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 Medical Research Council (MRC) has worked in Uganda since 1989 conducting population-based
evaluations in conjunction with the MOH and other partners to inform the control of the HIV/AIDS epidemic
and its consequences. For example, in collaboration with the Uganda Virus Research Institute and London
School of Hygiene and Tropical Medicine MRC is currently conducting large-scale field trails on HIV-
prevention strategies and ARV therapy approaches. As part of this, they have over 40 clusters, defined as
groups of communities being evaluated. In late FY04 a partnership between MRC, CDC and TASO was
established to conduct an evaluation to compare facility- and home-based ART service delivery systems.
The study population comprises 1000 current TASO clients served in the Jinja District branch. During that
time the study protocol was developed and approved, and systems to begin data collection were designed.
In FY05 activities focused on training TASO health care providers in delivering ART services to clients using
both the facility-based and home-based service delivery models; the enrollment of clients for the evaluation;
initial client registration data collection; an analysis of the existing TASO services and data for the clients
enrolled. In FY06, MRC through a sub-partner agreement with TASO provided funding to procure ART and
other related OI drugs for the 1,000 clients recruited as part of the targeted evaluation.
In FY08 follow-up of clients on ART will continue and clinical, laboratory, social, economic and behavioral
data will be recorded. The purpose of the evaluation is to follow the 1000 ART clients enrolled to measure
the two service delivery models effectiveness and costs, client behavior and adherence and, family
counseling and testing uptake. Other related MRC activities outlined in the strategic information section are
to provide support and technical assistance to TASO's HMIS unit and assist TASO with the conduct of
population-based client survey on behavior with treatment and adherence to the drug regime. The activity
will strengthen TASO's capacity in the collection and interpretation of client and service delivery data to
inform clinical services and program management. MRC/UVRI will also conduct the evaluation activities to
compare the effectiveness of both strategies. The primary outcome indicator for this evaluation is the
number of clients who experience treatment failure as measured by a viral load of >500 copies/microlitre
after initial successful viral suppression. Other outcomes include treatment adherence and uptake of VCT
services by clients' family members. Evaluation findings will be shared as appropriate to inform the national
program and other provider on the most effective approaches for clients to access HIV care and treatment
in resource-limited settings.
FY07 COP activity number linked to PHE project: 4691
Title of study: Comparison of Facility and Home-Based Antiretroviral Therapy Delivery Systems in Uganda
Time and money summary: We began in year 1 (2004) and we expect the work to be completed in year 4,
which is 2008. We received $450,000 in Year 1, $450,000 in Year 2, $550,000 in Year 3. We require a
further $800,000 [$650,000 for the PHE, $150,000 for ARV drugs] in year 4 for completion of the work.
Local Co-investigator: The local co-investigators are Dr Heiner Grosskurth, Director, MRC Uganda and Dr
Shabbar Jaffar, Epidemiologist, London School of Hygiene & Tropical Medicine. Both are responsible for all
aspects of the research on the ground and for strategic direction.
Overview: this project is evaluating home-based compared with facility-based delivery of antiretroviral
therapy (ART) in Jinja, South- East Uganda. This is collaboration between The AIDS Support Organisation
(TASO) which is responsible for service provision, MRC/UVRI which is conducting the evaluation, CDC
Uganda which is providing funding and technical support and the Ministry of Health.
The facility-based arm is a clinician led model, where clinical staff play the major role in managing patients
at the health facility. In the home-based strategy, non-clinical field officers deliver drugs and monitor and
support patients in the home. Patients also have access to clinicians but routine clinical appointments are
less frequent than for patients following the facility-based strategy. All patients are managed by a health
service provider (TASO) in close to normal health service conditions.
Evaluation Question: The study is evaluating whether home-based HIV care is approximately equivalent to
a standard facility-based approach. This will inform the public health authorities on the relative values of
these two strategies and could be invaluable information for scaling-up and sustaining ART.
Study design: We are comparing home-based care with a facility-based approach using a cluster
randomised trial. The evaluation is integrated into routine service delivery. The duration of recruitment of
patients and the evaluation is planned to be 4 years. Our primary evaluation measure is plasma viral load
(i.e. we will compare the two strategies in terms of virological failure). We are also measuring cost-
effectiveness, reported adherence, rate of uptake of voluntary counseling and testing among family
Importance/planned use of findings: Experience with ART in Africa especially in the public setting has been
limited. Little is known about which health delivery strategy would lead to better treatment effectiveness in a
setting where there is shortage of qualified medical personnel and health systems are weak and difficult to
access for patients. The evaluation will provide much needed information on the effectiveness of the two
ART delivery strategies and on adherence, sexual behaviour, uptake of voluntary counselling and testing
morbidity and mortality over a 3 year duration. Information generated from this evaluation will be of
immediate use to the people of Uganda and other resource limited settings.
Status of study/progress to date: is protocol developed, in scientific/human subjects/phe review, in
implementation? If behind schedule, please explain delays & plans to remedy/revised timeline.
The protocol is developed and has received ethical clearance. Enrolment of subjects into the study was
completed. Follow-up of subjects is continuing on schedule. A total of 1477 trial patients were invited to join
the evaluation, only 24 (1.6 %) refused to join the trial. Recruitment of subjects into the evaluation began on
5th February 2005 and ended on 7th December 2006. By 17 July 2007 3 (1.2%) subjects were lost to
follow-up and 78(5.4%) had withdrawn from the evaluation largely because they have moved out of the
catchment area (all 78 are still receiving antiretroviral therapy (ART)). In addition, 153 (10.5%) subjects
have died, and there have been 151 admissions to hospital of 125 subjects. The rates of deaths and
hospital admissions are broadly similar to other studies in resource limited settings.
Lessons Learned: We have not published any articles. We are in the preliminary stages of this study and
are not in a position to formally analyze our data. However, our data collection systems and follow-up of
subjects is complete and up-to-date. The study has high co-operation both from patients and from the public
Information Dissemination Plan: Information on the progress of this evaluation is regularly fed back to the
Ministry of Health, the AIDS Control Programme (ACP) and Uganda AIDS Commission (UAC) , TASO and
the patients. This information is being used to strengthen the ART services in the country. These meetings
will continue to be an avenue for giving feedback to all stakeholders. After the evaluation, we will
disseminate the findings to both trial subjects, the health services and ACP and UAC and other policy
makers. We will do this through meetings and presentations We will also publish the findings in international
journals in collaboration with our partners.
Planned FY08 activities
We will continue to monitor and follow-up study subjects enrolled in the evaluation. We will continue to
collect data on study subjects including on virological response, CD4 counts, reported adherence to
medication, costs of accessing care. Some of these data will be collected through laboratory testing. Some
through interview of study subjects. We will also continue to collect health services data including their costs
of delivering care.
We will continue to hold meetings between study investigators and the different stakeholders to inform them
of trial progress.
Salaries/fringe benefits: $ 360,000
Participant Incentives: 0
Laboratory testing: $120,000
Activity Narrative: Total: $650,000
We have asked for $360,000 for staff salaries for over 20 full-time staff. We need the staff for various
evaluation activities. We have not requested major equipment as this has been purchased from past
budgets. We have requested $30,000 for minor equipment, stationary (e.g. printing questionnaires), office
consumables (e.g. rent) and laboratory consumables. We asked for $60,000 travel to cover the costs of field
work operations (e.g. fuel supplies, insurance for vehicles, repairs) and for overseas travel. We have asked
$120,000 for plasma viral load testing and other laboratory testing. These are essential endpoints of the
trial. We have asked for $70,000 for other costs, which includes telephone and email services, electricity,
security, and overheads.