The U.S. government supports programs to combat global HIV/AIDS through an initiative that is known as the President's Emergency Plan for AIDS Relief (PEPFAR). This initiative was originally authorized in the U.S. Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 and focused on an emergency response to the HIV/AIDS pandemic to deliver lifesaving care and treatment in low- and middle-income countries (LMICs) with the highest burdens of disease. It was subsequently reauthorized in the Tom Lantos and Henry J. Hyde U.S. Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008 (the Lantos-Hyde Act).

Evaluation of PEPFAR makes recommendations for improving the U.S. government's bilateral programs as part of the U.S. response to global HIV/AIDS. The overall aim of this evaluation is a forward-looking approach to track and anticipate the evolution of the U.S. response to global HIV to be positioned to inform the ability of the U.S. government to address key issues under consideration at the time of the report release.

Contents

• THE NATIONAL ACADEMIES
• COMMITTEE ON THE OUTCOME AND IMPACT EVALUATION OF GLOBAL HIV/AIDS PROGRAMS IMPLEMENTED UNDER THE LANTOS-HYDE ACT OF 2008
• Reviewers
• Acknowledgments
• Preface
• Acronyms and Abbreviations
• Summary
  • EVALUATION APPROACH
  • EVALUATION CONCLUSIONS AND RECOMMENDATIONS
  • CONCLUSION
• I. Introduction
  • 1. Background
    • GLOBAL BURDEN OF HIV
    • HISTORY OF U.S. INVESTMENT TO RESPOND TO GLOBAL HIV/AIDS
    • REFERENCES
  • 2. Evaluation Scope and Approach
    • CONGRESSIONAL CHARGE
    • PLANNING PHASE FOR THE EVALUATION
    • INTERPRETATION OF THE CHARGE
    • OPERATIONAL PLANNING PHASE
    • CONCEPTUAL FRAMEWORK FOR THE EVALUATION
    • EVALUATION METHODS
    • OVERARCHING EVALUATION CHALLENGES AND LIMITATIONS
    • SUMMATION
    • REFERENCES
• II. PEPFAR Organization and Investment
  • 3. PEPFAR Organization and Implementation
    • ORGANIZATION OF PEPFAR AT THE CENTRAL/HEADQUARTERS LEVEL
    • ORGANIZATION OF PEPFAR AT THE COUNTRY LEVEL
    • PERSPECTIVES ON INTERAGENCY IMPLEMENTATION
    • PEPFAR IMPLEMENTATION IN THE CONTEXT OF THE HIV EPIDEMIC IN PARTNER COUNTRIES
    • PEPFAR IMPLEMENTATION AND THE POLICY ENVIRONMENT
    • SUMMATION
    • REFERENCES
  • 4. U.S. Funding for the PEPFAR Initiative
    • INTRODUCTION
    • PEPFAR'S CONTRIBUTION RELATIVE TO OTHER DONORS
    • OVERVIEW OF THE PEPFAR FUNDING PROCESS
    • PEPFAR FUNDING LEVELS AND DISTRIBUTION BY PROGRAMS AND PARTNERS
    • PEPFAR FUNDING BY COUNTRY CHARACTERISTICS
    • STRATEGIC USE OF PEPFAR RESOURCES
    • SUMMATION
    • REFERENCES
• III. PEPFAR Programmatic Activity
  • 5. Prevention
    • EVOLUTION OF HIV PREVENTION SCIENCE
    • OVERVIEW OF PEPFAR-SUPPORTED PREVENTION PROGRAMS
    • PREVENTION OF SEXUAL TRANSMISSION
    • PREVENTION OF MOTHER-TO-CHILD TRANSMISSION
    • INJECTION DRUG USE
    • BLOOD AND MEDICAL INJECTION SAFETY
    • HIV COUNSELING AND TESTING
    • ANALYSIS OF PREVENTION IMPACT
    • INTERVENTIONS ON THE HORIZON FOR PREVENTION STRATEGIES
    • SUMMATION
    • REFERENCES
  • 6. Care and Treatment
    • HIV COUNSELING AND TESTING
    • CLINICAL CARE AND NONCLINICAL SUPPORT SERVICES
    • ANTIRETROVIRAL THERAPY
    • SUMMATION FOR PEPFAR'S SUPPORT FOR CARE AND TREATMENT SERVICES
    • ONGOING CHALLENGES WITH ART COVERAGE
    • SUSTAINABILITY OF CARE AND TREATMENT
    • REFERENCES
  • 7. Children and Adolescents
    • BACKGROUND
    • FUNDING HISTORY FOR PEPFAR SUPPORT FOR CHILDREN AND ADOLESCENTS
    • PEPFAR'S PROGRAMS AND SERVICES FOR ORPHANS AND VULNERABLE CHILDREN
    • PEPFAR'S PROGRAMS AND CHILD SURVIVAL
    • SUMMATION
    • REFERENCES
  • 8. Gender
    • INTRODUCTION
    • BACKGROUND
    • PEPFAR'S APPROACH TO GENDER
    • MEN WHO HAVE SEX WITH MEN
    • MEASUREMENT AND EVALUATION OF GENDER EFFORTS
    • SUMMATION
    • REFERENCES
  • 9. Strengthening Health Systems for an Effective HIV/AIDS Response
    • BACKGROUND AND CONTEXT FOR SYSTEMS DEVELOPMENT AND FUNCTIONING FOR HEALTH
    • OVERVIEW OF PEPFAR'S HEALTH SYSTEMS STRENGTHENING ACTIVITIES
    • LEADERSHIP AND GOVERNANCE
    • FINANCING
    • HEALTH INFORMATION
    • MEDICAL PRODUCTS AND TECHNOLOGIES
    • CHALLENGES
    • WORKFORCE
    • SERVICE DELIVERY
    • SUMMATION
    • REFERENCES
• IV. Future of U.S. Government Involvement in the Global Response to HIV/AIDS
  • 10. Progress Toward Transitioning to a Sustainable Response in Partner Countries
    • EVOLUTION OF THE U.S. RESPONSE TO GLOBAL HIV
    • COUNTRY OWNERSHIP: A FUNDAMENTAL ELEMENT OF PROGRESS TOWARD SUSTAINABILITY
    • OTHER KEY ELEMENTS FOR ACHIEVING SUSTAINABILITY
    • KEY BARRIERS TO ACHIEVING COUNTRY OWNERSHIP AND SUSTAINABILITY
    • SUMMATION
    • REFERENCES
  • 11. PEPFAR's Knowledge Management
    • INTRODUCTION
    • PROGRAM TARGETS AND PRIORITIES
    • PROGRAM MONITORING DATA
    • PEPFAR SUPPORT FOR EPIDEMIOLOGICAL DATA
    • PEPFAR SUPPORT FOR DATA USE BY PARTNER COUNTRY STAKEHOLDERS
    • PEPFAR-SUPPORTED EVALUATION AND RESEARCH ACTIVITIES
    • KNOWLEDGE TRANSFER AND LEARNING WITHIN PEPFAR
    • PEPFAR'S KNOWLEDGE DISSEMINATION EXTERNAL TO PEPFAR
    • SUMMATION
    • RECOMMENDATIONS
    • REFERENCES
• Appendixes
  • Appendix A Statement of Task
  • Appendix B Recommendations
  • Appendix C Evaluation Methods
  • Appendix D Committee, Consultant, and Staff Biographies

This study was supported by Contract/Grant No. SAQMMA09M0693 between the National Academy of Sciences and the U.S. Department of State. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the organizations or agencies that provided support for the project.

Suggested citation:

IOM (Institute of Medicine). 2013. Evaluation of PEPFAR. Washington, DC: The National Academies Press.

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.