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The number of HIV-related deaths each year is falling globally, treatment is becoming more effective and cheaper, yet the rate of new infections is still too high to reach the UN’s goal of less than 500,000 new infections per year by 2020. CGD’s work on the economics of HIV introduced the concept of the AIDS transition—the point in time when the number of people living with the disease begins to fall. Our work also models the effects and implications of policies to reduce new infections and expand treatment.
What do the US Congress, the US Senate and the White House have in common? (This isn’t a trick question). Both the House and the Senate matched the President’s FY14 request for global AIDS spending, including $4.02 billion for the President’s Emergency Plan for AIDS Relief (PEPFAR) and $1.65 for the Global Fund – marking a rare sweet spot where the executive and legislative branches agree.
As the largest bilateral donor in global health, the President’s Emergency Plan for AIDS Relief (PEPFAR) is unequaled in its reach and impact. Yet despite its larger-than-life profile, we’ve found that the details of its implementation arrangements and decision-making often remains obscure to the longstanding chagrin of globalhealthobservers. Among the common questions: Where does scarce PEPFAR funding go? Which countries and implementers receive the bulk of PEPFAR funds? And what factors influence PEPFAR’s allocation of resources across recipient countries?
Ten years ago – on May 27, 2003 – the President’s Emergency Plan for AIDS Relief was born with the stroke of a pen by President George W. Bush. Over the last decade, the program has experienced tremendous growth and made inroads against HIV/AIDS, TB and malaria in some of the world’s hardest hit areas. And through it all, PEPFAR managed to maintain bi-partisan support that bridged two US Administrations, six US congressional sessions, and one global economic crisis.
The recent IOM evaluation of PEPFAR made clear that a key challenge for the program moving forward will be to get country governments to effectively assume primary responsibility of AIDS programs in their countries, both in terms of finances and “leadership”. But seeing that most PEPFAR funds are channeled through US-based contractors – and not country governments – it seems impractical to expect countries to be able to take real leadership and accountability for AIDS spending.
The Institute of Medicine, the prestigious health arm of the National Academy of Sciences, has weighed in with a massive report on the President’s Emergency Plan for AIDS Relief (PEPFAR), the multibillion dollar US effort to confront the epidemic in the developing world. The evaluation validates PEPFAR’s enormous reach during its first 10 years and identifies concrete actions that Congress and PEPFAR should take for the program to become more sustainable moving forward.
The Institute of Medicine (IOM) will soon release its much anticipated report evaluating the implementation of the President’s Emergency Plan for AIDS Relief (PEPFAR). Conducted at the request of Congress, the forthcoming report should follow up on points raised by a previous IOM report (2007), which provided a “short-term evaluation” of implementation after PEPFAR’s first three years, and which was soon followed by PEPFAR’s Congressional reauthorization in 2008. The new report is expected to broadly assess the cumulative performance of US HIV/AIDS programs, with two main tasks:
Without PEPFAR, it’s safe to say that almost all of Africa would be stuck near zero HIV treatment coverage. Instead, 49 percent of HIV-infected people were receiving life-saving treatment in 2014, rising to 56 percent by 2015, and the top-performing countries are still gaining ground. This dramatic increase in treatment coverage is a prodigious achievement—and the United States deserves most of the credit. But despite these accomplishments, much more work is needed to reach the end of the epidemic.
Earlier this month, Ambassador Goosby officially announced that he was stepping down from his role as Global AIDS Coordinator where he led the President’s Emergency Plan for AIDS Relief for the past four years. As my colleague Amanda blogged in anticipation of Dr. Goosby’s departure, his service will be remembered for strengthening the evidence base behind PEPFAR’s work.
The President's Emergency Plan for AIDS Relief (PEPFAR) is the single largest funder of global AIDS relief programs, but it does not regularly release data on how its money is spent. In this report, CGD's HIV/AIDS Monitor Team analyzes a newly available dataset of PEPFAR funding. They find, among other things, that only 30% of funds in 15 focus countries have gone to local organizations. They urge PEPFAR to regularly publish such funding data to improve transparency and strengthen coordination with host country governments and other stakeholders, and they suggest actions PEPFAR should take to improve the effectiveness and sustainability of its programs.
Donors spend billions of dollars to fight HIV/AIDS in developing countries, but poor integration between donors and host country health systems risks undermining international efforts to prevent and treat AIDS. In this analysis, CGD’s HIV/AIDS Monitor argues that donors need to pay more attention to their overall effect on health systems, finding that the big international donors often create duplicate AIDS-specific systems that competitively draw on the health resources of developing countries. The report recommends taking specific steps to more broadly improve health information systems, improve supply chain systems, and strengthen the health workforce.
There’s no doubt that Treatment as Prevention (TasP) will receive continued emphasis at this year’s International Aids Conference (IAC), as advocates argue for aggressively expanding treatment from the 9 million worldwide currently on antiretrovirals (ARVs) to the 35 million people who are HIV infected. But at the TasP workshop in Vancouver last month the more challenging and novel topic was pre-exposure prophylaxis, or PrEP. A whole array of sessions on PrEP is already on the agenda for next week’s conference in Melbourne, and our bet is that PrEP will generate a lot of buzz – an approach with intriguing potential, but edgy downside possibilities.