CT teams and community health
workers (CHWs) if referred patients attend the facilities to which they have been referred.
ACTIVITY 2: Improve the Quality of TB/HIV Care and Treatment
TB/HIV clinical training & mentoring will be provided for all relevant health care workers, in accordance with
the South African National TB Control Program guidelines and national guidelines for HIV care, utilizing
materials adopted by the Western Cape Department of Health (i.e. PALSA plus). Training will focus on the
co-management of TB, HIV and STIs. Health care providers will also be trained to routinely counsel TB
patients about the benefits of knowing their HIV status and to give patients the opportunity to test or to opt
out of testing. HIV-infected TB patients will be offered cotrimoxazole prophylaxis and will have a CD4 count
done as part of screening for antiretroviral therapy (ART). The new NTCP TB register will be introduced to
register all TB patients, to document their HIV status, and to record which TB patients are started on
cotrimoxazole and screened for ART. Health workers who provide care for TB patients will be trained on the
prevention and management of opportunistic infections, on ART and on the new TB register.
Health workers, who provide HIV care, including pediatric services, will be trained to screen all HIV-infected
clients for TB and to screen asymptomatic patients for IPT. HIV-infected individuals with symptoms of TB
will be provided with diagnostic services at the level of care where screened (i.e. ART clinic), including TB
culture. Recording and reporting of TB status will occur at the closest TB treatment clinic. TBCA will work
closely with DOH to integrate services, to allow co-infected patients to seek care at one point of service.
Under the guidance of the clinical coordinator, two nurse mentors will visit health facilities on a regular basis
to provide supervisory support to ensure optimal co-management of HIV, TB and STIs. These visits will
reinforce didactic training and will assist health staff in facilities to solve clinical problems they encounter
through case studies. Nurse mentors will also liaise with the community team leader in each facility to assist
with monitoring referrals to ensure a continuum of care between communities, clinics and hospitals. Training
and mentoring initiatives will address clinical issues identified through quality assurance reviews.
ACTIVITY 3: Improve TB and ART Case Holding through Community-based Adherence Support
The policy of the Western Cape Department of Health is to provide funding for multi-skilled community
health workers (CHWs) rather than community workers that focus on vertical program. CHWs will be trained
on priority health issues to provide integrated community care. They will be responsible for the following
-HIV prevention and condom distribution
-Education on STI symptoms and the importance of seeking treatment for STIs
-Promotion of HIV voluntary counseling and testing, particularly for pregnant women
-Infant feeding counseling
-Education on TB symptoms and the importance of seeking treatment for TB
-Screening community members for TB and STI symptoms and referring suspects to health facilities
-Education on the importance of adhering to prophylaxis (isoniazid and cotrimoxazole), antiretroviral
treatment and TB treatment
-Monitoring and providing adherence support to TB patients and HIV-infected clients taking prophylaxis or
ARVs with modified directly observed treatment (DOT)
-Identification of malnourished children and referral to health facilities
-Assistance in obtaining social support grants
-Referral to support services to address substance abuse and domestic violence
Activity Narrative: -Stigma and discrimination towards people living with HIV will be addressed through the efforts of
community mobilizers and CHWs who will increase awareness of HIV in their communities utilizing IEC
The TB Alliance DOTS Support Association (TADSA) will be a partner in the formative assessment of
adherence support services. The first step will be to identify existing organizations that are providing home-
based care services in the area. Where possible, existing home-based carers will be recruited and trained
to provide more comprehensive care as CHWs. Carers who are already engaged in home-based care and
who receive a stipend from the provincial government will integrate the new activities into their existing
functions. In areas where there are no home-based care organizations, CHWs will be recruited from the
communities in the catchment areas of the facilities. Stipends for CHWs will be funded from the PEPFAR
budget, at a similar rate to what the Provincial Government pays. This will ensure sustainability for when the
program is taken over by the government. TBCA has a well developed system of financial controls for
managing the payment of stipends. Approximately ten CHWs and one community team leader will be
employed per health facility, depending on the estimated burden of TB & HIV in the community (see Activity
Health facilities will inform TBCA community team leaders of all patients who are initiated on prophylaxis,
ART or TB treatment. Community team leaders will identify a CHW who lives close to the patient and
arrange for the CHW to meet the patient. Patients on treatment will be visited by a CHW daily for the first
two weeks of treatment, then weekly up to eight weeks of treatment, then every two weeks (modified DOT).
CHWs will identify any potential adherence problems, try to address them with the patient and inform the
health professionals of issues that need to be addressed (e.g., side effects).
ACTIVITY 4: Assessment of Quality of Services
The University of the Western Cape, School of Public Health, will be sub-contracted to evaluate the quality
of TB/HIV/STI services. This will be done by conducting facility audits using an integrated TB/HIV/STI
evaluation tool at the beginning of the project, at one year and at the end of the project.
The quality of services will also be assessed through routine TB and HIV monitoring and evaluation.
Existing forms and registers will be reviewed and, if necessary, be revised, piloted and implemented to
collect information for key indicators. District and facility managers will be assisted in monitoring progress in
achieving agreed upon targets.
A baseline survey will be done to assess demographics, TB and HIV education and stigma as well as health
seeking behaviors and uptake of VCT. This survey will be repeated at the end of the project to assess the
impact of the services provided.
ACTIVITY 5: Improving HIV and TB treatment Adherence and Outcomes
Drawing on ART adherence promotion models this project evaluates a pilot program using lay health
workers to support adherence to TB treatment in Cape Town. The pilot replicates what are seen as the key
elements of the ART adherence model: intensive treatment counseling and preparation sessions by trained
lay adherence counselors; the use of a 'buddy' to support patients; and frequent lay treatment supporters
visits to help patients manage problems that arise during treatment. A qualitative assessment will be done
of the feasibility and acceptability of the adherence model. TB treatment outcomes using the adherence
model will be compared with treatment outcomes with the standard of care (directly observed treatment).
This project will increase access to HIV voluntary counseling and testing (CT) in non-clinical sites and in
facilities with a large number of TB cases. Two mobile services and fixed non-clinical sites in easily
accessible areas such as taxi ranks and shopping areas will provide CT services. TBCA will also assist the
district in training and supervising counselors in clinical sites. Target populations include the general
population, at risk populations, the business community, discordant couples, pregnant women and orphans
and vulnerable children.
TB Care Association (TBCA) has been providing community-based counseling, emergency material relief,
and support, and TB treatment support in the Western Cape since 1992. Provision of non-clinical CT and
counseling mentorship are new initiatives that will be conducted in collaboration with the Department of
Health. Women are at higher risk for HIV infection. The provision of CT will therefore benefit women who
test HIV positive and will access care and support. Men utilize health services less than women and will
therefore benefit from the provision of CT in non-clinical CT sites. TBCA is exploring the possibility of
expanding activities to the Northern Cape province.
ACTIVITIES AND EXPECTED RESULTS
ACTIVITY 1: Non-clinical Counseling and Testing
TBCA will hold consultations will be held with key stakeholders from government, non-governmental
organizations, community-based organizations and the private sector, to identify sites in which to establish
new services or strengthen existing services for HIV counseling and testing. The West Coast Winelands
District has suggested that non-clinical CT sites should be established in the taxi ranks in Malmesbury,
Saldanha and Vredenburg. Additionally, two mobile CT teams will provide services in underserved rural and
peri-urban areas and in private sector workplaces such as farms and factories. In small towns, mobile CT
teams will conduct door-to-door community-based CT. A "100% cover" campaign will be piloted. This
campaign aims to counsel and test all the population over 14 years and to promote 100% condom use.
PEPFAR funds will be used to purchase two vehicles for the mobile CT teams.
Counseling and testing teams will be recruited, hired and trained in collaboration with NGOs that are
already providing CT services in the area. Each team will include two lay counselors, one nurse counselor
(who will also do the HIV testing) and a community mobilizer funded by PEPFAR. Five CT teams will be
hired and trained in the first year of the project.
Gender equity in HIV and AIDS programs will be addressed through the provision of non-clinical CT that will
increase access to men. The education provided by the community mobilizer and the risk reduction
counseling will help to change male norms and behaviors and reduce violence and coercion. As more
people access CT, it is hoped that there will be more discussion of HIV in communities and that stigma and
discrimination towards people living with HIV will decrease.
The community mobilizer will provide education on HIV prevention (abstinence, being faithful, using
condoms), the benefits of knowing your HIV status, TB and STI symptoms and the importance of being
treated for TB and STIs. Couples will be encouraged to go for counseling together. The community
mobilizer will also distribute condoms.
Counseling and testing will be provided according to national and international standards. Counseling will
focus on personalized risk assessment and risk reduction. Correct condom use will be demonstrated and
condoms, procured by the Department of Health will be dispensed. HIV testing will be informed, voluntary
and consented. Rapid test kits will be provided by the National Department of Health (NDOH).
Any individual who agrees to HIV counseling and testing will also be screened for tuberculosis and sexually
transmitted infections (see TB/HIV Program Area). If symptoms are present, they will be referred to the
nearest clinic/hospital where further investigations and/or treatment will be available. All HIV-positive clients
will be referred for HIV clinical care and support services and will be counselled on preventing transmission
with a specific focus on discordant couples. The CT register will have additional columns to indicate if
clients have TB or STI symptoms as well as a column to determine if the patient presents at the health
facility to which they are referred.
workers if referred patients attend the facilities to which they have been referred.
ACTIVITY 2: Training and Supervision of Counselors
PEPFAR funds will be used to hire a CT Coordinator to train, mentor and supervise the CT teams. Training
will comply with national guidelines and will be conducted in collaboration with National Department of
Health and the AIDS Training Information and Counseling Centre (ATICC). Additional training will be
provided on couple counseling for concordant and discordant couples, counseling for youth, and counseling
to address substance abuse and domestic violence. The CT Coordinator will also visit clinical CT sites to
provide mentorship and technical support, focusing on TB treatment facilities. The five CT teams, consisting
of five nurse counselors, ten lay counselors and five community mobilizers, will be trained. Additionally, one
counselor in each of the 11 facilities will be trained, mentored and supervized. In health facilities, routine
counseling and testing will be offered to pregnant women and patients with TB or sexually transmitted
ACTIVITY 3: Measuring Costs and Assessing Cost-effectiveness of Non-Clinical HIV Counseling and
Activity Narrative: To assess the affordability of the interventions, a cost-effectiveness analysis will be done through a sub-
contract with the Health Economics Unit of the University of Cape Town. The cost per person post-test
counseled will be measured and the cost per HIV infection averted will be estimated for non-clinical HIV
counseling and testing compared to standard HIV counseling and testing. The opportunity costs of adding
TB and STI screening during pre-test counseling will be measured.
The project aims to counsel and test 10,000 people the first year. These results contribute to the PEPFAR 2
-7-10 goals by improving access to and quality of CT services in order to identify HIV-infected persons and
increase the number of persons receiving ARV services.
This is a new activity in FY 2008.
TB Care Association (TBCA) will support care and treatment services at three hospital-based clinics and
eight primary health clinics (PHC). Training and mentoring on topics to ensure provision of quality care will
be provided: clinical care, social support, monitoring & evaluation, and health system support. Referral
systems, including community adherence support and coordination of services between hospital and PHC,
will be strengthened through human resource, capacity development and programmatic support. People
infected and affected by HIV, including healthcare providers will be the beneficiaries of this PEPFAR-
TBCA has been providing community-based counseling, emergency material relief, and support, and TB
treatment support in the Western Cape since 1992. Support for HIV care and treatment services in the West
Coast Winelands is a new initiative. Training and mentoring activities will be done in collaboration with the
Department of Health (DOH). Support has been requested by the Western Cape province and all program
activities will occur within public health facilities. Essential drugs and ARVs will be procured through DOH,
and the National Health Laboratory Service (NHLS), through the DOH, will provide laboratory services. The
Western Cape has identified the West Coast Winelands as a district that would benefit from technical
assistance because the burden of TB with HIV co-infection is high. In Malmesbury, clinical support will be
provided at Swartland Hospital (ART site) and Dorp and West Bank clinics. In Saldanha, clinical support will
be provided in Dorp and Diaz Ville clinics. In Vredenburg, clinical support will be provided in Vredenburg
Hospital (ART site) and Dorp and Hannah Coetzee clinics. In Atlantis, clinical support will be provided in
Wesfleur Hospital (ART site) and Saxon Sea and Protea Park clinics. In summary, three hospitals and eight
clinics will be supported in the Western Cape province. TBCA is exploring the possibility of expanding
activities to the Northern Cape province.
ACTIVITIES AND EXPECTED RESULTS
ACTIVITY 1: Integration of Services and Quality Assurance
The first activity is human capacity development, focusing on integration of the HIV program into primary
healthcare services, including pediatrics. Under the guidance of the clinical coordinator, two TBCA-
employed nurse mentors with extensive experience in HIV care and treatment will work closely with the
DOH to identify training/mentoring needs. DOH clinicians will be trained through didactic and mentoring
sessions, on topics including identification and counseling of victims of abuse, reducing stigma, clinical
management of patients, integration of services, and clinical management of TB and HIV. HIV testing, care
and treatment will be strengthened by ensuring all clinicians involved in patient care (doctors, nurses,
pharmacists) in all areas of patient care services (outpatient services, pediatrics, TB, family planning,
antenatal services) are clinically competent in managing HIV-infected clients. A quality assurance program
will be implemented through support of the DOH multi-disciplinary team meetings, provision of clinical
updates and in-service mentoring, and introduction of a formal routine chart review, in collaboration with
clinic managers. National and provincial standards of care and guidelines will be followed. TBCA will work
closely with DOH to facilitate coordination of services among the three hospitals and their affiliated clinics,
anticipating provision of ART at clinic level by end of FY 2008. Systems support will be provided as needs
are identified (e.g., down-referral of drugs, strengthening of patient referrals). Ten percent of the budget will
be spent on promoting pediatric services.
ACTIVITY 2: Community Mobilization Related to Care and Treatment
The second activity is to strengthen community involvement in HIV care and treatment services through
outreach services provided by community health workers (CHW). In consultation with the DOH, TBCA will
employ one community team leader and ten CHWs for each clinical site supported. The Western Cape
province has plans to expand CHW programs, therefore sustainability will be addressed. TBCA will train the
CHWs on priority health issues so that they are multi-skilled to provide integrated community care. The role
of the CHWs will be to promote information, education, communication (IEC) in the communities they serve.
IEC activities aim to increase awareness of the availability of comprehensive HIV services; tp promote HIV
prevention, including prevention with positives; to ensure family-centered care through referrals of family
members affected by HIV; and to ensure community-level follow-up of patients who have not returned for
routine care (in collaboration with M&E). Existing community groups will be encouraged to participate, and
through collaboration with existing home-based care programs, community-based wellness programs will
encourage patients to seek routine care. Peer counseling and education provided by the CHWs will target
male behaviors. The team leaders and TBCA-employed nurse mentors who supervise them will facilitate
links with social development programs, nutritional support programs, and other governmental and non-
ACTIVITY 3: Strengthening Clinical Services through Monitoring and Evaluation (M&E) Support
The final activity is to assist with monitoring and evaluation of the national comprehensive HIV care and
treatment program at supported sites. TBCA will employ a data capturer at each site to assist with TB/HIV
reporting. Coordination of M&E with clinical services will ensure prompt follow-up of patients enrolled in care
who do not return to clinic. Data collection will be facilitated through provision of computers to each clinic.
Training needs related to capturing quality data will be identified and addressed. Gender equity in the HIV
program will be revealed through collection of data showing breakdown of women and men receiving
prevention, care and treatment services. The data capturers will liaise with community team leaders to
follow up patients referred from TBCA-supported voluntary counseling and testing sites that tested HIV
positive as well as those who have TB or STI symptoms.
These results contribute to the PEPFAR 2-7-10 goals by improving access to care and treatment services,
thereby increasing the number of persons receiving ARV services.