With the President’s Emergency Plan For AIDS Relief poised to continue to expand the numbers of people being treated for HIV worldwide, while “transitioning” from providing services and supplies to countries confronting HIV to providing guidance and support to those countries’ efforts, a new report from the United States Government Accountability Office on PEPFAR says improvements in how the program evaluates and communicates its work will be critical to attaining both goals.
The report, Millions Being Treated, but Better Information Management Needed to Further Improve and Expand Treatment, incorporates findings from earlier reports over the last two years on PEPFAR planning, evaluating and reporting as well as three this year examining PEPFAR drug supply chains, treatment costs, and treatment results.The three reports this year on treatment, and the report just released were completed in response to requests 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.
In the three reports examining components of treatment efforts released in May, the GAO advised that PEPFAR needed to better address weaknesses in recipient country’s management of antiretroviral drugs, gather more comprehensive treatment retention data, and improve the accuracy of its estimates of treatment costs.
At the same time, the reports have added up a list of PEPFAR successes, including that PEPFAR has saved $934 million since 2005 through switches from brand name antiretroviral drugs to generic equivalents. In addition, PEPFAR has saved money through growth and over time, with treatment programs reaping the benefits of purchasing drugs on larger scales, and overcoming early inefficiencies as programs have matured. And, in the last year PEPFAR made treatment available to more people than in any year before.
But, the new report, as well as earlier reports, have noted that PEPFAR’s planning was not always supported by findings in evaluations. In turn, the Office of the Global AIDS Coordinator has not required teams in the field to include evaluation plans in their yearly operation plans, leading to a lack of information to support planning.
The GAO recommends that the Office of the Global AIDS Coordinator include information in its report to Congress that would make the program’s progress clearer and better supported by comparing its results to its targets and delineating what has been done to validate its data. The GAO also recommends that the program adhere to common evaluation standards, develop evaluation plans and means of identifying appropriate evaluators, and making evaluation information accessible online.