Launched in 2003 by President George W. Bush, PEPFAR holds a place in history as the largest effort by any nation to combat a single disease. In the first five years of the program, PEPFAR focused on establishing and scaling up prevention, care and treatment programs. It achieved success in expanding access to HIV prevention, care and treatment in low-resource settings. During its first phase, PEPFAR supported the provision of treatment to more than 2 million people, care to more than 10 million people, including more than 4 million orphans and vulnerable children, and prevention of mother-to-child treatment services during nearly 16 million pregnancies.
This global epidemic requires a comprehensive, multisectoral approach that expands access to prevention, care and treatment. As PEPFAR works to build upon its successes, it will focus on transitioning from an emergency response to promoting sustainable country programs.
Sustainable programs must be country-owned and country-driven. Given that the AIDS epidemic represents a shared global burden among nations, the next phase of PEPFAR represents an opportunity for the United States to support shared responsibility with partner countries. To seize this opportunity, PEPFAR is supporting countries in taking leadership of the responses to their epidemics. In addition, to support an expanded collective impact at the country level, PEPFAR is increasing collaboration with multilateral organizations.
Sustainable programs must address HIV/AIDS within a broader health and development context. PEPFAR must be responsive to the overall health needs faced by people living with HIV/AIDS (PLWHA), their families, and their communities, linking the HIV response to a diverse array of global health challenges. As a component of the Global Health Initiative, PEPFAR will be carefully and purposefully integrated with other health and development programs.
Integration expands country capacity to address a broader array of health demands and to respond to new and emerging challenges presented by HIV. Strategic coordination furthers the reach of bilateral assistance, leverages the work of multilateral organizations, promotes country ownership, and increases the sustainability of national health programs.
Sustainable programs must build upon our strengths and increase efficiencies. PEPFAR is renewing its emphasis on a "whole of government" response, ensuring that agencies focus on core competencies and better coordination to maximize the effectiveness of U.S. Government (USG) assistance. It is also identifying and implementing efficiencies in its work at both field and headquarters levels to ensure value for money. To build upon the strengths of proven programs, PEPFAR is scaling up effective interventions, particularly in prevention. Finally, it is working to ensure that increased access to coverage is accompanied by an emphasis on quality of services.
PEPFAR's Targets from Fiscal Year (FY) 2010- FY 2014:*
Care and Support and Treatment
In this second phase of PEPFAR, a new program strategy is underway that supports the Administration's overall emphasis on improving health outcomes, increasing program sustainability and integration, and strengthening health systems. Some of these changes are already being implemented with planning and programming for FY 2010. Over the next year, PEPFAR will be working closely with country teams in order to translate, prioritize, and implement this strategy in a manner appropriate to the country context. More information on the broader strategic framework for PEPFAR activities can be found in the strategy annexes which will be made available at www.pepfar.gov/strategy.
Prevention remains the paramount challenge of the HIV epidemic, and the major priority for the next five years of PEPFAR. Successful prevention programs require a combination of evidence-based, mutually reinforcing biomedical, behavioral, and structural interventions. PEPFAR is expanding its prevention activities with an emphasis on the following:
Linking HIV/AIDS to Women's and Children's Health
According to the World Health Organization (WHO), AIDS is the leading cause of death among women aged 15-44 worldwide.1 Nearly 60% of those living with HIV in sub-Saharan Africa are women.2 UNICEF estimates that nearly 12 million children in sub-Saharan Africa have lost one or both parents to HIV/AIDS.3 Women and children living with HIV also face other conditions, ranging from inadequate access to family planning to lack of antenatal care to the need for food and nutrition support. As part of its overall prevention, care and support, and treatment efforts, PEPFAR is leveraging and linking HIV services to broader delivery mechanisms that improve health outcomes for women and children. Some of these activities include:
PEPFAR's treatment programs provide essential medications to more than two million people. PEPFAR also contributes to the strengthening of the health systems needed to deliver these drugs in low-resource settings. In addition, PEPFAR serves populations with special treatment needs, like children. Together, all global efforts support approximately four million people on antiretroviral treatment, but at least five million more are still in need of ARV drugs.4 This figure will likely double with the recent revision of WHO recommendations for treatment initiation. As part of its reauthorization, PEPFAR was charged with supporting increased treatment commensurate with increased appropriations and efficiencies realized. PEPFAR's treatment strategy over the next five years emphasizes the following activities:
Health Systems Strengthening
PEPFAR has had a positive impact on the capacity of country health systems to address the WHO's six building blocks of health systems functions. However, the program to date has not placed a deliberate focus on the strategic strengthening of health systems. In its next phase, PEPFAR is working to enhance the ability of governments to manage their epidemics, respond to broader health needs impacting affected communities, and address new and emerging health concerns. PEPFAR now emphasizes the incorporation of health systems strengthening goals into its prevention, care and treatment portfolios. Doing so will help to reduce the burden of HIV/AIDS on the overall health system. Planned activities include the following:
PEPFAR's commitment to the principles of country ownership highlights a new focus on engaging in true partnership with countries. These partnerships pave the way for new approaches to foreign assistance based upon principles and directions common to partner country plans and USG objectives. Over the next five years, PEPFAR's emphasis on country ownership will include:
As the largest component of President Obama's Global Health Initiative, PEPFAR is actively working to enhance the integration of quality interventions with the broader health and development programs of the USG, country partners, multilateral organizations, and other donors. Through activities like co-location of services and expanded training of health care workers, PEPFAR can expand access to overall care and support for infected and affected individuals. As noted earlier, a particular focus of PEPFAR's integration is to expand access to care for women and children. PEPFAR is also emphasizing engagement with broader health and development programs. Some examples include:
PEPFAR is part of a shared global responsibility to address global health needs. Its success has been closely linked to the success of newer multilateral initiatives such as the Global Fund for AIDS, Tuberculosis and Malaria (Global Fund), and long-standing multilateral organizations including the Joint United Nations Programme on HIV/AIDS (UNAIDS) and WHO. PEPFAR is expanding its multilateral engagement with the goal of strengthening these institutions and leveraging their work to maximize the impact of PEPFAR. PEPFAR's multilateral engagement includes a new emphasis on the following:
Monitoring, Metrics and Research
PEPFAR's work can and should be systematically studied and analyzed to help inform public health and clinical practice. PEPFAR is not a research organization, but is expanding its current partnerships with implementers, researchers, and academic organizations to improve the science that guides this work. As PEPFAR transitions to support sustainable, country-led systems, it will improve efforts to contribute to the evidence base around HIV interventions, as well as broader health systems strengthening and integration. Over its next phase, PEPFAR will support the following new initiatives:
* For more information on PEPFAR's data collection, please visit: www.pepfar.gov/2009results/.
| U.S. Government interagency website managed by the Office of U.S. Global AIDS Coordinator|
and the Bureau of Public Affairs, U.S. State Department.