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.
Subdivisions of Program Areas, these track general higher level sub-classifications of expenditure.
Subdivisions of Major categories, these are the most detailed expenditure data.
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
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
This activity is a continuation from FY 2007. New activities and emphases include: focus on the palliative
care prevention package (including "Prevention for Positives"); cotrimoxizole prophylaxis; provision of
bednets to prevent malaria (supported by the President's Malaria Initiative through RAPIDS); Clorin to
ensure safe drinking water; increased support for pediatric ART (P-ART) through the use of Dried Blood
Spot testing of infants and referrals of HIV+ infants for P-ART. SUCCESS II will continue to provide a
quality package of adult and child palliative care, which will include pain management in hospices.
SUCCESS II will emphasize prevention for positives such as avoiding risky sexual behavior, promoting
abstinence and faithfulness, and reducing alcohol intake. Lastly, SUCCESS II will emphasize sustainability
and capacity building for it partners.
In FY 2008, CRS will continue to provide quality, community-based palliative care (HBHC) services through
six Catholic Diocese home-based care programs and ten faith-, community-based hospices in seven
provinces. In FY 2007, SUCCESS reached 33,984 PLWHA with home-based and hospice care. In FY
2008, the SUCCESS II project will operate in seven provinces and support 13 hospices serving at least
38,320 PLWHA in 45 districts providing geographic coverage to roughly 62% of all districts in Zambia at an
average cost of about $81 per client. Nationally, SUCCESS II will have 99 service locations. The
SUCCESS M&E system enables managers and staff to account for individual clients, analyze data
effectively, and use data for program management and planning.
SUCCESS II will link to other PEPFAR-funded projects, such as AIDS-Relief, CIDRZ, and ZPCT, and to
GRZ services, for treatment of opportunistic infections (OIs), sexually transmitted infections (STIs), and for
ART. SUCCESS II will strengthen linkages to and from Prevention of Mother to Child Transmission
services (PMTCT), such as ZPCT. For example, SUCCESS will provide PMTCT sites with coordinates of its
home-based care programs, to which PMTCT providers will refer PMTCT clients for follow-up in the
community from birth through at least six months to support breast-feeding and timely weaning using
appropriate weaning and complementary foods. SUCCESS will also refer female PLWHA who are (or may
be) pregnant to PMTCT.
SUCCESS II is a leader in hospice care in Zambia. It leverages the nationwide health care infrastructure of
the Catholic Church to reach underserved, rural areas. SUCCESS II collaborates with RAPIDS, a HBC
project serving urban PLWHA, and refers clients to government health facilities for clinical care and ARV
treatment. SUCCESS II provides a standardized package of quality, holistic HBHC and services in-line with
international and national HBC guidelines. Quality assurance mechanisms will include caregiver checklists,
patient chart review, and monthly care improvement meetings between caregivers and nurse supervisors.
The HBC service package includes home visits, basic nursing care, pastoral and psychosocial support,
malaria prevention, nutrition counseling, targeted nutritional supplements for malnourished PLWHA in line
with PEPFAR guidelines, Clorin for household safe water to reduce diarrheal disease, DOTS for HIV co-
infected TB PLWHA, plus clinical referral for OIs, TB and ART. SUCCESS will identify more HIV-positive
infants and children in need of HBHC, nutritional support, and/or referrals. .
SUCCESS II has established three care categories to provide a better match between client needs and
caregiver support: 1) newly infected but asymptomatic; 2) house- or bed-bound with advanced illness; or 3)
clients on ART returning to healthy, active living with adherence support. The SUCCESS II family-based
CT model will identify newly infected clients earlier for appropriate treatment and care. SUCCESS II will
support and extend the outreach of ART, sharing the load of patient follow-on monitoring and care.
SUCCESS will support Prevention for Positives. For example, SUCCESS will counsel PLWHA on behavior
change (reducing alcohol intake to decrease risky sexual behavior, increasing abstinence and faithfulness),
nutrition, and provide appropriate, factual information Other Prevention strategies.
SUCCESS II will continue to support hospices to improve the quality of in-patient care for PLWHA, and to
provide CT and family support including day-care for HIV+ children. FY 2007 was the launch of oral
morphine for hospices. SUCCESS II will support the provision of oral morphine for quality pain management
elsewhere and will continue to work with MOH to ensure that the initiative is extended further to HBHC
providers throughout Zambia. SUCCESS II will award block grants to qualifying hospices to help them
attain and maintain acceptable standards of care. Block grants may pay for medical equipment, training,
staff/patient transport, and quality improvement. SUCCESS II will work with the Twinning Center to support
the Palliative Care Association of Zambia (PCAZ. PCAZ will facilitate training and policy development.
PCAZ will provide sustainable PC leadership in Zambia, including training for caregivers and technical
assistance to the GRZ in designing national Palliative Care guidelines and standards.
SUCCESS II will continue to refine the quality of home-based care and hospice services and partners. It
will focus on symptom and pain control, patient and family education, linkages with OVC, PMTCT, ART, TB
program sites, and a standard quality training package for HBHC volunteers and staff. It will build partner
organizational capacity. It will increase referrals to pediatric services; ART and PC, ensuring clinical care
for children. SUCCESS II partners will procure basic medications especially oral morphine and supplies for
HBHC as needed, using private matching funds. SUCCESS II leverages non-PEPFAR sources to ensure
availability of basic medications for home-based care.
SUCCESS II care coordinators will refer clients to needed services, and link clients to clinical care in district
and provincial facilities, to ART services, and follow up with community-based adherence support. Partners
also link to local branches of PLWHA and OVC support groups and to local GRZ structures. Trained
volunteer caregivers, supervised by nurses, continue to form the backbone of this model. To ease gender-
based burdens in care giving, SUCCESS II will actively recruit male and youth caregivers. In FY 2008,
SUCCESS II will train over 2,000 individuals to provide HIV palliative care. SUCCESS II offers its
volunteers monthly support meetings, refresher trainings, tools for work, and CT services to boost retention.
SUCCESS will support gender equity efforts in palliative care (led by SHARe), for example, to reduce
violence against women related to HIV diagnosis or discordant HIV results. SUCCESS will also support
efforts by SHARe to promote leadership initiatives, especially those focusing on promoting increased
leadership roles for PLWHA in all HIV/AIDS activities. SUCCESS will support efforts by AIHA-PCAZ to
advocate for, promote, and disseminate policies and guidelines for comprehensive palliative care.
SUCCESS II will provide targeted nutritional supplements to malnourished PLWHA in line with OGAC and
Activity Narrative: GRZ guidelines. SUCCESS II will provide food and nutritional support with estimated value of $525,000.
SUCCESS II will leverage FFP and WFP food to obtain food rations for food insecure PLWHA and families,
in a wrap-around model. SUCCESS will participate in efforts by FANTA and IYCN to determine nutritional
needs, and promote better nutritional assessment, counseling, and support in all palliative care activities, in
coordination with GRZ agencies such as the National Food and Nutrition Commission (NFNC), NAC and
the MOH Nutrition focal persons.
For sustainability, CRS will continue to build the capacity of diocesan and hospice partners, training
providers and staff at multiple levels as well as training trainers. CRS will support PCAZ master trainers to
carry out HBHC training with diocesan home-based care programs and hospices, and work with PCAZ to
implement national PC standards and guidelines. SUCCESS will support efforts by AIHA, PCAZ and others
to establish professional accreditation standards and procedures for all palliative care services and facilities.
SUCCESS II will share best practices, lessons learnt across partners through meetings, exchange visits,
and disseminate end-line evaluation results. SUCCESS II will continue monitoring, for data accuracy, and
use performance and service data as tools to adjust program components.
To further promote sustainability, SUCCESS II will build Catholic Diocese management capacity through
organizational development, strategic planning, financial accountability, and policy development. Catholic
Church structures in Zambia, and their significant, enduring complementary role in the GRZ health system,
will outlive external funding. One advantage of SUCCESS II is the reach of Zambian Catholic structures
into rural communities. Partners are encouraged to link with local government institutions and
To diversify funding, SUCCESS II supports partners in accessing other funds as well linking with USAID
Economic Growth and Development implementing partners using their market survey and research
resources. In FY 2008, CRS will continue to support partners in their sustainability strategies.
All FY 2008 targets will be reached by September 30, 2009.
This activity is a continuation from FY 2007. New activities and emphases include: increased use of the
recently approved finger-stick protocol to allow an expansion of CT into the community; greater focus on the
palliative care prevention package in all service settings including CT; as well as increased support for
Pediatric ART (PART) through screening of infants using Dried Blood Spot (DBS) samples for diagnosis
using PCR technology, where available, with consequent referral of HIV positive infants for PART.
In FY 2008, SUCCESS II will also work on sustainability and capacity building in the last year of PEPFAR.
The most lasting gains in sustainability will be in terms of: organizational sustainability (organizations will
continue operations after PEPFAR); and sustainability of services (organizations will continue services as
resources permit). The most difficult to achieve will be financial sustainability (maintaining the same level of
SUCCESS II has established a large platform for HIV service delivery in six of nine dioceses (7 provinces)
in Zambia. SUCCESS II views CT as an integral component of high quality, community-based palliative
care (HBHC). SUCCESS II has achieved its CT targets. In FY 2007, SUCCESS II had a CT target of
12,000, and reached 100% of its target. In FY 2008, SUCCESS II will target 20,500 PLWHA in 45 of
Zambia's 72 districts (geographic coverage of more than 62% of all districts) with CT services and will train
850 persons, including health workers, caregivers, teachers, and local leaders in counseling or testing,
including pediatric CT. The cost per client counseled and tested, for 2008 will likely drop as SUCCESS'
partners increase the volume of counseling and testing, and become more efficient especially with the roll
out of finger-prick CT. However, because SUCCESS II works in rural areas, the cost per client will likely
remain higher than for CT delivered in densely populated urban and peri-urban areas. The target and cost
estimate rely heavily on provision of test kits by the GRZ's District Health Management Team, which the
USG is supporting through the JSI/Supply Chain Management Services project.
SUCCESS II will support its partners to provide on-site CT services that meet national and international
standards, focusing on those areas where other USG supported CT does not exist. CT, the entry point for
HIV/AIDS care and treatment, enables SUCCESS II to identify and refer PLWHA early for palliative care
and ART. Early identification of HIV infection allows PLWHA to initiate behavior change and participate in
Prevention-for-Positives programming. This reinforces USG Zambia Prevention targets. It also may help in
preventing or delaying orphanhood for Zambian children born to couples, in which one or both partner is
HIV-positive, provided that they take appropriate precautions. In FY 2008, SUCCESS will support 19
service locations providing counseling and testing according to national and international standards
SUCCESS II has set an indirect target of referring at least 4,550 individuals found to be HIV positive for
ART, including infants and children. Assuming that there is a reliable and adequate supply of test kits,
SUCCCESS II partners will scale up CT services through innovative methods, such as community CT, and
to the extent possible, will share its trained counselors with government health facilities when and where
they are short staffed.
Catholic Diocese partners will mobilize communities and use community participation to increase
acceptance and the uptake of CT, taking CT activities directly into the communities and households.
SUCCESS-II introduced finger-prick testing technology at a community level following NAC/GRZ and
International CT guidelines. This builds on the established care relationships in the communities and allows
for privacy and convenience of CT in the home. Since rapid testing is not effective in infants under 18
months, they will either: a) drawn a drop of blood for PCR analysis using Dry Blood Spot (DBS) technology
(available in Lusaka, Livingstone and Ndola); or b) where DBS and PCR are not available, home-based
care volunteers will visually screen infants for signs of "growth faltering" and other symptoms associated
with HIV/AIDS, and refer for presumptive clinical care until confirming diagnosis. This community CT model
also provides some relief for the health care human resource crisis in Zambia, by providing additional health
care providers to work in SUCCESS II rural service delivery sites and allowing scarce GRZ facility CT staff
to remain at their service sites to meet the increasing demand for CT services. In FY 2008, SUCCESS II
will train 850 individuals in counseling and testing according to national and international standards
SUCCESS II partners use a network model and create linkages to existing ART services. SUCCESS II
works hand in hand with the GRZ local health structures to coordinate CT services and link to other NGOs
and CT providers who operate Mobile Testing services. SUCCESS II will continue to provide training at
multiple levels, such as Rapid Test Training for registered nurses and counselors, and training on finger
prick testing for the many more ‘lay' counselors. In this technical area, appropriate GRZ trainers are
utilized, so as to carry on national protocols and guidelines.
SUCCESS II partners collaborate in numerous ways. The bi-annual meeting brings all SUCCESS II
partners together for cross-fertilization of programming ideas, issues, and lessons learned. Partners make
exchange visits to each other's sites, affording closer observation of on-the-ground best practices and skills
transfer. SUCCESS II monitoring and evaluation staff and program team continue to deepen the quality of
monitoring activities, not only for data accuracy but to use their performance and service delivery data as
programming tools for adjusting emphases or inputs.
SUCCESS II builds its partners' management capacity to promote sustainability within the Catholic structure
in Zambia, and the significant complementary role it plays to the GRZ health system. One of the
comparative advantages of SUCCESS II is the extensive reach of the diocesan structure into rural and often
isolated communities. Investment in their management capacity enhances program effectiveness and
sustainability. SUCCESS II trains its implementing partners in financial management and accountability,
logistics and commodities distribution, organizational development and strategic planning, as well as
providing mentoring on staff management and policy development. The projects are strongly encouraged to
link with local government structures and institutions. An example of strategic networking for sustainability
is having a Catholic Bishop sitting on the Board of Directors of a provincial government hospital. Key
networking also takes place at the integral community level, where local traditional leaders are involved in
parish home-based care coordinating committees. Each partner will be encouraged and supported to
become registered and/or accredited to receive drugs or kits supplied free by GRZ.
Diversification of funding support is also a key factor in sustainability. CRS management capacity building
also supports partners in accessing other funds when possible, and partners are in a better position to
attract other funds with their project management ability enhanced through SUCCESS II.
All FY 2008 targets will be reached by September 30, 2009.
This activity is linked to activities in palliative care, counseling and testing and to other ART adherence and
PEPFAR-funded palliative care projects. SUCCESS does not provide ART directly, rather, it supports
adherence by clients of other direct ART providers. The CRS SUCCESS II Project is a follow-on to the first
SUCCESS Project and this activity is a continuation from FY 2007.
Through its adherence support efforts, SUCCESS will help the GRZ and USG Zambia to: support an
increase in the number of ART patients and sites receiving ART; and support ART quality improvement and
M&E. SUCCESS will also establish links to ART Centers of Excellence and other USG supported ART sites
as client referral destinations. SUCCESS will utilize the Centers of Excellence as a source of learning for
adults and pediatric ART.
SUCCESS will provide particular adherence support in remote, rural areas of Zambia through its vast
community based volunteer network nation-wide. These volunteers will direct clients to ART sites and in
cases where transport is a major barrier, will assist with client transport. In addition, SUCCESS will facilitate
where and when possible in bringing ART closer to clients, for example, through support of ART in hospice
or other community settings.
In FY 2007, SUCCESS targeted 2,500 PLWHA, located in the vicinity of ART sites, for a combination of
adherence support and nutritional supplementation. Program coordinators, volunteer caregivers, and
hospice staff were trained in ART and Adherence Support, relevant to their provider level. In addition,
SUCCESS formalized referral linkages between its diocesan partners and AIDS-Relief, CIDRZ, and ZPCT
ART sites in eight Provinces. 1,400 home-based care clients have received ART through CIDRZ in
Western Province, as well as many other ZPCT-supported GRZ clinical sites. These two-way referrals -
from home-based care to ART clinical facilities and back to home-based care for adherence support -
weave a strong continuum of care.
In FY 2008, SUCCESS II will continue to promote and support the rapid scale up of ART for Zambian
PLWHA through its partners. SUCCESS II will refine and expand its client referral to ART services
mechanism, and expand its ART literacy and adherence support programming to include community
adherence support groups. Pediatric ART (through referrals) and adherence referral and support will be
scaled-up. SUCCESS II will refer as many of its home-based care clients and post-test HIV positive people
to USG-supported ART sites as possible. SUCCESS II has set a target of providing adherence support for
6,850 PLWHA who will receive ART from the network model. SUCCESS II will provide support to
community based ART, transporting ART clients who live far from ART sites to the clinic for care or for ARV
re-supply, as a means to boost adherence, and to minimize the difficulty of reaching ART sites for PLWHA
who live in remote areas.
SUCCESS II will refer clients as follows: in Solwezi Diocese (Northwest province), to Mukinge Mission
Hospital (supported by AIDS-Relief); in Kasempa District, and Solwezi General, Kabompo District, Zambezi
District, and Mwinilunga District Hospitals (supported by ZPCT). In Mongu Diocese (Western Province),
SUCCESS will refer HBC clients to Lewanika General Hospital (CIDRZ) (1,400 HBC clients are already
linked to ART). In Mansa Diocese (Northern Province), clients are linked to Mansa General and
Kawambwa District Hospitals, (ZPCT). In Mpika Diocese (Northern Province), clients are referred to
Chilonga Mission Hospital (AIDS-Relief) and to Mpika and Chinsali District Hospitals and Nakonde Rural
HC (ZPCT). In Chipata Diocese (Eastern Province) clients will be referred to St. Francis Mission Hospital
(AIDS-Relief) in Petauke; in Kasama to Kasama General Hospital and Mbala District Hospital (ZPCT).
Monze Diocese (Southern Province) will refer to Macha and Mutendere. Mission Hospitals (AIDS-Relief).
AIDS-Relief is developing a further site in Monze, which will link with SUCCESS II palliative care support.
Adherence support, initially made possibly by GHAI rapid expansion funding, will continue with the
widespread training of caregivers on ART, ART literacy and Adherence support education, and the ensuing
application among the patients on ARVs in partner programs. The partners will continue to include PLWHA
in the adherence trainings to further empower those who are closest to the need and will strive to include a
balanced number of male and female adherence supporters.
SUCCESS II will continue to provide severely malnourished ART patients with nutritional supplements in
accordance with OGAC guidelines, or through wraparound arrangements with Food for Peace (FFP), the
World Food Programme (WFP), Global Fund or other donors. In FY 2008, SUCCESS II will continue to
provide High Energy Protein Supplements and Ready to Use Therapeutic with estimated value of $700,000.
‘Adherence vehicles,' managed by the dioceses, and also supported with GHAI Rapid Expansion funding,
will provide needed transport for non-ambulatory patients to often-distant ART sites, transport of test
samples to labs, and transport of adherence supporters to visit distant clients in need of regular follow up.
This vital support will continue and will provide a continuum of care from testing, palliative care, ART
treatment, and adherence.
SUCCESS II will support ART through many, well-established referral linkages for other services outside its
care and support package. SUCCESS II already has an established and effective network of trained
community volunteer caregivers who carry out ART literacy education and ART adherence support.
SUCCESS II will continue to provide training at multiple levels, for volunteers and staff for all partners. To
build local capacity, Trainings of Trainers are held and then training is cascaded to subsequent levels of
local personnel until all are trained in the programming area relevant to their role in the project. Due to the
sparse population in rural Zambia, the SUCCESS II project will continue to train a large cohort of potential
caregivers in order to cover the long distances between PLWHA homes and to ensure regular care and
support to clients. SUCCESS II will also train by leveraging and linking partners, such as carrying out ART
literacy and adherence support trainings with AIDS-Relief co-trainers in areas where SUCCESS II and AIDS
-Relief are co-located. Joint training strengthens the linking to ART, and follow on adherence support for
compliance to treatment. Further, the use of standardized adherence support training materials builds
A further dimension of sustainability will be achieved when home-based care/ART clients return to active
family and community life, knowing how to manage their now-chronic illness. Many positive-living PLWHA
become role models in their communities helping to reduce stigma and effectively breaking one of the
barriers of accessing treatment for HIV. Collaboration across SUCCESS II partners is achieved in
numerous ways. Annual meetings will bring SUCCESS II partners together for cross-fertilization of
programming ideas, issues, and lessons learnt. Partners will be encouraged to make exchange visits to
Activity Narrative: each other's operational sites, affording closer observation of on-the-ground best practices and skills
transfer. SUCCESS II monitoring and evaluation staff and program team will continue to strengthen the
quality of monitoring activities.
The second component of SUCCESS II sustainability is building management capacity of Catholic Church
structures in Zambia, and leveraging the significant complementary role of the Church health structures,
which will outlive external funding trends. One comparative advantage of SUCCESS II is the extensive
reach of diocesan structures into rural communities. To build capacity, SUCCESS II will train implementing
partners in financial management and accountability, logistics and commodities distribution, organizational
development and strategic planning, as well as staff management and policy development. The projects
are strongly encouraged to link with local government structures and institutions.
Another aspect of program sustainability includes the use of strategic networking, e.g. encouraging a
Bishop to sit on the Board of Directors of a provincial hospital. Key networking also takes place at the
integral community level, where local traditional leaders are involved in parish HBC coordinating
committees. SUCCESS II will also promote diversification of funding support as a key factor in
sustainability. Management capacity building will support partners in accessing other funds. Partners will
be in a better position to attract other funds with their project management ability enhanced through
All FY 2008 targets will be reached by September 30, 2009.