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.
Activities for Track 1 and Track 2 funding at site level overlap, therefore the narratives for the two tracks of funding are the same. AIDSRelief (AR) aims at providing durable comprehensive quality care to persons infected with HIV/AIDS. AR strategic program implementation components are developed toward increasing the sustainability of quality HIV care. AR currently serves in 8 provinces and at 19 treatment facilities, primarily in rural Zambia, with target populations that include HIV exposed and infected children, HIV infected adults and pregnant women, alcohol and substance abusers, and prisoners. Our HIV services wrap around a family centered care approach that is strongly linked to the community and integrated with monitoring and evaluation strategies, designed to integrate the family in health decisions including prevention strategies, adherence, and family testing. Our activities and strategic plan can be divided into six major components: 1) community based treatment services (CBTS); 2) medical care including adult and pediatric anti-retroviral therapy (ART), TB and STI management, maternal child health and early infant survival, palliative care, training and professional development; 3) Nursing Care; 4) Outcomes and Evaluation (O&E); 5) Laboratory services; and 6) Health Systems Strengthening (HSS). AR program components are focused on integrating prevention as the primary means to reduce new HIV and TB infections. Our plans for transitioning and sustainability are incorporated into each of these areas of focus and Local Partner Treatment Facility (LPTF) support is accomplished by multi-disciplinary teams with members representing each of the above categories. These teams provide regular on-site support to address critical issues and ensure that necessary components for quality care are developed and maintained. The sites are taking ownership of a comprehensive care delivery model that has been reinforced through mentoring and site visits. Smart Care data and patient outcomes information is regularly fed back to sites to strengthen data use for continuous quality improvement at site level.
Our medical component works closely with the Ministry of Health (MOH) in implementing HIV care and treatment at the site level, conducting trainings accredited by the MOH, plus providing significant assistance in developing antiretroviral therapy (ART), opportunistic infections, prevention of mother to child transmission of HIV (PMTCT), TB, and Pediatric guidelines and training materials. We have partnered with the University Teaching Hospital (UTH), University of Zambia (UNZA) and the MOH in implementing the HIV Diploma Course that trains providers as HIV experts. We have partnered with the General Nursing Council and other implementing partners (University of Alabama/Center for Infectious Disease Research Zambia and Zambia Prevention, Care, and Treatment) in the pilot HIV Nurse Practitioners Diploma program in efforts to task shift and decentralize care to be closer to the patient. AR serves with the Medicine Council of Zambia (MCZ) to develop accreditation of treatment facilities and also certification of ART providers. AR O&E component ensures sites understand quality assurance and develop strategies to implement treatment efficiencies, plus capture key indicators to streamline technical support to areas of identified need. Our HSS component focuses on developing plans to decentralize HIV care to the community through satellite clinics, and task shifting some care responsibilities to trained health care workers. Our CBTS team incorporates the community into each aspect of the HIV care and treatment continuum. Developing integration of health care services at the site level so that TB/HIV, PMTCT/ART, pediatrics and STI efforts harmonize with the community based programs improves cost efficiencies and has lead to an overall program lost to follow up of less than 2% and an overall retention rate of 85%. The management team is also investing in assisting sites with budget development to ensure cost effective strategies to provide sustainable quality programs.
AR focuses on frequent onsite support as a means of disseminating information, initiating new strategies, building linkages, and addressing prevention interventions. Key priorities for CY 2010 focus on prevention with positives, encouraging couple/family counseling and testing, early infant diagnosis and treatment, ensuring all HIV+ pregnant women have access to counseling, testing and ART at all levels, and increased linkages with facilities performing male circumcision. Our CBTS team performs community based pediatric training focusing on identification of infants at risk and the importance of early treatment, as well as strengthening community capacity for couples counseling, and using prevention for positives strategies and prevention counseling for HIV negative clients. Strong linkages with existing home based care facilities strengthen this capacity.
Our transition and sustainability plan encompasses coordinating site support with the Churches Health Association of Zambia, plus scaling up Chreso ART Center for direct funding. AR will coordinate technical support with the MOH, UTH, and UNZA.
AR cannot meet the demand for ART scale up and ensure the same quality of care with level funding, but we will continue to evaluate and implement cost-efficiencies through strategies, such as performance based funding that will allow some scale up of ART.
Adult care and support services are largely centered on the work of the Community Based Treatment Services (CBTS) that focuses on incorporating the community to extend and optimize the quality of life for people living with HIV. In FY 2010 the CBTS specialists will work with adherence staff, community health workers (CHW), and treatment support groups to provide training on treatment preparation, support, and reducing transmission of HIV infection; they will continue tracking patients on care and ART for adherence to prophylaxis and treatment. CBTS will provide messages on prevention to those in care and on ART and ensure clients have access to support groups. In addition, they will help to ensure that clients in care remain linked to the clinic and receive follow up CD4, and preventive health care including cotrimoxazole prophylaxis, insecticide-treated nets, nutritional assessment, prevention assessment, education about clean water, and treatment of diarrhea and other acute illnesses. CBTS will also train staff and CHW to utilize the patient as a window into the family and strengthen the relationship with HIV positive family members not yet on ART. The CBTS team will also help to identify HIV positive individuals at risk for poor adherence including, but not limited to, substance abuse and mental health issues. CBTS will work closely with the networks of local home based care providers and services that are integral parts of our strategic task shifting plans. The CBTS team will support linkages between the ART clinic and the community based support groups including palliative care services.
Another component of Adult Care and Support is training on palliative care provided by palliative care specialist on regional teams. Their training focuses on pain as the 'fifth vital sign', recognizing and addressing provider burn out and stress in the workplace, pain and symptom management in relation to OI, mental health including end of life care, and understanding supportive care for women and children. AIDSRelief (AR) will continue this activity in FY 2010
AR will integrate prevention for positives (PWP) into the standard of care in FY 2010. We will work with the MOH to integrate PWP into national treatment and care guidelines.
In FY 2010 AIDSRelief (AR) will focus on strengthening the quality and delivery of ART services. One of the center pieces of the AR program is our commitment to on-site training and mentoring. During regular site support visits we conduct Ministry of Health (MOH) sponsored trainings for sites in a particular region, and incorporated into all of these trainings is mentoring opportunities in both the out and in patient setting. During these visits indicators are collected and assist in determining site needs and to identify gaps. In FY 2010 AIDSRelief will continue with these activities. In conjunction with the MOH, University of Zambia (UNZA), and the University Teaching Hospital (UTH) a fully UNZA accredited 12 month HIV Diploma course was initiated for advanced training of physicians. The course is taught by a combination of faculty from the University of Maryland and the UTH. The first graduation will include 13 residents. This diploma course will produce the next generation of HIV educators and decision leaders in Zambia. In FY 2010 AR will continue supporting this course.
Nursing is the pivot point for effective task shifting and addressing the ever increasing human resource crisis in Zambia. The nursing strategic plan centers around three stages of task shifting: level one focuses on shifting basic nursing care and triage to community health workers, level two on preparing nurses to triage and refill prescriptions on stable patients, and level three on developing a cadre of nurses to become Nurse Practitioners. The nursing team focuses on providing appropriate MOH approved trainings for nurses, and continues to work closely with General Nursing Council of Zambia (GNC) to teach and mentor nurses as ART prescribers and providers. In FY 2010 AR will continue supporting and strengthening the Nurse Practitioners Diploma program.
We shall conduct nutrition assessment for all clients before commencement of ART for appropriate nutritional interventions. The outcomes and evaluation team have been working with clinical teams to support the use of data for program improvements at site levels.
The AIDSRelief (AR) strategy to further close the gaps in pediatric care and support is anchored by a focus on early infant/childhood survival and includes six target areas to be addressed across all 19 sites: mother-to-child transmission; pediatric HIV testing and counseling for infants, children, adolescents, and their families; comprehensive; care of exposed infants and their HIV+ mothers, including provision of co-trimoxazole (CTX) prophylaxis for exposed and infected children, as well as a comprehensive preventive care package for exposed, infected, and affected children; treatment of infected children, including ART, OI treatment, infant feeding and nutrition assessments, palliative care, and psychosocial support services; care for families; and outcomes and evaluation.
AR will continue to focus on diagnosis and turnover of results for Early Infant Diagnosis to ensure timely initiation of all infants confirmed positive. AR will also provide oversight and ongoing training of staff in correct Dried Blood Spots methodologies. Training to ensure prompt recognition of developmental delays, failure to thrive, TB, and recurrent infections will be emphasized at the provider and community levels. All HIV exposed infants will be enrolled in care through their second birthday to ensure ongoing Septrin prophylaxis, prompt diagnosis, routine vaccinations, and support for maternal health. ART and OI treatment is discussed in Pediatric Treatment.
Family involvement is a key to supporting best outcomes for HIV+ infants and children, and emphasis on male involvement is incorporated into pediatric care messages. Providing strategies for ART clinics to see all family members on the same day helps promote this endpoint
AIDS Relief (AR) is committed to ensuring the long term health of all HIV-infected children through the provision of comprehensive quality care and treatment. At the site level, ongoing technical support will be provided in 3 key areas: determining eligibility; treatment initiation, monitoring and follow up; and practical pediatric treatment challenges.
Treatment initiation begins with early diagnosis of pediatric HIV infection. As guidelines for treatment initiation continue to change based on available evidence, the local clinical staff will be oriented to the new guidelines through training and mentorship. This will include current information on which regimen to use for children with a known history of NNRTI exposure in Zambia, there is now agreement that all NVP exposed infants will be started on a boosted PI regimen. Providers will also receive ongoing training and mentoring in recognizing and treating ARV-related toxicities; treatment failure; OI treatment and prevention; and nutrition recommendations for infected children on treatment. Additionally, ongoing, on-site training and mentoring in the recognition and management of key clinical conditions HIV-TB co-infection, Pneumocystis Carinii Pneumonia, HIV encephalopathy, growth failure, nutrition assessment and others which render a child eligible for ART treatment will be provided. We will link with DHMTs for the provision of Food By Prescription services.
Third, providers, adherence counselors, and pharmacy staff will be trained and updated in practical issues which can create specific challenges for pediatric ART care, such as treatment preparation, disclosure counseling, adolescent issues; treatment support, storage and administration of ARVs, and when and how to re-dose ARVs.
AR will provide both central and local training and mentoring in the MOH Pediatric HIV Care Training Course for staff and providers that have not yet received it. In an effort to both decentralize care and strengthen district-level capacity, providers from rural health centers affiliated with our local partners, as well as those from the associated district-level facilities, will be included in these trainings.