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 2008 2009
The program will support the expansion of comprehensive HIV/AIDS prevention, care and treatment
services to HIV-infected children and their families and provide pediatric HIV training opportunities for
clinical and ancillary health professionals.
Comprehensive HIV services will include antiretroviral therapy (ART); adherence counseling; tuberculosis
(TB) diagnosis and treatment; diagnosis and treatment of opportunistic infections (OI); provision of basic
preventive care package (BCP); confidential HIV counseling and testing; family support interventions
including prevention with positives and discordant couple counseling for parents; family psycho-social
support; and related interventions for orphans and vulnerable children (OVC). Following national pediatric
treatment guidelines and strategies, in FY08 program initiatives will continue the care and treatment of
pediatric and family member patients and expand quality pediatric care to additional clients using a family
centered approach to ensure the pediatric patients and their families receive related services and support
required for OVCs.
In support of national services and satellite sites and to ensure full access to high-quality pediatric care and
treatment services throughout the country, initiatives to train and mentor doctors, nurses, counselors, and
allied health care providers in the public and private sector will be established to support basic preventive
palliative care, and antiretroviral provision to children living with HIV/AIDS. The program will participate in
the development of the Uganda national Positive prevention curriculum and provide leadership in area of
adolescent care, e.g. disclosure, sex and sexuality, adolescent counseling.
Activities to integrate prevention messages into all care and treatment services will be developed for
implementation by all staff. Specific interventions to support adolescent care, treatment, adherence, and
prevention message will be developed and integrated into clinical and family services. Regular abstinence
being faithful (AB) messages will be provided for Adolescent and Youth peer support groups. Health
education sessions including "Positive Prevention" (PP) messages will be provided both in-clinic and
through home counseling. These messages will target children over 12 years of age and their family
members especially parents. For older children 13 years and above and youth, AB will be supplemented by
condom skills building during support group meetings with counselors. Condoms (for those that are sexually
active) will be distributed to adolescents and their adult family members through in-clinic counselors, the
home health team, and clinicians following age-appropriate counseling. Through community outreaches
caretakers of children will be mobilized and provided with health education sessions with special focus on
AB messages. Pediatric health professional trainings will include pediatric HIV counseling issues as part of
its curriculum, whereby abstinence/being faithful messages are discussed. The counseling training will
support health workers; however, the beneficiaries of the PP trainings will be health workers, community
members, and the adolescents and youths themselves. To ensure equitable access to high-quality pediatric
HIV services, satellite sites will be established in peri-urban and rural health care facilities.
clinical and ancillary health professionals. Comprehensive HIV services will include antiretroviral therapy
(ART); adherence counseling, TB screening and treatment; diagnosis and treatment of opportunistic
infections (OI); provision of basic preventive care package (BCP); confidential HIV counseling and testing;
family support interventions including prevention with positives and discordant couple counseling for
parents; family psycho-social support; and related interventions for orphans and vulnerable children (OVC).
Following national pediatric treatment guidelines and strategies, in FY08 program initiatives will continue the
care and treatment of pediatric and family member patients and expand quality pediatric care to additional
clients using a family centered approach to ensure the pediatric patients and their families receive related
services and support required for OVCs.
prevention message will be developed and integrated into clinical and family services. Programming for
‘Other prevention' will be primarily supported through home-based HIV counseling and testing (HBHCT),
health education and "Positive Prevention" messages provided by the health workers either in the home or
the clinic. Health education, counseling and distribution of condoms are components of this prevention
initiative which will focus on the families of HIV-infected children. Condom will be offered through all clinics
and only made available to youth through a counselor or other health professional after a counseling
session. Family Planning (FP) will be provided to women of reproductive age attending the clinics and any
adolescent female identified as sexually active. HBHCT supports family HIV testing and HIV status
disclosure, as well as behavior change and harm reduction counseling. Through Community Care Support
Programs caretakers of children will be mobilized and provided with prevention messages. Measures will
be taken to increase access and utilization of FP services among PIDC adolescents and caretakers.
Sexually Transmitted Diseases (STD) diagnosis and treatment and cervical cancer screening services will
be made available through this program.
The program will support health professional trainings for all cadres (nurses, doctors, counselors etc) to
include pediatric HIV counseling issues as part of its curriculum, and other prevention messages will be
included in the training. It is estimated that such training initiatives will reach no less than 360 health
professionals in the coming year. To ensure equitable access to high-quality pediatric HIV services, satellite
sites will be established in peri-urban and rural health care facilities.
(ART); adherence counseling; tuberculosis (TB) diagnosis and treatment; diagnosis and treatment of
opportunistic infections (OI); provision of basic preventive care package (BCP); confidential HIV counseling
and testing; family support interventions including prevention with positives and discordant couple
counseling for parents; family psycho-social support; and related interventions for orphans and vulnerable
children (OVC). Following national pediatric treatment guidelines and strategies, in FY08 program initiatives
will continue the care and treatment of pediatric and family member patients and expand quality pediatric
care to additional clients using a family centered approach to ensure the pediatric patients and their families
receive related services and support required for OVCs. In support of national services and satellite sites
and to ensure full access to high-quality pediatric care and treatment services throughout the country,
initiatives to train and mentor doctors, nurses, counselors, and allied health care providers in the public and
private sector will be established to support basic preventive palliative care, and antiretroviral provision to
children living with HIV/AIDS. The program will participate in the development of the Uganda national
Positive prevention curriculum and provide leadership in area of adolescent care, e.g. disclosure, sex and
sexuality, adolescent counseling.
Through this program, palliative basic HIV care will be provided to all HIV infected children in care (majority
of whom are not yet receiving antiretroviral therapy), HIV exposed infants (infants born to HIV infected
women) for whom a definite HIV diagnosis will be made at 18 months of age, and family members of HIV
infected children. All of these children require regular monitoring for potential disease progression and HIV
disease transmission in the case of the exposed infants. Palliative care services provided will include
prevention and treatment of opportunistic infections, provision of basic preventive care package (comprising
of daily cotrimoxazole for prophylaxis of OIs, insecticide treated mosquito nets for malaria prevention, safe
water systems for diarrhea prevention, micronutrient nutritional supplementation), diagnosis and treatment
of sexually transmitted infections, TB care, and regular assessment of immunological status for ART
eligibility using CD4 testing. HIV exposed infants will be offered HIV testing using DNA-PCR through the
‘early infant diagnosis' program implemented by the MOH. All these children will receive basic palliative
care and will be followed up closely until a definitive HIV diagnosis is made. Children found to be infected
will continue to receive palliative care plus ART if eligible and those found HIV- will be discharged from
these clinics. Staffing, ongoing clinical services (including monitoring investigations, medical supplies and
medications) and training are the primary palliative care/basic care activities. Investigations provided to
children with a definitive HIV diagnosis will include, but are not limited to, baseline TB screening, a baseline
CD4+ count, and follow-up CD4+ counts every 6 months. Additionally, these children benefit from in-clinic
food, food supplements, psychosocial support, cotrimoxazole prophylaxis, multi-vitamins, basic care
package, and any other medications and interventions necessary to reduce opportunities for disease
progression or infection.
In FY08, palliative care/basic care funds will be used to support the activities described above. Home-based
follow-up and HBHCT services will be expanded to include all children and families in care, and not only
those children who are on ART. This expansion will allow for better follow-up of all missing patients and
could potentially lead to reduced mortality. Additionally, linkages and training opportunities with other NGOs
and service organizations developing their pediatric HIV care and treatment capacity will be conducted.
Trainings will take a three-pronged approach, including didactic trainings, practical clinical attachments to
high volume pediatric clinics, and on-site support supervision. It is estimated that no less than 600 health
professionals will participate in these training exercises.
Comprehensive HIV services will include antiretroviral therapy (ART); adherence counseling, TB screening
and treatment; diagnosis and treatment of opportunistic infections (OI); provision of basic preventive care
package (BCP); confidential HIV counseling and testing; family support interventions including prevention
with positives and discordant couple counseling for parents; family psycho-social support; and related
interventions for orphans and vulnerable children (OVC). Following national pediatric treatment guidelines
and strategies, in FY08 program initiatives will continue the care and treatment of pediatric and family
member patients and expand quality pediatric care to additional clients using a family centered approach to
ensure the pediatric patients and their families receive related services and support required for OVCs.
prevention message will be developed and integrated into clinical and family services. To ensure equitable
access to high-quality pediatric HIV services, satellite sites will be established in peri-urban and rural health
care facilities. In support of national services and satellite sites and to ensure full access to high-quality
pediatric care and treatment services throughout the country, initiatives to train and mentor doctors, nurses,
counselors, and allied health care providers in the public and private sector will be established to support
basic preventive palliative care, and antiretroviral provision to children living with HIV/AIDS.
TB screening and treatment services will be provided for HIV-exposed children, newly diagnosed HIV
infected children, and existing pediatric patients receiving regular palliative care and/ or antiretroviral
therapy (ART). TB screening including a PPD will be performed on all newly diagnosed HIV infected
children. Available data suggests a ~16% PPD reactive rate among newly diagnosed HIV infected pediatric
patients in the existing clinics. Children with reactive PPD but without evidence of active disease will be
provided with isoniazid (INH) preventive treatment (IPT) and followed up closely to ensure adherence and
minimize side effects. During the first 100 days of ART, available clinic data revealed that the risk of
unmasking TB-IRIS at the Pediatric Infectious Diseases clinic (PIDC) increased 2.7 fold compared to pre-
ART (95% CI=2.1 to 2.5; P<.001) and immune reconstitution post-antiretroviral within 6 month of initiating
ART occurred in 6.2% (104/1669) of all patients on ART. Children on ART will therefore be closely
monitored on a monthly basis and evaluated for development of TB. Children with CD4 counts <200 cells/ul
at initiation of ART will have a second PPD placed 6 months later as evidence has shown that such children
had a 41% longer time to TB unmasking, implying a longer time was needed for restoration of antigen-
specific immunity. Transport reimbursement will be provided to needy clients to return for PPD reading at
the clinic (It is estimated that 22% [~555] patients will need such assistance). TB screening will be extended
to family members of all PPD reactive children.
Children who are symptomatic for TB will be actively evaluated using clinical assessment, sputum smears,
and radiological examination. Children found to have active TB will be treated according to the national
guidelines provided by MOH/NTLP for management of TB in children. Anti-TB drugs/ medications will be
provided through the National TB and Leprosy Program. At the same time, children will be assessed for
ART eligibility using WHO clinical staging and CD4 where available. For those that are co-infected with TB
and HIV, ART will be initiated at CD4 <350 in line with the revised National ART guidelines. For patients
requiring concurrent administration of anti-TB and antiretroviral therapy, precautions will be taken to
minimize toxicity and drug interactions and ensure adherence. For children with TB and HIV who are not yet
ART eligible, treatment for TB will be administered and the patient revaluated at the end of treatment for
ART eligibility. All children will receive cotrimoxazole prophylaxis as part of basic palliative basic care and
will be followed up regularly. In FY08, palliative TB/HIV care activities will continue at the existing Mulago
PIDC and its satellite clinics in Kampala and services will be expanded to reach rural district clinics and
health centers to provide TB screening and treatment services. It is estimated that >2500 children will have
a PPD performed in FY08. Approximately 16% of those screened with a PPD will be reactive or have
symptoms suggestive of TB and will, therefore, have chest x-rays performed. Of the existing 5000 HIV
infected children in active follow-up by end of June 2007, plus the patients recruited by March 2008, it is
estimated that >336 will require TB treatment.
No less than 360 health professionals will be trained in TB/HIV through this program. Training will strive to
enhance the knowledge and expertise of health professionals in diagnosis, care, and treatment of children
co-infected with TB/HIV as TB has a significant effect on morbidity, mortality and ARV drug treatment
options and outcomes. Appropriate pediatric diagnostic techniques and treatment options/interactions will
be emphasized through these training efforts.
Majority of children attending pediatric HIV care clinics are orphaned (~54% of the children seen at the
PIDC have lost one or more biological parent). Additionally, 66% have baseline weight and height less than
the 2.5th centile indicating inadequate nutrition, while others are deemed vulnerable simply due to their HIV
positive status, guardian's low household income, and lack of access to education. Hence, all children
attending pediatric HIV care clinics are considered vulnerable. This program will support provision of
specialized OVC services including play therapy, psychosocial support, health care, and nutritional support.
In FY08, more than 9,000 HIV+ children will benefit from OVC services. Vulnerable adolescents will benefit
services such as nutritional support, technical and life skills training. Children in need of OVC services that
may not be available through this program for example legal services and school fees support will be
referred to other providers.
HIV Counseling and Testing (HCT) will be provided in several forms: 1) early diagnosis of children below 18
months of age with DNA-PCR; 2) Voluntary Counseling and Testing (VCT) for children 18 months to 18
years using EIA antibody testing; 3) in clinic HIV counseling and testing of family/household members of
clients attending the clinic ;4) home-based HIV counseling and testing of family/household members
(HBHCT) of index patients; and, 5) Community-based HIV counseling and testing in the rural eastern and
western regional districts where such services are currently lacking. DNA-PCR testing at the regional
referral hospitals will be supported through the MOH in collaboration with JCRC and is aimed at improving
early infant diagnosis of HIV nationwide. The target populations that will benefit from these services include
vulnerable infants, children and youth, and adults in HIV/AIDS-affected families. The MOH has developed
infant and early HIV diagnosis guidelines and monitoring tools that are going to be disseminated to all
providers in the coming year. HIV exposed infants are identified in the postnatal, immunization, and other
child clinics are screened for HIV infection at 6 weeks (or earliest contact between 6 weeks and 18 months)
using DNA-PCR testing. Blood specimens for DNA-PCR are collected using Dried Blood Spot (DBS)
technique and transported to the regional referral laboratories for testing. HIV infected infants are linked to
palliative and ART services while the HIV negative have enhanced prevention messages during post test
counseling. Specialized infant feeding counseling messages are provided to HIV+ mothers who continue to
breastfeed their HIV- infants to reduce future possibilities for HIV transmission to the infant.
In FY08, it is estimated that approximately 38,000 children and adults will be screened for HIV through
various urban and rural clinics. More than 9,500 of the 38,000 screened are anticipated to be infants <18
months. These infants will require DNA-PCR testing. In line with HIV counseling and testing (HCT) policy of
2005, the program will also support the roll-out of Pediatric HIV routine counseling and testing (RCT) in all
the facilities in Uganda. Additionally, linkages and training opportunities with other NGOs and service
organizations to assist in the development of pediatric HIV counseling and testing capacity will be
conducted. For these capacity building initiatives, it is estimated that approximately 600 health professionals
will be trained. The program will contribute to the development of pediatric counseling and testing expertise
throughout the country. Health professionals will benefit from pediatric-specific HIV/AIDS training and
capacity building in the form of didactic trainings, support supervision, and clinical attachments to high
volume pediatric HIV specialty centers like the Mulago PIDC. Through the UNICEF/Clinton Foundation
collaboration, IEC materials aimed at informing the population on linking PMTCT to HIV care and infant
feeding are being designed.
Only 30 out of 220 accredited antiretroviral therapy (ART) sites provide pediatric services (report of National
Strategic Framework evaluation 2001-2006 of June 2007). Challenges related to pediatric ART include high
cost of pediatric ARVs, inadequate skills, and limited resources for diagnosis of HIV in children. This activity
will strengthen capacity for pediatric ART scale-up to several rural districts. The program will conduct
training for capacity building in ART delivery through didactic methods, clinical attachment, and mentoring
and support supervision to reach 600 health care providers. The program will work closely with the PMTCT
program and the national early infant diagnosis to identify HIV infected children. ARV Services will
emphasize clinical support and care and treatment monitoring to an estimated 5000 children and their
parents already receiving care at the various established pediatric clinics. ARV services will include
screening for ART eligibility using WHO and MOH national guidelines. Eligible patients and their carers will
then receive preparatory counseling focusing on adherence to ART and regular follow-up of patients
ensured. Commodity procurement, opportunistic infection treatment and ART monitoring investigations,
adherence support and follow-up, personnel, quality assurance and monitoring and evaluation of
programming associated with the children and family members on ART will also be covered under this
funding. Adherence follow-up and monitoring will be accomplished through enhanced in-clinic counseling
and home health services.
It is estimated that no less than 360 health professionals will participate in pediatric-specific training
activities supported through this program. Increased numbers of children and families will benefit from
quality pediatric HIV care and treatment services through these trainings and capacity building sharing of
best practices.
services and support required for OVCs. Activities to integrate prevention messages into all care and
treatment services will be developed for implementation by all staff. Specific interventions to support
adolescent care, treatment, adherence, and prevention message will be developed and integrated into
clinical and family services.
The program will support the strengthening of laboratory services for diagnosis of HIV, diagnosis of
opportunistic infections (OI), assessment for ART eligibility, immunological monitoring for antiretroviral
therapy (ART), diagnosis of sexually transmitted infections, and evaluation of patients in care through
hematological and chemistry testing. Several HIV testing initiatives will be supported in order to identify
more children and link them to appropriate HIV care services. These will include VCT for those referred to
the clinics, home based HIV testing attending clinics, Home based HIV testing offered to family members of
HIV infected children (HBHCT), and routine HIV tesing and counseling (RTC) for hospitalized children.
Children below 18 months of age will be tested for HIV using virologic DNA-PCR techniques that will be
made available at the regional referral hospital laboratories through support from the MOH. The MOH has
developed guidelines for the implementation of the ‘early infant diagnosis program' that aims at identifying
HIV-infected infants and linking them to palliative care services at the earliest opportunity. Dried Blood spot
(DBS) blood specimens collected from infants at 6 weeks of age attending post-natal or immunization clinics
will be transported to the regional laboratories for testing. For older children above 18 months of age and
family members of HIV- infected children will be tested for HIV using EIA tests or rapid test kits. The
program will support laboratory services for 5000 children in the existing clinics at PIDC Kampala and
several other satellites located in rural and urban areas as pediatric services are scaled up. All clinics will
provide services in HIV palliative care, tuberculosis (TB) care, (ART), OI care and management of sexually
transmitted infections (STI).
To ensure equitable access to high-quality pediatric HIV services, satellite sites will be established in peri-
urban and rural health care facilities. In support of national services and satellite sites and to ensure full
access to high-quality pediatric care and treatment services throughout the country, initiatives to train and
mentor doctors, nurses, counselors, and allied health care providers in the public and private sector will be
established to support basic preventive palliative care, and antiretroviral provision to more children living
with HIV/AIDS. A minimum of 12 health workers will be trained in the provision of laboratory services.
