for family-based care services. PEPFAR, working with its partners, needs to plan strategically to implement comprehensive services and build capacity at the community level.

In the care category, PEPFAR’s program guidance is inconsistent in terms of integration of services, as evidenced by the exclusion of the services of traditional healers from what are identified as key areas of training for the provision of comprehensive care through home-based programs. At the same time, PEPFAR does have training programs targeting the development of partnerships with traditional healers to address issues related to adherence to ART and discussion of the effectiveness of ART with patients (OGAC, 2005d, 2006a). In addition, the Committee believes further work is needed to incorporate in PEPFAR’s training curricula and programmatic guidance cross-cutting issues and services such as nutrition and adherence to ART and other medications. Moreover, integration of palliative and preventive care guidance would have positive benefits in supporting overall wellness before and during ART. Other benefits could include impeding the synergism recently reported between malaria and high rates of transmission of HIV. Given the known concomitant effects of malaria and HIV, intensification of scaling-up efforts of PEPFAR’s secondary preventive care services and improving their linkages to services for comorbid infections is necessary. Doing so could contribute to efforts to keep people healthier longer, regardless of whether they are eligible for ART. Such linkages may be imperiled, however, if funding for these other key health care services lags far behind the enormous increases in funding for HIV/AIDS services from multiple sources.

Recommendation 6-1: The U.S. Global AIDS Coordinator should continue to promote and support a community-based, family-centered model of care in order to enhance and coordinate supportive care services for people living with HIV/AIDS, with special emphasis on orphans, vulnerable children, and people requiring end-of-life care. This model should include integration as appropriate with prevention and treatment programs and linkages with other public-sector and nongovernmental organization services within and outside of the health sector, such as primary health care, nutrition support, education, social work, and the work of agencies facilitating income generation.

CONCLUSION

As discussed at PEPFAR’s third annual meeting in Durban, South Africa (OGAC, 2006e), challenges to PEPFAR’s care services include the limited attention care has received as a result of confusion about what PEPFAR means by palliative care, as well as budgetary constraints; implementation



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