the 5–10 percent range, with the goal of increasing to 15 percent (OGAC, 2006e).

To help address the universal challenges involved in pediatric treatment (discussed below in the section on issues and opportunities for improvement), in early 2006 PEPFAR announced a public–private partnership that would be devoted to scientific and technical discussions of solutions for pediatric HIV treatment, formulations, and access. This partnership includes innovator and generic pharmaceutical companies, multilateral organizations such as the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the United Nations Children’s Fund (UNICEF), and agencies across the U.S. government. The partners are expected to contribute their diverse expertise to accelerate children’s access to treatment. The partnership met twice in 2006. Its initial plans include the following: (1) identify scientific obstacles to pediatric treatment that the partnership could address; (2) take practical steps and share best practices on the scientific issues surrounding dosing of ARVs for pediatric patients; and (3) develop systems for clinical and technical support to facilitate rapid regulatory review, approval, manufacture, and availability of pediatric ARV formulations (OGAC, 2006c).

Virtually every treatment program that the committee visited in the focus countries was crowded to the point of overflowing, and many programs reported long waiting lists. Many people lamented the lack of availability of ART for large numbers of those identified as eligible and expressed the hope that scale-up of treatment could proceed even more rapidly.

In all focus countries, ART roll-out to rural areas has been slow and challenging. In these areas, transportation is often poor, and trained health care workers and laboratory facilities are either minimal or nonexistent. The inability to reach some health care facilities during the rainy season in several countries is a major challenge. A challenge to PEPFAR is the need to collaborate with host governments to develop means of overcoming these obstacles and to demonstrate to all countries how rural treatment can best be achieved.