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: 2008
The African Medical and Research Foundation (AMREF) aims to address the need to strengthen voluntary
counseling and testing (VCT) services in partnership with the Eastern Cape Department of Health. The
project is comprised of a series of coordinated interventions that aim to achieve two main outcomes: (1)
assess and build the capacity of the selected CT sites in the Eastern Cape Province (Amatole, Chris Hani
and Ukhahlamba districts) and, (2) strengthen the integration and coordination of HIV and TB services in
selected facilities in the same areas. The target population includes health professionals working in CT and
TB services, lay councilors, DOTS supporters, traditional leaders and local communities. AMREF will
emphasize the strengthening of CT services and co-ordination of CT and TB services to enable increased
access to and quality of CT services.
AMREF will strengthen the current TBCT initiative. Working in partnership with key government and non-
governmental- and community-based organizations at the provincial, district and municipality levels,
AMREF will use PEPFAR funds to strengthen and improve the quality HIV counseling, testing, support and
care services and will ensure that effective referral is taking place. The project also aims to improve
community communication and reduce stigma surrounding TB and HIV co-infection through developing
communication materials and strategies with the full participation of community members and relevant
ACTIVITIES AND EXPECTED RESULTS
AMREF SA has collaborated with the Eastern Cape Department of Health in developing this proposal in
response to the urgent need for strengthening the current CT program. This activity includes developing
comprehensive training programs; continual mentoring of trainees by local partners; developing and
strengthening sustainable systems for quality CT services; strengthening referral systems; improving CT
and TB co-ordination; and increasing demand for CT services. In the third year of the project, AMREF will
expand the program area and focus its activities to assessment of CT services, capacity building through
training and mentoring support, and monitoring of the referral system. FY 2008 activities will focus on
selected training for service providers in expansion areas, social mobilization, reduction of stigma and
discrimination, social marketing for CT, mentoring, and technical support to retained FY 2006 and FY 2007
facilities. AMREF will continue with mentoring and monitoring referral systems and skills application in
delivering quality services.
ACTIVITY 1: Operations Research
AMREF will expand its program from 70 to 176 facilities, where 106 additional facilities will fall under the
Buffalo City local service area (LSA), based on discussions with the Eastern Cape Department of Health. In
line with FY 2006 approach, AMREF will further test and disseminate "best practice" models through
operations research aimed at assessing the capacity of health workers and quality of CT services and
integration with TB services in expansion area. AMREF will document lessons learned and generate
evidence on approaches and strategies that have the greatest positive impact on CT services in terms of
improving access to appropriate and quality services and cross referrals between CT and TB services.
PEPFAR funds will be used to roll out a monitoring system for tracking and analysis of CT services and to
build capacity of health workers to increase coordination between CT and TB services which can be used to
inform policy makers at all levels.
ACTIVITY 2: Capacity Building
The expansion will include expanded coverage into Buffalo City (based on preliminary discussions with
ECDOH) where only 11 facilities are supported with FY 2006 and FY 2007 funds. An additional 106 facilities
will be supported (showing a 251% increase from 70 facilities supported with FY 2006 and FY 2007 funds to
the proposed 176 sites). AMREF will facilitate effective planning and coordination, through workshops,
mentoring, on-site support and training programs to improve the overall quality of service provision for CT in
the expansion LSAs. Capacity building will focus on the critical weaknesses that have been identified by the
provincial and district DOH of the Eastern Cape and NGO partners at the local level. This activity includes
improving the knowledge and skills of CT and TB service providers and NGO partners. Capacity building
activities will focus on developing skills to refer and support CT services effectively; and use of a functional
recording system to follow-up and monitor delivery of and demand for CT services at local service areas
(i.e. facility levels). Health professionals from 106 additional facilities will be trained in counseling and
testing according to national and international standards. Capacity building assistance to strengthen data
collection, management and organizational systems will be included in the AMREF agreement with Centers
for Disease Control and Prevention (CDC). In line with South African National Strategic Plan (2007 to 2011),
AMREF will strengthen the capacity of facilities to implement provider-initiated testing and counseling,
especially among TB patients. AMREF will retain current districts (Chris Hani, Amatole, and Ukhahlamba) in
FY2008. Under the retained facilities, AMREF will use the FY 2008 funds to (a) support facilities in
establishing a Counselors Support System/Forum aimed at reducing burn out of counselors and helping
improve the quality of counseling services offered to clients; and (b) strengthen district HAST Committees
through capacity building (training) and mentoring using supported LSAs as mentor sites for a district model
of CT-TB integration.
ACTIVITY 3 - Referral Systems
AMREF will institutionalize the use of systems and tools for cross referrals from CT and TB services.
AMREF will work in collaboration with service providers in establishing referral systems to promote
screening of TB patients for HIV and screening of CT clients for TB. This will enable accurate data and
monitoring of the number of HIV infected clients that are undergoing screening for TB. AMREF will also
expand referral systems to include expansion sites. Through local partnerships and networks, AMREF will
advocate for CT policy change through engagement of policy makers with the aim of strengthening of CT-
TB integration and provision of facilitating provider-initiated TC.
ACTIVITY 4: Community Mobilization
AMREF will facilitate community mobilization for testing through further support of social marketing
campaigns using mass media messages and inter-personal communication. Information, Education and
Communication (IEC) materials developed with FY 200820082008 funds will be disseminated through
community members and service providers. Youth advocates will be engaged to discuss issues around
testing with their peers. Messages will also inform people of service provision and assist in facilitating
linkages between prevention, testing, treatment, care and support services. Social marketing will focus on
Community-led information education communication (IEC) material development and dissemination. Youth
advocate training and support for peer education and mobilization for prevention and testing.Strengthening
of existing attempts to promote couples counseling and Behavior Change Communication (BCC) through
mass media messages (radio, community talks) and inter-personal communication. Training for NGOs,
CBOs, FBOs and traditional healers, leaders and other community stakeholders (HBC, CCW, CHWs etc) in
community mobilization, BCC, IEC material development, and support to assist them facilitate access to
testing for community members. It is estimated that 310,104 people are infected with HIV in the four
targeted LSAs and approximately 2.9% access CT (NDOH, 2006).
AMREF will assist PEPFAR in reaching the vision outlined in the South African Five Year Strategy by
increasing access to care and treatment through the improvement of health services to deliver quality CT for
local communities and improved CT/TB coordination and by strengthening and improving the quality of CT
programs through implementation, evaluation and replication of best practices in the area of CT
programming. AMREF activities will contribute to the PEPFAR 2-7-10 goals by ensuring community
involvement and increased capacity and referral for CT programs.
African Medical Research Foundation (AMREF) will employ three key strategies: 1) Implement social
marketing and stigma reduction strategies; 2) Health system strengthening (training and mentoring including
sub-granting and support); and 3) Community partnerships. The project will tap into previously developed
and tested AMREF training curricula, partnerships with government and community counseling and testing
(CT) providers. The project will expand CT coverage by both improving and ensuring quality, accessibility,
appropriateness and convenience of services and developing targeted social marketing campaigns to
improve CT uptake.
ACTIVITIES AND EXPECTED RESULTS:
ACTIVITY 1: NGO VCT Assessment
AMREF will map NGO VCT sites surrounding selected facilities; assess the service in terms of
confidentiality practices, compliance with quality assurance methods for rapid testing, accessibility, quality,
utilization of VCT services, data management; and client awareness/perceptions of local communities of
VCT services and facilities. AMREF will assess clients' referral sources, perceptions, opening hours of and
waiting times at the VCT service; application of existing policies and guidelines on VCT related services;
and audit the structural conditions of VCT facilities. AMREF will assess the extent to which TB staff from
health facilities are testing TB patients for HIV and monitoring the CD4 count of TB patients. With the aim of
expanding access to VCT services, AMREF will review the relationship between NGOs offering (or seeking
to offer) VCT and the Department of Health, specifically to understand the role that NGOs can play in
expansion of VCT services.
ACTIVITY 2: Social Marketing and Stigma Reduction
Key activities include: 1) Desktop review of VCT social marketing activities (Government, CBOs, etc);
consultation at all levels (national to district); assessment of knowledge, attitudes and perceptions (KAP)
about HIV/AIDS and VCT within local targeted communities; 2) Design and develop information, education,
and communication materials; (3) Build capacity of local stakeholders in order to fight stigma; 4) Social
marketing campaign and facilitation of access to wider sources of care and support for people living with
HIV; and 5) Conduct monitoring and evaluation (M&E) and documentation of best practices.
ACTIVITY 3. Health Systems Strengthening
Activities will focus on building the capacity of VCT services through training and mentoring to improve
quality, confidentially, equity, access and demand for services and strengthen coordination between VCT
and TB services. The program will also strengthen the capacity of health service staff at VCT and TB clinics
to monitor and evaluate and keep accurate records of patients and services.
AMREF will train and mentor 30 VCT staff at selected VCT centers in HIV counseling and testing according
to national and/or international standards; support TB and HIV linkages, TB symptoms and referral to TB
testing; improve VCT service management and mentoring for clinic staff. To strengthen quality assurance
AMREF will train 60 mentors in mentoring and coaching VCT staff and will develop a mentoring system to
ensure that VCT testing staff are mobilising and referring. AMREF will strengthen the district health
information systems (DHIS) and improve providers' ability to collect and analyze data, document results,
and use data effectively in health service planning and management. AMREF will train 60 government
HIV/AIDS STI and TB (HAST) committee members in M&E for comprehensive care.
AMREF will train 30 CBO carers, managers and nurses in ARV literacy; strengthen and support HAST
committees to encourage networking and collaborative service provision between TB and HIV/AIDS
services; mobilise and motivate TB patients for HIV testing and vice versa. AMREF will develop a referral
system, tools and guidelines for health professionals, local NGOs/CBOS, primary health care and
community service providers, in collaboration with VCT and TB nurses; and will monitor the implementation
of the referral system.