PEPFAR Releases More Details on Its Five-Year Strategy

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PEPFAR today released three “annexes” to its five-year global AIDS strategy, offering some additional details and context for the plan issued last week on World AIDS Day.

The first annex, which can be found here, addresses PEPFAR’s prevention, care, and treatment plans for the next five years. “Prevention remains the paramount challenge of the HIV epidemic,” the document notes, emphasizing that prevention efforts will be a key priority for PEPFAR as the program transitions from an emergency response to a more long-term effort. 

A top prevention goal, the annex says, will be to help countries better map their HIV epidemic and reassess their prevention efforts based on that new data. There will be an emphasis on “combination” prevention strategies that include behavioral, biomedical and structural components.

On treatment, the document points to the recent decision by the WHO to change its treatment guidelines (calling for antiretroviral treatment to begin at a CD4 cell count of 350 rather than 200) as evidence of the growing challenge in meeting global treatment needs. The five-year global AIDS strategy PEPFAR released last week included a treatment goal of reaching more than 4 million people over the next five years, a major disappointment to advocates who had called for a much bolder target. In the annex, PEPFAR says that it will focus on reaching the sickest people first, as well as pregnant women and patients co-infected with HIV & TB.

“PEPFAR will continue to scale up its treatment programming in a manner that emphasizes health systems strengthening and creation of country level capacity,” the document says. “Millions of people with CD4 cell counts under 200/mm3 are not currently reached by treatment. Within the context of national priorities, PEPFAR is making it a priority to reach the sickest individuals first, in order to prevent as many immediate deaths as possible.”

The second annex, which can be found here and is titled “PEPFAR and the Global Context of HIV,” describes the partnership frameworks, efforts to find cost-savings and to build sustainability and country capacity, and a push to enhance international coordination and commitment to the global AIDS fight.

The third annex, which can be found here, delves into PEPFAR’s role in the Obama Administration’s Global Health Initiative. It states, for example, that PEPFAR will contribute to the GHI by adopting a “women and girl-centered approach to health and gender equity” and that it will increase its impact “through strategy integration and coordination.” This annex also discusses PEPFAR’s role in health system strengthening and human resource development.

Each annex is lengthy, so it will take a while to sort through these pages and determine their significance. Please share your insights/assessments!

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