Introduction


Report 108-346, accompanying S. 2812, called upon the Office of the United States Global AIDS Coordinator to report as follows:

The Committee requests the Global HIV/AIDS Coordinator, in consultation with the USAID Administrator, to submit a report describing the activities of all relevant government agencies regarding the treatment of children with HIV/AIDS for fiscal years 2003 and 2004, and proposed activities for 2005. For each fiscal year, the report should include: a description of the specific types of activities supported; the total number of children in treatment programs; the total amount of money devoted to pediatric treatment, including funding for the purchase of anti-retroviral drugs, pediatric-specific training of medical professionals and the purchase of pediatric-appropriate technologies; and, a description of activities to ensure that HIV/AIDS drugs, including fixed dose combinations, are available in pediatric formulations, and that they include appropriate dosing information for all pediatric subpopulations.



�A few years ago, a little girl in Namibia was born to a mother and father who both had HIV; she had the disease, as well. The name her parents gave her translates as the phrase, "There is no good in the world." Months ago, the girl was very sick and losing weight and close to death. But today, she and her entire family are receiving lifesaving medicine. Now she's a beautiful, shy, thriving six-year-old, with a new life ahead of her, and there's a little more good in the world.�

President George W. Bush
June 30, 2005

Why the Emergency Plan reports on results

The Emergency Plan focuses on support for the national strategies of host nations. While tracking the results of support provided in this way poses significant challenges, it is important that the U.S. do so. Among the key reasons:

  • To provide data that can be used to improve programs
  • To promote accountability and good governance in country
  • To meet the obligation of accountability to Congress and American taxpayers

As information on results is gathered, it is important to remember that the results are being achieved in the context of support for multisectoral national responses, including governments, the private sector, faith-based and community-based organizations, and to give credit to those who are making these results possible: the talented and dedicated people in-country. The American people are honored to stand by their side in the global fight against HIV/AIDS.

How U.S. support is provided

The First Annual Report to Congress of the Emergency Plan describes the ways in which U.S. support is provided. Where partnership limitations or technical, material or financial constraints require it, the Emergency Plan, or another donor, may support every aspect of the complete package of prevention, treatment, or care services at a specific public or private delivery site, in coordination with host-country national strategies. In many areas, the Emergency Plan will coordinate with other partners to leverage resources at a specific site, providing those essential aspects of quality services that others cannot provide due to limited technical and/or financial circumstances. For example, in some settings antiretroviral drugs (ARVs) are provided to specific sites through the host-country government or other donors such as the Global Fund to Fight AIDS, Tuberculosis and Malaria, while the Emergency Plan may contribute other essential services, training, commodities, and infrastructure to support treatment. �Downstream� site-specific support refers to these instances where the Emergency Plan is providing all or part of the necessary components for quality treatment at the point at which services are delivered.

Beyond the site-oriented downstream components of services, support is required to provide other critical elements, which may include the training of physicians, nurses, laboratory technicians, other health care providers, and counselors or outreach workers; laboratory systems; strategic information systems, including surveillance and monitoring and evaluation systems; logistics and distribution systems; and other support that is essential to the effective roll-out of quality services. This coordination and leveraging of resources optimizes results while limiting duplication of effort among donors, with roles determined within the context of each national strategy. Such support, however, often cannot easily be attributed to specific sites because it is national or regional in nature, and, in fact, many sites benefit from these strategic and comprehensive improvements. Therefore, this support is referred to as �upstream� support and is essential to developing network systems for prevention, treatment, and care.

How data in this report were derived

Where downstream service delivery sites were directly supported by U.S. Government funding, distinct individuals receiving services at those sites were counted. Support to a specific site may or may not be in partnership with other funding sources for HIV prevention, care, and treatment. For example, the U.S. Government may fund the clinical staff delivering prevention of mother-to-child transmission (PMTCT) services, while Global Fund monies support the ARVs used in the clinic. For support to national HIV/AIDS programs provided upstream (for which funding is not directly given to a specific service delivery site or program), the Emergency Plan estimated, in conjunction with other partners and national governments, the number of individuals receiving services as a result of the U.S. Government�s contribution to national, regional, or local activities.

Emergency Plan partners who provide downstream services are required to report on the age and sex of their clients; this may or may not be in addition to what partners are required to report to the national HIV/AIDS program in a given country. As a result, some partners have had to modify their data collection and reporting systems to meet U.S. Government requirements. The ability to disaggregate data by age is improving and the proportion of Emergency Plan sites that can report on pediatric patients served has increased significantly from FY2003 to the time of this report.

In the PMTCT context, for example, as part of the overall monitoring of HIV prevention activities and in support of the broader range of services needed by HIV-positive children, country teams monitor those activities aimed at providing the minimum package of services for preventing mother-to-child transmission. These services include counseling and testing for pregnant women; short-course antiretroviral prophylaxis; counseling and support for safe infant feeding practices; and family planning counseling or referral. These data are drawn from program reports and health management information systems.

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