District Priorities


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Sub-national units (SNUs) are prioritized by the PEPFAR program according to the level of support they receive, and expectations for achieving 90/90/90 or 95/95/95 targets during the Country/Regional Operational Plan process. Currently, there are five priority levels: Attained, Scale-Up: Saturation, Scale-Up: Aggressive, Sustained, and Central Support. Generally, PEPFAR funding and activities are most concentrated in Attained and Scale-Up SNUs, while programming in Sustained and Centrally Supported districts is more limited to commodity support, technical assistance and passive enrollment in testing and treatment. To understand PEPFAR's investment in a district, it is often useful to consider both district priority and service type together.

PEPFAR defines the districts more specifically in their guidance for COP 2018 in the following way:

  • Attained: Geographic areas that have achieved ≥90% treatment coverage in both males and females within the following age bands: <1, 1-9, 10-14, 15-19, 20-24, 25-29, 30-34, 35-39, 40-49, and 50+. Getting to >90% treatment coverage by both males in females within the finer age bands at sub-national levels will ensure that the country gets to 95/95/95 overall.
  • Scale-Up: Saturation: Geographic areas with the highest HIV prevalence nationally that have not yet achieved 90% treatment coverage, particularly among the populations groups experiencing the greatest burden of disease. SNUs receive intensive PEPFAR support with a target of reaching 90% of people at all ages, gender and risk groups, living with HIV (PLHIV) on ART by 2018 and 2019.
  • Scale-Up: Aggressive:Geographic areas with the highest HIV prevalence nationally that have not yet achieved 90% treatment coverage, particularly among the populations groups experiencing the greatest burden of disease. SNUs receive intensive PEPFAR support with an overall goal of an increased rate of ‘new on ART,’ but are not expected to reach 90% of PLHIV by 2018 or 2019.
  • Sustained: Sustained Districts receive a package of services provided by PEPFAR that are different in each country and include passive enrollment via HIV testing and counseling on request or as indicated by clinical symptomology, care and treatment services for PLHIV, and essential laboratory services for PLHIV. As the high burden Scale-Up Districts are saturated, Sustained Districts will be aggressively scaled to reach 95/95/95 goals by 2020.
  • Central Support: In Central Support Districts, site-specific activities have transitioned to government or other support. Central Support Districts will continue to receive PEPFAR national support for overarching activities, such as quality assurance and quality improvement (QA/QI) to ensure that patients continue to receive quality services. PEPFAR will continue monitoring activities in central support SNUs annually using the following indicators: PMTCT_STAT, PMTCT_ART, HTS_TST, TX_CURR, TX_NEW, and TX_RET. Results for all centrally supported SNUs and sites should be reported for all Standard Process countries annually via the MOH data alignment process. Standard process countries that did not participate in the MOH data alignment in FY 17 will be required to do so in FY 18.