This Operational Plan of the President's Emergency Plan for AIDS Relief (PEPFAR) serves as the fourth PEPFAR Operational Plan for fiscal year (FY) 2009. The PEPFAR Operational Plan links all sources of PEPFAR funding, some of which are notified and detailed to Congress by other parts of the United States Government (USG). It also provides descriptions to support notification to Congress for funds from the Global Health and Child Survival (GHCS-State) account and descriptions of activities supporting PEPFAR from other appropriation accounts. It is organized into seven sections.

This introduction, Section I, describes how this year's Operational Plan has been organized, provides a brief note on the progress of PEPFAR and highlights new PEPFAR initiatives. These new initiatives include the development of Partnership Frameworks, the Headquarters Operational Plan and indirect cost modeling.

The budget presentation of this year's Operational Plan can be found in Section II, the Summary Plan Presentation, which provides summary budget information describing how PEPFAR resources will be implemented. Through a series of annotated tables and graphs, the summary plan illustrates national and regional priorities for resource distribution and PEPFAR investment by region. Summary budget information is also provided for Headquarters Operational Plan activities.

Sections III-VI contain the supporting narratives for the Summary Plan Presentation. Section III provides an overview of the country and regional programs preparing PEPFAR country operational plans. Section IV will provide a more limited overview of the PEPFAR activities in the PEPFAR countries that do not prepare PEPFAR operational plans but receive funding through the GHCS-State account. This section will be completed in a future iteration of this operational plan when the GHCS-State funds for other PEPFAR countries are notified. Section V describes the programs planned in the Headquarters Operational Plan, which includes all PEPFAR funded activities not currently planned by country or regional teams. Section VI provides a description of funding for international partners. Section VII, the appendices, contains supplemental budget tables, an acronym list, reference links to additional resources found at PEPFAR.gov, and additional narrative supporting documents.

This January 2009 PEPFAR Operational Plan serves as the fourth iteration and will be updated as additional funding is approved. This plan outlines the annual HIV/AIDS investment which is anticipated to have an immediate impact on people and strengthen the capacity of partner nations to expand programs.

The FY 2009 figures reflect funds appropriated in the Department of State, Foreign Operations, and Related Programs Appropriations Act, 2009 ( Division H, P.L. 111-8)1, under the heading "Global Health and Child Survival", the Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2009 (Division F, P.L. 111-8), and for Department of Defense the Consolidated Security, Disaster Assistance, and Continuing Appropriations Act, 2009 ( Division C, P.L. 110-329) under the heading "Defense Health Program".

Progress to Date

On World AIDS Day 2009, PEPFAR announced that, through its partnerships with more than 30 countries, PEPFAR directly supported life-saving antiretroviral treatment for over 2.4 million men, women and children, as of September 30, 2009. They represent more than half of the estimated four million individuals in low and middle-income countries on treatment.

In addition, by September 30, 2009, PEPFAR partnerships have directly supported care for nearly 11 million people affected by HIV/AIDS, including 3.6 million orphans and vulnerable children.

In FY 2009, PEPFAR directly supported prevention of mother-to-child transmission programs that allowed nearly 100,000 babies of HIV-positive mothers to be born HIV-free, adding to the nearly 240,000 babies born without HIV due to PEPFAR support during FYs 2004-2008.

In FY 2009, PEPFAR also directly supported HIV counseling and testing for nearly 29 million people, providing a critical entry point to prevention, treatment, and care.

From FY 2010 onward, PEPFAR will report on partner countries' national achievements in service delivery and health systems strengthening, as well as PEPFAR direct contributions to those achievements. The new national health systems indicators are being developed in collaboration with partner countries and multilateral organizations. Through September 30, 2009, the last point at which indirect results will be reported before this transition to national indicators, PEPFAR indirectly supported treatment for 539,700 people in the 15 original PEPFAR focus countries.

1 The FY 2008 Department of State, Foreign Operations, and Related Programs Appropriations Act, 2008 (Division J, P.L. 110-161) appropriated all HIV/AIDS funding into one Global Health and Child Survival account with distinctions by agency of apportionment and periods of availability. The portion labeled GHCS-State is apportioned directly to the Department of State and is no year funding. The portion labeled GHCS-USAID is apportioned directly to USAID and is available for two years.

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