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Letter Report
Pages 1-23

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From page 1...
... The legislation emphasized the establishment of programs that focus on national HIV/AIDS strategies of recipient countries, women and children, strengthening of health care infrastructure and workforce, and effective monitoring and evaluation to assess programmatic success. This legislation also required the President to establish the Office of the Global AIDS Coordinator (OGAC)
From page 2...
... PEPFAR has estab lished additional goals for its prevention, treatment and care programs in these countries, specifi cally: to support prevention of 7 million new HIV infections, treatment of 2 million HIV-infected 11
From page 3...
... government agencies, are responsible for supporting programs in PEPFAR countries with specific technical and im plementation issues. Each of the focus countries has a U.S.
From page 4...
... The Committee is prepared to find considerable changes in PEPFAR throughout its evaluation, and has developed an approach to the evaluation that will allow it to adapt not only to changes in PEPFAR implementation, but also to what the Commit tee learns as the evaluation proceeds. The Committee's evaluation plan should be viewed as a 13
From page 5...
... We plan to publish the plan for a long-term study shortly after publication of the mandated report. This long-term evaluation plan will be informed by the Committee's fuller understanding of PEPFAR implementation and the challenging ex perience of evaluating it.
From page 6...
... The Committee has considered peer-reviewed literature on global efforts to combat HIV/AIDS in resource-limited settings, documentation provided by OGAC, and other program-related materials. The Committee has heard testimony from OGAC officials and PEPFAR Mission staff; global organizations such as the World Health Organization, UNAIDS, Global Fund, and World Bank; and numerous PEPFAR grantees and partners.
From page 7...
... Is PEPFAR functioning as a Learning Organization How is PEPFAR evaluating its own performance? Focus Countries Harmonization To what degree is PEPFAR harmonized with the National Plan, National Strategy Coordinating Entity, and National Monitoring & Evaluation Framework?
From page 8...
... The global HIV/AIDS community, led by organizations such as those of UNAIDS, has published guidelines outlining international consensus strategies for the development and implementation of prevention, treat ment, and care programs. · Does the PEPFAR strategy address the major elements of the Act such as: o Developing specific objectives, approaches and strategies for activities related to HIV/AIDS prevention, treatment and care?
From page 9...
... (Sec.101.b.3.B & N) · Is the PEPFAR strategy consistent with best practices outlined in global consensus docu ments related to prevention, treatment and care of HIV/AIDS including: o The Global Strategy Framework on HIV/AIDS (UNAIDS, 2001)
From page 10...
... Coordination Coordination is one of the key elements of PEPFAR implementation identified by the Act. More specifically, the stated objectives within the legislation include strengthening coordination among U.S.
From page 11...
... o Prevention of 7 Million HIV Infections o Treatment of 2 Million HIV-infected People with ART o Care for 10 Million People Infected with and Affected by HIV/AIDS o Reduction of the HIV/AIDS Epidemic in the Focus Countries o Improved Survival and Quality of Life for People in the Focus Countries o Sustainable Programs and Systems o Enhanced Knowledge Base · How does PEPFAR manage difficult monitoring and evaluation issues such as measurement of infections prevented and attribution of people treated or cared for? · How does PEPFAR assure the quality of programs and services?
From page 12...
... All of the PEPFAR focus countries have national AIDS authorities, and thus with this commitment, "Harmonization" with the Three Ones of each focus country be 21
From page 13...
... . The targets for PEPFAR-funded prevention, treat ment and care programs -- to support prevention of 7 million new HIV infections, treatment of 2 million HIV-infected people with ART, and care of 10 million people infected and affected by HIV/AIDS -- were introduced in the State of the Union address given by President Bush in 2003, referenced in the Act, and later included in the PEPFAR strategy (OGAC, 2004)
From page 14...
... · How are prevention, treatment, and care programs and activities progressing? · Has PEPFAR achieved the intermediate milestones established to measure progress in reaching its goals of supporting the prevention of 7 million HIV infections, treatment of 2 million HIV-infected people with ART, and care for 10 million people infected and af fected by HIV/AIDS?
From page 15...
... Capacity Building In order to meet the goals of expanding and sustaining HIV/AIDS prevention, treatment, and care, PEPFAR must address the common barriers that affect progress in many countries: namely the scarcity of human resources and institutional capacity compounded by fragile health care sys tems (OGAC, 2005a)
From page 16...
... To answer ques tions related to PEPFAR resource allocation, the committee will review and analyze budgetary and programmatic data provided by OGAC, PEPFAR Missions, and others. The Committee will examine the major aspects of program implementation including PEPFAR management; har monization; prevention, treatment, and care programs and activities; capacity building; and inte gration through a wide variety of approaches including review of the scientific literature; analy sis of PEPFAR guidance and other documents, national plans, and focus country reports; analysis of data from PEPFAR and other programs and donors; and discussions with OGAC staff, Mission staff, focus country officials, partners, program officials, community groups, and officials from other donor organizations.
From page 17...
... Thus, visits to the focus countries to directly observe implementation activities are a critical part of the Committee's evaluation plan. The Committee anticipates that these country visits will provide insight into the programmatic successes and challenges through concrete examples and first-hand accounts of how PEPFAR is working on the ground.
From page 18...
... Also, it may not be possible for the Committee to know the pre cise nature of the redacted information or its impact on our analysis. The Committee may en counter similar difficulties with respect to unpublished monitoring and evaluation data that PEPFAR has collected.
From page 19...
... 2005b. Basic Requirements Under the President's Emergency Plan for AIDS Relief for All Bilateral Pro grams.
From page 20...
... Additional members who serve only on the subcommittees provide expanded expertise in the following areas: child psychology/psychiatry, child wel fare/services, demography, health communication, health education, infectious disease (pediat ric) , laboratory quality, logistics, palliative care, and pharmacology.
From page 21...
... its,mS s,s M.D., rpenter, Jai­ Bertozzi, Holzem Ca Red Wei Chair Hoosen Henry David Helen Olaitan Burton Chair Curran McCaw-Binns, Garnett Macklin, Paltiel, Merson Committee mes ke Chair Vice Stefano Ja William Affette Charles Geoff Ruth David Priscilla Heather Mi subcommittees.eht on only M.D., M.D. .D.hP serve Subcommit- Ph.D., Ph.D.
From page 22...
... Additional staff on board included detailees from other US gov ernment agencies, contractors, fellows, and interns. August 2005 Basic Requirements Under the President's Emergency Plan for AIDS Relief for all Bilateral Programs published May 2008 United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 expires 2008 Goal of 2 million People with HIV/AIDS on Antiretroviral Therapy 2008 Goal of 10 million People Affected by HIV/AIDS Receiving Care 2010 Goal of Preventing 7 million HIV Infections 31
From page 23...
... APPENDIX 3 Abbreviations AIDS Acquired Immunodeficiency Syndrome ART Antiretroviral Therapy ARV Antiretroviral Drug CDC Centers for Disease Control and Prevention COP Country Operational Plan DoD Department of Defense DoL Department of Labor HHS Health and Human Services HIV Human Immunodeficiency Virus HRSA Health Resources and Services Administration ILO International Labour Organization NIH National Institutes of Health OGAC Office of the Global AIDS Coordinator PEPFAR The President's Emergency Plan for AIDS Relief UNAIDS Joint United Nations Programme on HIV/AIDS UNICEF United Nations Children's Fund USAID U.S. Agency for International Development WHO World Health Organization 32


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