existing systems to work for the partnership; lacking adequate transparency in sharing plans for an exit strategy; and lacking long-term plans for sustainability (Health GAP, 2005; EPN, 2004, 2006). The Partnership for Supply Chain Management has articulated plans to address each of these concerns (Partnership for Supply Chain Management, 2006; OGAC, 2007), but it is too soon to determine how effectively it is carrying out these plans.

The Committee believes it is critical that the Partnership for Supply Chain Management not create a parallel, U.S.-controlled system, but rather strengthen existing local, national, and regional systems, as well as facilitate technology transfer and regional harmonization to ensure sustainability well beyond the life of PEPFAR. To this end, the partnership requires the ability to respond genuinely to local priorities and needs rather than imposing a uniform solution. Evaluating the effectiveness of the partnership in these terms would encourage it to operate in this manner (see Chapter 8).

CONCLUSION

PEPFAR has supported a rapid and substantial expansion of the availability of ART to men, women, and children in the focus countries and has provided support to strengthen the associated workforce, laboratory, procurement, and supply chain systems. The primary early accomplishment of the U.S. Global AIDS Initiative has been to demonstrate that HIV/AIDS services, particularly treatment, can be rapidly scaled up in resource-constrained and otherwise severely challenged environments such as those existing in the focus countries—something many had doubted could be done (UNAIDS, 2001; WHO, 2003a,b; IOM, 2005). But the impact of the expanded availability of ART on the countries’ epidemics remains to be demonstrated, and further expansion of treatment and strengthening of related systems are needed. Meeting these needs will continue to be challenging, and continued support from the U.S. Global AIDS Initiative, with the improvements suggested by the Committee, will be necessary to assist the focus countries in sustaining and expanding the gains made against their HIV/AIDS epidemics.

REFERENCES

Aaron, L., D. Saadoun, I. Calatroni, O. Launay, N. Memain, V. Vincent, G. Marchal, B. Dupont, O. Bouchaud, D. Valeyre, and O. Lortholary. 2004. Tuberculosis in HIV-infected patients: A comprehensive review. Clinical Microbiology and Infection 10:388–398.

Calmy, A., L. Pinoges, E. Szumilin, R. Zachariah, and N. L. Ford. 2006. Generic fixed-dose combination antiretroviral treatment in resource-poor settings: Multicentric observational cohort. AIDS 20(8):1163–1169.

Castro, A., and P. Farmer. 2005. Understanding and addressing AIDS-related stigma: From anthropological theory to clinical practice in Haiti. American Journal of Public Health 95:53–59.



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