More complete data on PEPFAR results needed, says second GAO treatment report

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GAOResultsCoverThe second of two reports from the U.S. Government Accountability Office reviewing HIV treatment efforts suppported by the President’s Emergency Plan For AIDS Relief concludes that incomplete information on the results of those efforts will interfere with accurately evaluating partner countries’ abilities to sustain treatment programs.

The GAO also has produced a report on PEPFAR treatment costs, covered here yesterday, and plans a third review of PEPFAR supply chains. The reports were produced in response to a request from Republican Senators Lamar Alexander (R-TN), who is ranking member of the Senate Health, and Education, Labor and Pensions Committee, Richard Burr (R -NC), Michael Enzi (R-WY) and Johnny Isakson (all ranking members of HELP subcommittees), and Tom Coburn (R-OK), ranking member of the Senate Committee on Homeland Security.

The review of treatment results found that PEPFAR data on rates of retention in HIV treatment programs only reflected rates of retention in facilities directly supported by PEPFAR. But in countries where government and private facilities receiving technical assistance from PEPFAR have begun to take over the care of stable patients, data on the retention of those patients is not reliably available. In addition, data on the numbers of people receiving treatment is similarly limited, not reflecting those on treatment in programs that, while not directly supported by PEPFAR, were made possible through contributions PEPFAR has made to technical and management capacities.

At the same time, the report gives an informative glimpse of revealing, if limited PEPFAR results data. For example, while indicating rates of retention in treatment higher than 90 percent in Botswana, China and Rwanda, data also show some of the lowest rates of treatment retention in South Africa, a country slated for “transition” to “country ownership” in the next few years. Country teams in the Dominican Republic, Kenya, and Zimbabwe were not able to produce data on retention rates, according to the report. The report also notes that treatment retention data was scarce for populations known to face significant barriers to accessing care, including children and adolescents, injecting drug users, men who have sex with men, and people involved in sex work.

The report authors note that the U.S. Office of the Global AIDS Coordinator, which coordinates PEFAR activities, has not produced a common set of indicators to monitor and improve program quality. The report, which was completed through reviews of PEPFAR documents, previous GAO reports,  as well as interviews in the United States, Kenya, South Africa, and Uganda, concludes that without reliable standards to monitor program quality, assessment of partner country programs will remain incomplete.

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