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 2009
Activity Narrative
This activity relates to Palliative care - home-based and Counseling and testing.
Building on the USG public sector programs, this activity is a follow-on to the Education Sector Workplace
AIDS Policy Implementation (ESWAPI) that provided support to the education sector that ended in July
2008. The new follow-on program called Supporting Public sector workplaces to Expand Action and
Responses against HIV/AIDS (SPEAR) is the USG prime mechanism for leveraging public sector support to
increase access to and utilization of HIV/AIDS treatment, prevention and care services to selected sectors
that include: ministries of Internal Affairs (MoIA); Local Government (MoLG); and Education and Sports
(MoES). The SPEAR program is supporting 3 sectors that have worked with the National HIV/AIDS
Program to develop and integrate HIV/AIDS into their work place through operationalization of the new
National HIV/AIDS workplace policy. World Vision is the lead implementing agency for the USAID funded-
five year program. The SPEAR initiative, which begun in June 2008 aims to achieve three key results:
1. Supporting public sectors have policies, plans and activities that assure availability, integration and
utilization of sustainable HIV prevention, care and treatment services for their employees
2. Increasing access to and utilization of quality HIV prevention, care and treatment services by target public
sector workers, with a focus on identifying HIV-positive individuals and facilitating access to networked care
and treatment services
3. Improving access and use of wrap-around services by target public sector workers living with HIV/AIDS
and their families through effective partnerships with other USG and non-USG supported programs
On the overall, ESWAPI which ended in July 2008 trained 630 Behavior Change Agents (BCAs) and
reached over 50,000 MoES employees and their dependants with prevention programs over a period of 3
years.
In FY 2009, SPEAR project activities under this program area (Sexual Prevention) will be geared towards
increasing personal perception of risk of HIV infection/transmission and utilization of prevention services
through aggressive targeted behavior change programs. Activities will include: Conducting sectoral
assessments: in the MoIA and MoLG to ascertain the variations in KAP, the variations in risk factors (both
behavior and socio-economic), and the most effective channels through which each population segment
can be effectively reached. This assessment will be combined with the policy assessment planned for the
Ministries of internal Affairs and Ministry of Local Government. The KAP survey will include the communities
where some of the target audiences leave e.g. police/prisons barracks and boarder post custom quarters.
Developing/adopting targeted behavior change messages: This activity focuses on taping into locally and
internationally available behavior change communication expertise and the using the power of peer
influence to change and model public sector employees' behaviors for HIV/AIDS prevention. Led by an
international BCC consultant, SPEAR will review ongoing behavior change programs in Uganda and
beyond; assess their appropriateness for prevention among adult public sector workers; identify the gaps in
terms of messages, dissemination channels; and develop an initial strategy for
adopting/adapting/developing targeted behavior change programs (messages, a mix of dissemination
channels and performance indicators) for the target ministries/departments. Behavior change messages will
seek to increase perception of benefits of safer behaviors compared to the costs of risky behavior.
Specifically, messages will target reducing those behaviors that increase risk for HIV transmission such as
engaging in casual sex encounters, transactional sex and sex with an HIV-positive partner or whose status
is unknown + dealing with concurrent multiple sexual partners. To ensure that target public sectors identify
with the behavior change messages communicated, SPEAR will involve the relevant ministries/workplaces
in adapting the messages. Facilitating creative communication for behavior change: The project will involve
employees and utilize the existing structures in the target line ministries as agents for passing on BCC
messages to their colleagues and peers. Specific messages and modes of delivery will be adopted to
ensure that the hard to reach and underserved areas are not left out or underserved. Additional messages
will be developed for dissemination to police, prisons, schools and guards during their routine parades.
Training behavior change agents: SPEAR will work with the respective workplaces to identify and train
about 2,500 workers and their families in influencing their peers' self-efficacy and promoting positive
behavior change. Developing and executing a multi-dimensional BCC program: Depending on evidence
gathered regarding effective BCC channels, SPEAR will develop a BCC campaign that may integrate the
use of "affinity groups," small groups discussions, public talks by PHA and experts on HIV/AIDS, public
relations (such as radio talk shows and TV panels), posters, media advocacy, and educative entertainment
tailored to meet the needs of public sector workplaces. The activities will cover employees in MoIA, MoLG
and MoES in all the 81 districts of Uganda. The project will liaise with other ongoing behavior change
programs such as by MoH, UAC and AFFORD. About 150,000 public sector workers and their families are
targeted for behavior change drive in FY 2009.
Also, SPEAR project will support the target public sectors to have policies, plans and activities that assure
availability, integration and utilization of sustainable HIV/AIDS prevention, care and treatment services for
their employees. Activities will include training 20 individuals in workplace HIV-related policy; and 100
workplace AIDS policy implementation champions to operationalize policy and plans. About, 30 points of
operation will be supported with institutional capacity building for workplace HIV/AIDS policy implementation
including having costed workplace HIV/AIDS related work plans. About, 50 individuals will be trained in
workplace HIV-related community mobilization for prevention, care and/or treatment; and 500 will be trained
in HIV-related stigma and discrimination reduction. SPEAR project will support 10 stigma and discrimination
(S&D) campaigns/events, to reach / benefit 1,000 people.
These activities will be conducted in the workplaces of the three target ministries i.e. MoES, MoIA and
MoLG countrywide, starting from headquarter employees through the districts to the lower levels. SPEAR
will support human resource departments and PHA support groups to organize creative events (such as
debates, radio seminars, video shows, concerts, testimonies, etc) and Anti- S&D campaigns to highlight
dangers of S&D and raise awareness in the respective communities. SPEAR will build the capacity of the
three target line ministries to fight workplace related stigma and discrimination engage in policy reforms,
financial and program planning for HIV/AIDS interventions in their respective workplaces. Capacity building
is essential for enhancing sustainability of HIV/AIDS interventions in the workplaces.
New/Continuing Activity: Continuing Activity
Continuing Activity: 16271
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
16271 16271.08 U.S. Agency for World Vision 12196 12196.08 Public Sector $50,000
International Uganda Work Place
Development Program
(ESWAPI)
Emphasis Areas
Gender
* Addressing male norms and behaviors
* Increasing gender equity in HIV/AIDS programs
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $20,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.02:
Continuing Activity: 15917
15917 15917.08 U.S. Agency for World Vision 12196 12196.08 Public Sector $650,000
Estimated amount of funding that is planned for Human Capacity Development $200,000
Table 3.3.03:
This activity relates to sexual prevention and Counseling and testing.
On the overall, ESWAPI which ended in July 2008 facilitated over 1,000 MoES employees and their
immediate dependants to access one or more forms of palliative care over a period of 3 years.
Improved access and utilization of care, treatment and support services for HIV-positive public sector
workers has direct and positive implications for addressing the impacts of HIV/AIDS in the workplace.
Access to anti-retroviral treatment leads to reduction in absenteeism and turnover, improves morale and
productivity. In addition, increased access to care and treatment enhances stigma reduction, disclosure and
utilization of positive prevention. A challenge identified during the implementation of ESWAPI was that
employees who know their HIV-positive status may not risk disclosing their status to seek care and
treatment. This finding suggests the need for effective training of peer counselors, human resource officers
and behavior change agents with an emphasis on upholding counselors' ethics and improving employees'
confidence in the confidentiality of counseling sessions.
In FY 2009, SPEAR project activities under the program area -Adult Care and Treatment (Care and
support) will contribute towards improving access to and utilization of a range of HIV-related care and
support services (excluding TB) as well as wrap around services for HIV-positive public sector workers and
their families. The specific activities will include: Training workplace-based health workers in palliative care:
To enhance quality care services, SPEAR will work with other ongoing programs to strengthen the capacity
of health care providers in target workplaces, including school nurses and health workers in police, prisons
and local government health facilities (that have not yet been trained by other programs) through training
and refresher training in palliative care according to MoH protocols and guidelines. Training will emphasize
clinical skills including: diagnosis, prevention and treatment of 1opportunistic infections (OIs), nutritional
assessment, treatment of psychological conditions, as well as anti-retroviral therapy (ART) eligibility
assessment, adherence monitoring and counseling. Additionally, health care providers will be trained in the
skills needed to ensure continuity of service provision from testing to care and treatment for PHA.
Workplace-based health workers will also be trained in recognizing the need for referral to clinics and
community-based delivery systems to strengthen activities for prevention of opportunistic infections through
the administration of septrin (cotrimoxazole) and fluconazole prophylaxis and a scale-up of treatment
literacy.
Training of lay volunteer palliative caregivers: In addition to health workers, SPEAR will support the
respective AIDS
Control Program units and partners to carry out refresher training and training of more volunteer public
sector workers and their family members in palliative care (including counseling, psychosocial support), in
accordance with Ministry of Health standards. Examples of lay palliative care volunteers to be trained
include associate counselors, home-based caregivers, ART adherence monitors and adherence
counselors. The associate counselors will disseminate information about HIV/AIDS care, support services,
and be available for psychosocial support and counseling colleagues in the workplace. During this first year,
SPEAR will facilitate training of 200 volunteers in palliative care/ART knowledge and skills to supplement
the efforts of 100 health workers.
The Public Sector workplace policy identifies a range of care and support services including wellness
programs, psychosocial support, home based care, treatment (OI & ART) and legal advice for HIV/AIDS
positive employees. This activity is thus designed to tap into and build upon services being provided by
existing family, community, FBO, private and public health and social support systems to increase care,
treatment and support to teachers and MoES employees living with HIV/AIDS. SPEAR will create
awareness among teachers and public sector employees of the targeted line ministries, i.e MoES, MoIA &
MoLG about available care and treatment services within their communities and encourage them to seek,
participate in and benefit from these programs. Formation and activities of associations of public sector
employees living with HIV/AIDS will also be supported. SPEAR will establish formal collaboration with local
and national HIV/AIDS service providers and negotiate mechanisms through which beneficiaries can be
linked or referred to their programs. The project will commit to identifying and referring public sector
employees that need care and treatment while seeking partner organizations' provision of these services.
SPEAR targets, with improved palliative care and referral skills, to reach 1,000 individuals with HIV-related
palliative care and 200 with ART services within FY 2009.
New/Continuing Activity: New Activity
Continuing Activity:
Health-related Wraparound Programs
* Family Planning
Estimated amount of funding that is planned for Human Capacity Development $75,000
Table 3.3.08:
This activity relates to palliative care - home-based and sexual prevention.
On the overall, ESWAPI which ended in July 2008 facilitated around 12,500 MoES employees to access
and utilize HCT services.
HCT is a critical entry point for prevention, care and treatment efforts. Therefore for HIV-infected patients to
optimally benefit from the therapies available to them, they must be diagnosed early and appropriately.
However, only 12% of Ugandans aged 15-49 know their HIV status. The rise in the number of discordant
couples and HIV transmission via marriage is evidence of the need for increased and improved counseling
and testing for couples. HCT is an essential component of prevention, both among sero-positive individuals
(to prevent re-infection) and sero-negative individuals (to clarify understanding about HIV risk and
transmission). In addition, demand for HCT remains unmet for a significant proportion of the general
population. This activity focuses on increasing demand and utilization of HCT services public sector
employees and their families not only for enhancing HIV/AIDS prevention, but also as a foundation for care,
treatment and support services.
In FY 2009, SPEAR project activities under the Counseling and Testing program area will be geared
towards increasing access to and utilization of HCT services by MoLG, MoES and MoIA public sector
workers and their families. SPEAR will partner with approximately 50 HCT outlets to provide HCT (VCT,
RCT, PITC, Outreach HCT, & Home-based HCT) to benefit public sector employees. Specific activities will
include promotion of HCT services to increase individual and social perceptions of the costs and benefits
associated with the service and adoption of the health behavior. The campaigns will involve a mix of
strategies to address the negative perceptions, reduce the barriers and encourage uptake of HCT among
target workers. This will be accomplished through collaboration and partnership with HCT service providers;
and expertly designed IEC materials and other HIV/AIDS educational opportunities by both the project team
and other partners. To ensure accurate and consistent messaging, a standard HCT promotional guide will
be developed covering the main aspects and key information about HCT. In the partnerships, SPEAR
project's role will be mobilizing public sector employees and their families to go for HCT; promoting HCT;
networking with MoH to ensure adequate supply of HIV testing kits; referring interested individuals for
confidential HCT; and facilitating HCT service providers to take outreach or mobile counseling and testing
services to workplaces in remote and underserved where necessary. Approximately 150,000 public sector
employees and their families are targeted in FY 2009.
SPEAR will facilitate selected HCT service providers including district hospitals, health center IVs and other
HCT service programs to ensure effective outreach and access to HCT by rural-based public sector
workers, without neglecting urban areas where most of the target population groups (police/prisons, security
guards and officers) are based. Facilitation of service providers will be in form of grants, contracts and
advances depending on agreed scopes of work. Additionally, SPEAR will support training of health workers
based in health units owned by the Uganda police and prisons in protocols and new approaches to HCT
(e.g. RCT, PITC), Couples counseling and testing, home-based counseling, etc so as to increase
opportunities and HCT coverage among target groups. These activities will be conducted in the workplaces
of the three target ministries i.e. MoES, MoIA and MoLG countrywide, starting from headquarter employees
through the districts to the lower levels.
Additionally, SPEAR will promote and facilitate pre-marital and couples HCT and mutual disclosure among
public sector workers. To increase convenience and opportunities for public sector workers to receive HCT
in a friendlier environment, SPEAR will work with public and private health facilities to promote "weekend
service windows." Experience from ESWAPI shows that some government workers are unable to visit
service centers during working hours.
Generate evidence for HCT promotion: SPEAR team will carry out limited operations research activities.
For example, a prospective cohort study could be conducted comparing sexual behaviors of workers in
public education workplaces (beneficiaries of this program) with those in the private education workplaces
(non-beneficiaries) in order to assess the effectiveness of HCT.
Continuing Activity: 15900
15900 15900.08 U.S. Agency for World Vision 12196 12196.08 Public Sector $150,000
Table 3.3.14:
