Institute of Medicine Report: PEPFAR has been “Globally Transformative”
Earlier this year, the Institute of Medicine (IOM) evaluated the impact and performance of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). The renowned 20-person evaluation committee, including Cathy Wilfert of the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), spent nearly two years (2010-2012) evaluating the program via country visits, direct interviews with key stakeholders at the country and global levels, document reviews, and data analysis. The committee, chaired by Dr. Robert Black of the Johns Hopkins University School of Public Health, found that the program has been “globally transformative—changing in many ways the paradigm of global health and what can be accomplished with ambitious goals, ample funding, and humanitarian commitment to a public health crisis.”
The report highlighted the significant progress PEPFAR has made to treat and prevent HIV/AIDS since its inception in 2003, “PEPFAR has achieved—and in some cases surpassed—its initial ambitious aims. These efforts have saved and improved the lives of millions of people around the world. That success has in effect ‘reset’ the baseline and shifted global expectations for what can be achieved in partner countries.”
A key program success has been its focus on the prevention of mother-to-child transmission (PMTCT) services. Implementing partners, such as EGPAF, have been able to provide anti-retroviral prophylaxis for millions of HIV-positive pregnant women and mothers. For example, in 2010 PEPFAR provided testing and counseling for nearly 8.4 million women and administered antiretroviral prophylaxis to prevent mother-to-child transmission to more than 600,000 HIV-positive pregnant women, which led to more than 114,000 children estimated to have been born HIV-free.
For the time period reported in the IOM document, EGPAF-supported PMTCT programs accounted for more than 25 percent of the total number of pregnant women reached with antiretroviral prophylaxis through PEPFAR. In addition, the largest PEPFAR-funded HIV care and treatment program to date, referred to as “Track 1.0,” was implemented by EGPAF in 2004, along with the International Center for AIDS Care and Treatment Programs at Columbia University (ICAP), Harvard University, and Catholic Relief Services. This program accounted for between 25 and 33 percent of all individuals receiving ART through PEPFAR funding from 2005-2011. Of the four Track 1.0 implementing partners, EGPAF was the largest enroller of adults and children on antiretroviral therapy (ART), accounting for nearly 40 percent of all Track 1.0 ART enrollments.
Despite the dramatic progress to date, the report also acknowledged that the task is nowhere near complete. There is a critical need for increased PMTCT services that are integrated with existing maternal-child health systems as well as continued scale-up of HIV/AIDS care and treatment services, especially for children. Through the end of 2011, 54 percent of HIV-positive adults eligible for treatment were receiving it, while only 28 percent of eligible children living with HIV accessed the medicines they need.
Specifically, the document outlines numerous important recommendations for the future direction of PEPFAR programs, including:
- Continued program scale-up that includes more efficient and effective service delivery models, an emphasis on HIV prevention services, and improved data collection.
- Continued health system strengthening efforts, with a focus on sustaining the HIV response in countries, especially health workforce, supply chain, and financing
- Transition to a sustainable response to allow partner country governments and other stakeholders to plan for sustainable programs and assume management of the HIV response.
- Develop a comprehensive knowledge management (KM) framework to streamline reporting and knowledge dissemination.
These recommendations align with EGPAF’s own program priorities, including expanded integration with maternal and child health services and health system strengthening. We are proud to partner with PEPFAR to dramatically reduce the disease burden in countries most-affected by the epidemic and advance our mission to eliminate pediatric HIV.
An AIDS-free generation is achievable, but only if the United States Government continues to support programs such as PEPFAR. As the IOM report noted, “As it moves forward, PEPFAR must continue to be bold in its vision, implementation, and global leadership, this time towards its aim of continuing to strengthen capacity in partner countries in responding to the pandemic.”
IOM’s full evaluation of PEPFAR is available here.
Dr. Nicholas Hellmann is Executive Vice President of Medical and Scientific Affairs at the Foundation, based in San Francisco, C.A.