Public Affairs Section

FY 2008 COP Guidance Updates
July 27, 2007

This week’s update contains important information on the following:
• Program area character limit
• Executive Summary Instructions
• Wraparounds
• Global Fund Technical Assistance
• Small Grants Program
• Definition of male circumcision emphasis area
• Emphasis areas and target populations for PHE activities
• Male Circumcision supplemental

Items in bold are new for this week. 

COP Guidance

Page 4:  Can the mini-COP Guidance be shared with partners?

Yes, the mini-COP Guidance may be shared with partners, but please keep in mind that the mini-COP Guidance was written for a USG audience and is not intended for the general public. 

Page 5 – Efforts to Reduce COP Burden:  The character limit for activity narratives has been increased to 10,000 characters.  This change is to allow country teams to add updates to existing narratives that are at or close to 8,000 characters.

The character limit for the program area narratives has also been increased to 10,000 characters, to allow updates without cutting text that remains current. 

Page 5 – PEPFAR in 2008:

PEPFAR is committed to providing care and treatment to people living with HIV/AIDS and orphans and vulnerable children.  PEPFAR is also committed to ensuring continuity of prevention services, especially those that directly lead to interruption of HIV transmission, including prevention of mother-to-child transmission and screening of blood for HIV prior to transfusion. The USG has helped to support services to millions of individuals.  It is essential that once the USG provides funding to initiate these services, we demonstrate our commitment to ensuring continuity of care to those individuals.  There may be instances where the USG will discontinue a program for any number of reasons.  If that should be the case, however, there must be a transition strategy or plan that ensures that these services are continued with the support of the host country, other international partner(s) or host nation partner(s).  This applies not only to individuals receiving anti-retroviral therapy, but to other HIV-positive individuals in care programs and orphans and vulnerable children.

Page 8 – Sustainability / Health Care Worker Salary Report

Background:
Country estimates of the number of health worker salaries that PEPFAR supports have become important as our  focus moves to sustainable programs and scaling up country activities.   This information is critical to our ability to advance, with host country and international partners, strategies and approaches to address what may be the single largest barrier to improving HIV AIDS care and health care in general in the countries in which we work, i.e., an adequate work-force.
 
To ensure adequate information to address this issue, the sustainability section of the FY 08 COP Guidance requests that countries provide estimates of the number of health care workers receiving full or partial salary support in FY 2008.  The PEFPAR guidance document Support for Host Country Staffing, issued in August 2006, remains in effect; this request for data assumes that all salary support reported is in keeping with the guidance.

This request for estimates of the number of health care workers whose salaries are supported either in full or part by PEPFAR includes all individuals that the USG is supporting to implement and manage programs and deliver services through the private, non-government and government sectors.  Please note that the request excludes USG staff, including direct-hires, FSNs, and contract staff working at US agency country offices or headquarters. The request includes, however, all USG agency or contractor staff who may be sitting in government facilities and whose primary role is the provision of technical assistance and support for implementation. Examples are provided in the section on Definitions.

In Table 1 of the FY 2008 COP, we request that you estimate the number of health care workers receiving full or partial USG salary support in three categories.  Partial support is defined as anything from 1-99% and full support is defined as 100%.  These estimates should be unduplicated numbers of workers to be supported through all COP activities. Please include only support from field resources. Information for Track One grantees and grantees with central funding will be provided through a separate data-call at headquarters.

Definitions:

Individuals may receive salary support ranging from partial support (less than 100%) to full support (100%). A health worker should only be counted once in any of the three categories.  The three categories are as follows:

Clinical Services Staff:  staff for whom salary support will be provided in facility-based clinical service delivery settings such as MTCT clinics; counseling and testing sites; treatment and care sites; or OVC family support units. Examples include nurses, physicians, health officers, pharmacists, counselors, and laboratory staff.  Community outreach staff attached to clinical programs who work from the base of a health center but whose primary role may be community outreach are counted in this category. Peace Corps volunteers, however, who may be based in a health center but whose primary role is community outreach, should not be counted in this category; they should be included under community service staff (see below). Managers and administrative staff are excluded from this count.

Community Services Staff:  staff for whom salary support will be provided to work in community-based service delivery settings, such as home-based community care, prevention outreach, and community-based OVC programs. Examples of workers include peer educators and outreach workers. Managers and administrative staff are excluded from this count.

Managerial and Support Staff: managerial and administrative staff that PEPFAR contributes salary support for across all program service categories.  Managerial and administrative staff include senior management, technical advisors, budget analysts, clerks, monitoring and evaluation staff, information technology, transportation, security, clerical and reception staff, etc.  Included in this category are government workers who are receiving additional support in keeping with PEPFAR guidance, Peace Corps volunteers posted at district HIV/AIDS management offices, CDC employees or contractors placed in government facilities but whose primary task is technical assistance, and USAID institutional contractor technical advisor staff who are placed in governmental or non-governmental organizations.

If health care workers provide services in more than one category, for example nurses who provides both clinical services and community outreach, place their counts in the category where they spend the majority of their time.

Where it is not clear in which category to report a particular type of health worker please use your best professional judgment as to which is the most appropriate category.

Page 13 – Priority Program Areas

BEHAVIOR CHANGE

Preventing new infections represents the only long-term, sustainable way to turn the tide against HIV/AIDS. Successful strategies for fostering effective behavior change require comprehensive, multi-sectoral, complex prevention interventions that address prevailing norms associated with the spread of HIV, while still meeting the needs of people who face elevated risk exposure.  Prevention programs must move beyond raising awareness about HIV, to encouraging people to make positive and lasting behavior changes by creating an enabling environment that supports individuals to make safer choices and sustain healthy  behaviors.  
 
Approaches and mix of prevention strategies must be responsive to the stage of the epidemic.  However, no one intervention is likely to be fully protective and thus multiple prevention approaches are needed.  Comprehensive prevention programs should take into consideration the coverage, dose (intensity) and quality of combined intervention strategies. In concentrated epidemics, that are driven by sexual and injection practices, especially among HIV-vulnerable groups including sex workers, men-having-sex-with men and injection drug users, targeted programs should continue to expand coverage of proven interventions. However, in generalized epidemics, driven primarily by sexual behavior in the general population, program efforts should focus on large-scale, fundamental changes in community norms, social values and sexual practices to create social and community change.  Behavioral outcomes, such as abstaining or delaying the age of first sex, reducing number and concurrency of sexual partners, being faithful to a single, HIV-negative partner, and using condoms correctly and consistently, can reduce the risk and rates of HIV infection. However, these ABC behavior change approaches should also link to HIV counseling and testing and include prevention strategies for people living with HIV, including discordant couples. These approaches should also then be coupled with other biomedical and social interventions that address structural determinants, such as addressing the  the particular vulnerabilities of women and girls and other marginalized populations.
 
For more information about programming by stage of the epidemic, please visit www.unaids.org/en or refer to the PEPFAR ABC Guidance. 

Page 18 – Wraparounds:

Wraparound collaborations are not required; however, we encourage country teams to look for ways to work with wraparound programs that are already active in your country.

Page 18 – Global Fund Technical Assistance:

Technical Assistance to the Global Fund can be funded either by country teams - using the field budget - or with headquarters central funds. 

The Global Fund Core Group is finishing an evaluation of last year’s TA process, and will send out revised guidelines for the upcoming year shortly.  We encourage you to start thinking and planning now.  If you have specific questions, please contact Ann Lion (lionak@state.gov). 

Page 20 – Small Grants Program:

Beginning in FY 2005, program funds were made available for all PEPFAR countries and regional programs that follow the criteria and reporting requirements listed below to support the development of small, local partners.  The program is known as the President’s Emergency Plan for AIDS Relief Small Grants Program, and replaces the Ambassador’s Self-Help Funds program for those activities addressing HIV/AIDS.

Country and regional programs should submit an entry for the PEPFAR Small Grants Program as part of their yearly operational plan (COP or F OP).  The total dollar amount of PEPFAR funds that can be dedicated to this program should not exceed $300,000 or 5% of the country allocation, whichever is the lower amount.  This amount includes all costs associated with the program, including support and overhead to an institutional contract to oversee grant management if that is the preferred implementing mechanism. 

Proposed Parameters and Application Process

Eligibility Criteria
• Any awardee must be an entirely local group.
• Awardees must reflect an emphasis on community-based groups, faith-based organizations and groups of persons living with HIV/AIDS.
• Small Grants Program funds should be allocated toward HIV prevention, care and support or capacity building.  They should not be used for direct costs of treatment

Accountability
• Programs must have definable objectives that contribute to HIV/AIDS prevention, care and/or (indirectly) treatment.
• Objectives must be measurable. 
• These will normally be one-time grants.  Renewals are permitted only where the grants show significant quantifiable contributions toward meeting country targets.

Submission and Reporting
• Funds for the program should be included in the mini-COP under the appropriate budget category, and should be described in the program area narrative.  
• Individual awards are not to exceed $25,000 per organization per year; the approximate number of grants and dollar amount per grant should be included in the narrative.  Grants should normally be in the range of $5,000 - $25,000.  The labor-intensive management requirements of administering each award should be taken into account.
• Once individual awards are made, the country or regional program will notify their core or regional team leader of which partners are awarded and at what funding level.  This information will be added in the sub-partner field for that activity.
• Successes and results from the Small Grants Program award should be included in the Annual Program Results and Semi-Annual Program Results due to S/GAC.  These results should be listed as a line item, like all other COP activities, including a list of partners funded with the appropriate partner designation.

Page 26 – Required Support Documents:  This year we have added a report that will automatically generate a budgetary requirements worksheet.  Therefore, we are modifying the COP guidance to document that you do not need to upload the budgetary requirements worksheet as a supporting document.  We do, however, encourage you to run this report before submitting your COP to see where you are in meeting the budgetary requirements, or to check COPRS data against your internal calculations. 

Page 32 – Executive Summary Instructions

For the FY08 Executive Summary, please update the Executive Summary used for FY07 Congressional Notifications.  The FY07 Executive Summary is posted on the Extranet https://www.pepfar.net/C2/C10/FY%202008%20COP%20Planning/default.aspx. 

Please upload the updated Executive Summary to COPRS as a Word document.

Instructions for Executive Summary/Congressional Notification:
1. Please update only the narrative sections and partner lists.  Please leave blank the Budget Summary, HIV/AIDS Epidemic information, Targets Table and the funding levels under Prevention, Care, Treatment and Other.  OGAC will complete these centrally.
2. Please do not refer to partner organizations by name (except for host government ministries) in the narrative of the Executive Summary.  List all partner organizations together at the end of each program area section. 

In addition, please follow these style guidelines:
1. Please insert two spaces after each period. 
2. Please spell out each acronym the first time it appears in the document, followed by the acronym in parentheses if it is used later in the document. 
3. Please write in the active voice, using direct and concise language.
4. Spell out all numbers less than 10.
5. Use the following formulation when referring to fiscal years:  FY 20XX (not FYXX or FY20XX).

Page 52 – CDC as Prime Partner: 
Question:  What should we do if CDC is procuring commodities, either through RPSO or another procurement?

Answer:  For all procurements through RPSO, the USG agency must be one of the Department of State Regional operating divisions.  There may be rare instances when CDC is procuring commodities; in such a case, CDC can be listed as the prime partner.  This rule is an attempt to avoid a situation in COPRS where a USG agency is listed as the prime partner, and funds are actually going to another organization that is in fact the prime partner. 

Page 98 – Male Circumcision:  Male circumcision has been added as an emphasis area tickbox to facilitate the need to attribute MC activities across a range of program areas.  In anticipation of Congressional requests and other inquiries, and the need to understand a country’s strategy and program, a separate form on MC will be forthcoming shortly. 

Male Circumcision Definition:
Under the leadership of host country governments, and consistent with local policies and norms, Emergency Plan funds can be used to support the implementation of safe male circumcision services. Select the "MC" emphasis area tickbox when Emergency Plan funds are supporting efforts related to male circumcision as an HIV prevention strategy. Approaches can range from preparatory activities to actual support for the surgical procedure.  PEPFAR follows the WHO/UNAIDS Recommendations for Male Circumcision for HIV Prevention http://www.who.int/hiv/topics/malecircumcision/en/index.html.

Page 99 – PHE:

If applicable, please check the relevant emphasis area tickboxes and target populations for PHE activities. 
 
Appendices

Appendix 6: USAID HQ Mechanisms:

USAID has developed a new central project for behavior change communication entitled: Partnership for Health and Development Communication (PHDC) project number: TBD-GH-07-2007.  This BCC follow-on project will replace both the Health Communication Partnership (HCP) and Internews. PHDC will provide integrated BCC programming for strategic health and development communication interventions in health, environment, democracy and governance and other agency priority programs. PHDC will focus on: developing evidence-based scaled up BCC programs; building in-country capacity and ensuring sustainability including development of the media; integrating BCC programs in the wider public health and development communities; and, generating and sharing lessons learned.  This project will be awarded in time to accept FY07 & HIV/AIDS COP08 funds. 

For more information on the project go to:
http://apply.grants.gov/opportunities/instructions/oppUSAID-WASHINGTON-M-OAA-GH-07-315-RFA-instructions.doc (see Section C: Program Description pp 25-43 for the technical description.  For more information please contact Nancy Lowenthal (nlowenthal@usaid.gov; 202 712 1682) and Gloria Coe (gcoe@usaid.gov).
 
Appendix 6: Central Contraceptive Procurement

If you are using the central contraceptive procurement, please list “Central Contraceptive Procurement” as the prime partner name and USAID as the agency. 

Appendix 12 – Multi-Country Public Health Evaluations: 

Multi-country studies may be generated in several ways—through development at country level, HQ level, and Evaluation Team level.  This update provides information on topics that Public Health Evaluation Teams will be developing for/with multi-country buy-in for submission with the FY08 COP.  These topics are based on opportunities and needs identified by TWGs, country teams, and through the priority-setting process.  If your country team or partners are interested in these topics, please contact the point person directly for information, input, and discussion.  Core activity narratives with projected requirements for country participation will be posted on PEPFAR.net and circulated in Notes to the Field for each topic once they are fully developed.  We encourage those who are interested in participating in new studies or linking with FY07-approved studies to contact the point persons of the relevant topics.  As additional topics are developed (by countries or by evaluation teams) they will also be posted on PEPFAR.net.

Eval Team Topic Point Person (s) Contact Info
MTCT/Peds Interventions for pregnant women:
• Optimizing treatment and care of pregnant and post-natal women (including screening eligibility for ART)
• ARV resistance RJ Simonds
Nathan Shaffer rxs5@cdc.gov
nas4@cdc.gov

MTCT/Peds Interventions for exposed infants:
• Infant feeding
• Infant diagnosis
• Models of follow-up and links to care RJ Simonds
Nathan Shaffer rxs5@cdc.gov
nas4@cdc.gov

MTCT/Peds Interventions for infected infants and children:
• Pediatric treatment, adherence, resistance RJ Simonds
Nathan Shaffer rxs5@cdc.gov
nas4@cdc.gov

Care/Treatment Interventions for persons initiating ART
• Immmunologic versus immunologic/virologic monitoring
• Initial screening/treatment for TB, OIs to prevent early mortality
• Nutritional interventions
• Adherence
• Optimal regimens for first and second line therapy, and criteria for switching to second line therapy Bill Levine wcl2@cdc.gov

Care/Treatment Interventions for HIV+ persons not yet eligible for ART:
• Acyclovir
• Nutritional interventions
• OI prophylaxis   Bill Levine wcl2@cdc.gov

Care/Treatment TB/HIV
• HIV testing of TB patients
• Linkage of TB patients testing HIV+ into care
• TB drug susceptibility surveys Bill Levine wcl2@cdc.gov

X-Cutting: MTCT/Peds &
Care/Treatment Reproductive health/family planning services
 Bill Levine
RJ Simonds
Nathan Shaffer wcl2@cdc.gov
rxs5@cdc.gov
nas4@cdc.gov

X-Cutting: MTCT/Peds &
Care/Treatment Costing of services Bill Levine
RJ Simonds
Nathan Shaffer wcl2@cdc.gov
rxs5@cdc.gov
nas4@cdc.gov

Sexual Transmission Prevention for vulnerable girls Benny Kottiri bkottiri@usaid.gov

Sexual Transmission Prevention for couples / concurrent partnerships Benny Kottiri bkottiri@usaid.gov

Appendix 23:  Male Circumcision Supplemental

In anticipation of Congressional requests, other inquiries, and the need to better understand each country’s male circumcision approach, we are asking all countries working on male circumcision to complete a short supplemental table.  If you check the male circumcision emphasis area, please make sure you include a line item in the supplemental.

This document can be downloaded from the COP Planning section of the Extranet.

Instructions

Component: Within the area of male circumcision, there are several component areas.  Please select the appropriate area from the drop-down menu.  If an activity has multiple component areas, please enter each component area as a separate line item.  

The component areas and definitions are:

Communications
Activities that seek to provide information regarding male circumcision for HIV prevention. Communication approaches can occur at the national level, such as media campaigns that encourage safe male circumcision as part of a comprehensive approach to prevention, as well as local and inter-personal communication strategies. Information about safety, quality and the need for a combination approach to male circumcision interventions is critical, especially for countries engaging in service delivery activities.
 
Formative work (or Needs Assessment)
There is a variety of formative work needed prior to engaging in male circumcision services for HIV prevention. These types of activities can include; clinic and community assessments, stake-holder meetings, feasibility studies, demand assessments, etc. Countries engaging in these types of activities are encouraged to utilize the WHO Assessment Tool Kit.
 
Policy
Activities related to policy work include support of National Male Circumcision Steering Committees, development of policy, stake-holder meetings between policy makers, donor coordination, etc.  Policy activities can also relate to what cadre of health care provider is able to perform and provide male circumcision surgeries.  PEPFAR must follow the lead of host country governments and WHO/UNAIDS in support of policy activities.
 
Service Delivery
Male circumcision services must be delivered within a clinical setting, as part of a comprehensive package of prevention services, which should include: provider initiated and delivered HIV counseling and testing; active exclusion of symptomatic STIs and syndromic treatment when required; counseling on behavior change; including a gender component that addresses male norms and behaviors; provision of condoms and counseling on their correct and consistent use; reduction of number and concurrency of sexual partners and delay/abstaining from sexual activity (ABC).  Male circumcision services are currently not recommended for men who are HIV-positive; all male circumcision service delivery sites must have active referral systems in place for those individuals who test HIV-positive.
 
Training
Male circumcision-related training activities can include training of health care professionals to perform the surgical procedure, training of trainers, establishing training curricula, developing pre- and in-service training strategies and approaches, and monitoring quality of services by trained personnel. All countries are encouraged to utilize the WHO Male Circumcision Training Manual.  Tracking of quality and adverse events is necessary for all programs supporting male circumcision service delivery.
 
Work with Traditional Providers
PEPFAR funds may not be used to support the provision of male circumcision in traditional settings, outside of clinical facilities. However, working with traditional providers can be very important and provide an opportunity for prevention interventions. Activities associated with traditional providers can include;  provision of information on safety; links with clinical male circumcision service sites, and support for other prevention interventions, such as behavior change counseling interventions.
 
Evaluation
Some male circumcision activities may be directly related to evaluation of approaches, such as assessment of behavioral disinhibition among men who undergo male circumcision for HIV prevention. Evaluation activities that track uptake, quality, approaches, adverse events, etc., should all be captured under this component. All activities related to evaluation must include a specific protocol and follow the PHE activity narrative format.

Activity ID: Enter the COPRS activity ID

Mechanism ID: Enter the COPRS mechanism ID

Agency:  Select the agency from the drop-down menu.

Funding Source: Select the funding source from the drop-down menu.

Prime Partner:  Enter the full prime partner name (no acronyms).

Program Area:  Select the COP Program Area from the drop-down menu.

Brief Description:  Write a short paragraph about the activity and component area, mentioning whether the project is being co-funded by another donor.  Feel free to cut and paste from the activity narrative in the COP.

Planned Funding:  Enter the planned funding for the component area in whole US Dollars.