by appearing to take credit for the country’s accomplishments. The program has since endeavored to be clear in its reporting that it is claiming credit for having provided some measure of support for a person’s ART rather than exclusively and directly providing the treatment. PEPFAR has also been working closely with the Global Fund, as well as with each focus country, to avoid overlaps in attribution. The Committee encourages PEPFAR to continue in this vein, participating in joint attribution and enhancing coordination among all donors and with the host countries.

PEPFAR’s strategy for achieving its treatment target includes

  • Rapidly scaling up treatment availability using a network model.

  • Building capacity for long-term sustainability of quality HIV/AIDS treatment programs.

  • Collecting strategic information with which to monitor and evaluate progress and ensure compliance with PEPFAR and national policies and strategies (OGAC, 2004).

To achieve the treatment target, PEPFAR’s approach to implementation is to assist countries in the “development of appropriate treatment protocols and policies to ensure safe and effective treatment services, drug supply, and equitable distribution of health resources,” and to work with existing clinical programs and develop additional infrastructure, staff, and technical capacity, as needed, to provide “long-term, widespread, high-quality, safe, and essential services to the maximum number of people in need” (OGAC, 2004, p. 11).

Results

According to the Office of the U.S. Global AIDS Coordinator (OGAC), 822,000 people were receiving PEPFAR-supported ART in the focus countries by the end of September 2006, as compared with 155,000 in fiscal year 2004. Approximately 61 percent of this total were women and 9 percent children (OGAC, 2007). These proportions for women and children compare favorably with global averages (WHO and UNAIDS, 2006; UNAIDS, 2006), but may need to increase to reflect actual needs. Recent data indicate that women are disproportionately represented among people living with HIV/AIDS and among the newly infected, particularly in resource-constrained countries, and that children accounted for more than 13 percent of AIDS deaths in 2005 (GAA, 2006; UNAIDS, 2006; WHO and UNAIDS, 2006).

PEPFAR has also supported training in the provision of ART for more than 100,000 health workers and training for more than 17,000 laboratory personnel, as well as significant expansion in the number of ART delivery



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