to pregnant and lactating women living with HIV/AIDS (OGAC, 2006b). Both the 2005 and 2006 Country Operational Plans describe ongoing and planned nutritional support activities, including collaborations with other, non-PEPFAR U.S. government food funding sources (see Box 5-3).

Need to Harmonize PEPFAR’s ARV Purchase Requirements with National Plans

PEPFAR has a stated goal of supporting rapid scale-up of ART and is “committed to funding the purchase of the lowest-cost ARVs from any source, regardless of origin, whether copies, generic, or branded, as long as those drugs are proven safe, effective, and of high quality, and their purchase is consistent with international law” (OGAC, 2006a, p. 47). However, PEPFAR’s quality assurance requirement has prevented the program from being fully harmonized with the ART programs of the focus countries and thus has limited PEPFAR’s ability to support the purchase of the focus countries’ first-choice ARVs.

When PEPFAR was initiated, the U.S. Global AIDS Coordinator determined that FDA approval would be the standard for assuring the quality of PEPFAR-provided ARVs. This standard differs from that of other donors—the Global Fund, the World Bank, and the agencies of the United Nations—as well as that of national HIV/AIDS programs, including those

BOX 5-3

Selected Examples of PEPFAR-Supported Nutritional Support Activities

In Kenya, PEPFAR is supporting a demonstration/training farm that fills food prescriptions for eligible patients. The initiative is a public–private partnership between U.S. and Kenyan organizations that involves several comprehensive HIV care clinics in urban and rural centers in western Kenya with close to 4,000 patients on ART.

In Ethiopia, PEPFAR coordinates with the U.S. Department of Agriculture food aid program. Funding is managed by USAID and is used to complement care programs for orphans and vulnerable children and people living with HIV/AIDS.

In Haiti, PEPFAR coordinates with other U.S. food assistance programs for the nutritional support of orphans.

In Mozambique, PEPFAR is supporting HIV-specific nutritional training for improved immune system response in people who are HIV-positive, as well as training on home garden food production specifically for resource-poor households to improve food security for those on ART.

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