Since 2004, the President’s Emergency Plan for AIDS Relief (PEPFAR) has invested over $1.2 billion in support of the national HIV response in Uganda, including direct support for life-saving antiretroviral treatment (ART) for more than 175,000 HIV-infected Ugandans as of September 30, 2009. You are a valued partner in this work, and we thank you for your commitment to those we serve.
Nonetheless, there remains a substantial unmet need for ART in Uganda that is growing annually. The U.S. Government is by far the largest source of support for treatment in Uganda, and we are committed to working with the Government of Uganda and all stakeholders to continue expansion of ART availability, working toward the ultimate goal of universal access to prevention, care and treatment.
The overall PEPFAR program in Uganda plans to continue to scale up access to ART at rates well above attrition. While the Office of the Global AIDS Coordinator has told us to expect future increases in the overall program budget, these increases will likely be more limited than in PEPFAR’s initial phase. As a result, it will be critical that every dollar spent achieves the greatest possible value for the people of Uganda. This will require each implementing partner to re-examine its system of service delivery. Each partner must identify innovative methods of reducing unit costs of quality service provision while maintaining high-quality programs that maximize adherence and positive patient outcomes and minimize loss-to-follow-up. Essential to our continued scale-up will be aggressive efforts to streamline the distribution of partners, and achieve other important efficiency gains at the systems and partner level. It is also critical that implementing partners further strengthen coordination and referral capacity to maximize access to care and treatment, and capitalize on prevention opportunities in the care and treatment setting, to complement our overall prevention efforts aimed at reducing new infections.
As we take these steps, we ask that each implementing partner intensify its focus on being a responsible steward of U.S. Government funds, and continue to enroll new patients consistent with your partner-level budgets and targets negotiated with the U.S. Government. As noted in prior communications, priority should be given to the sickest patients, eligible pregnant women, children, and TB/HIV patients.
Lastly, UNITAID has indicated plans to end its drug supply support in the near future. Partners using drugs donated by UNITAID through the Clinton Foundation or UNICEF should work with their COTR/AOTR/Project Manager to ensure that there is no disruption in treatment. Please be aware that PEPFAR is working with UNITAID headquarters to determine the extent to which UNITAID support of ARVs in Uganda could be extended, and we will keep you informed of any changes. We are also encouraged by the Global Fund’s recent release of previously blocked funds. We will offer technical assistance to the government to ensure these funds are urgently put to work to address the unmet HIV needs of the country.
We look forward to working with you as PEPFAR continues to support the expansion of treatment access in Uganda.
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