The Office of the Global AIDS Coordinator released its five-year global AIDS strategy today, marking World AIDS Day by outlining its vision for the transition of PEPFAR from an emergency response to a more sustainable, country-driven program.
The biggest news in the 20-page report can be found on page 6, where OGAC outlines its prevention and treatment targets from fiscal year 2010 through 2014. Those targets include:
*Supporting the prevention of 12 million new HIV infections;
*Providing direct support for more than 4 million people on treatment, a doubling of the estimated 2 million on treatment in PEPFAR’s first five years;
*Doubling the number of at-risk babies born free of HIV infection (during the first five years of PEPFAR, the program helped ensure that 240,000 babies of HIV-positive mothers were born without HIV);
*Ensuring that partner countries with generalized epidemics have 80 percent HIV testing coverage for pregnant women and 85 percent ARV prophylaxis and treatment for women found to be HIV-positive.
The treatment target of 4 million is well short of what HIV experts and advocates called for earlier this year in a memo to Ambassador Eric Goosby, the US Global AIDS Coordinator. That memo called on PEPFAR to reach 6 million people with lifesaving antiretroviral treatment by 2013 and 7 million by 2014. Those targets “continue U.S. leadership toward meeting global treatment needs” and “can clearly be reached under authorized funding levels,” the memo said.
The PEPFAR strategy document itself notes that in 2009 alone, PEPFAR supported 2.4 million patients on treatment and some have predicted the program will reach 3 million by year’s end. That means getting to 4 million by 2014 is not much of a scale up.
More broadly, the document outlines these general goals for moving into the next phase:
• Transition from an emergency response to promotion of sustainable country programs;
• Strengthen partner government capacity to lead the response to this epidemic and other health demands;
• Expand prevention, care, and treatment in both concentrated and generalized epidemics;
• Integrate and coordinate HIV/AIDS programs with broader global health and development programs to maximize impact on health systems; and
• Invest in innovation and operations research to evaluate impact, improve service delivery and maximize outcomes.
The document includes some interesting language about PEPFAR’s role in the Administration’s Global Health Initiative and in the White House’s new emphasis on strengthening health systems, including the concept of leveraging the investments in PEPFAR to achieve broader health outcomes.
For example, the report states that: “The systems of care established and strengthened by PEPFAR can serve as a platform to expand, integrate, and co-locate primary and specialty care services to best serve the needs of infected and affected populations.
“… PEPFAR now has the opportunity to strategically plan programs with greater consideration for the larger health systems impact. PEPFAR holds great potential for better across-the-board integration with broader health systems and development assistance, such as food, nutrition, and economic strengthening activities,” the report continues. “Integration can contribute to larger goals involving infrastructure, governance, sustainability, and community level health impacts, and allows PEPFAR to leverage its impact within a larger development context. In particular, the Global Health Initiative affords an opportunity to support expanded integration of PEPFAR programming with other USG health and development programming.”
In a section on integration, the report states that PEPFAR is the “largest component of President Obama’s Global Health Initiative” and as such is “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.”
There many other details in the report, which HIV experts and advocates will be pouring over in the coming hours and days. In addition, PEPFAR plans to release “annexes” to this strategy, which it says will provide detail about specific program areas.