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Index
A
ABC approach, 100, 120, 123, 135–137, 228–229
Abstinence, sexual, 64, 67, 100, 113, 120–121, 123.
See also ABC approach
Accountability
directions of, 46
PEPFAR funding and, 2, 11, 12, 82, 101
role of program monitoring and evaluation, 46
treatment delivery and, 144
Adherence to treatment, 141, 149–150
African Network of Religious Leaders Living with or Personally Affected by HIV/AIDS, 135
Age patterns of HIV infection, 23, 52
Antiretroviral therapy
access for marginalized groups, 156–157
adherence, 141, 149–150
attribution for successful implementation, 144–145
behavioral surveillance, 135
clinical care services and, 172
costs, 98–99
current delivery, 18, 145–146, 153, 268
effectiveness, 155
eligibility, 148, 154
follow-up, 149
future challenges, 164, 246, 252–253
generic drugs, 9, 10, 159, 160
guidelines, 146–147, 148, 154
harmonization of procurement, 158–160
host country program design, 147–148
human resources for delivery of, 14, 255–256, 257–258
initiation, 149
integration with prevention and care activities, 155, 200
laboratory services, 161
nutritional support, 157–158
obstacles to delivery, 141
patient evaluation for, 148
patient preparation for, 148–149, 154
pediatric care, 155–156
PEPFAR accomplishments, 5, 141, 164, 245
PEPFAR five-year performance targets, 4, 58, 144
PEPFAR funding, 98–99, 252
PEPFAR policies and programs, 141, 143
pregnancy during, 196–197
to prevent mother-to-child HIV transmission, 113, 127, 245, 268
quality standard, 9–10, 142, 158–159, 160
recommendations for improving availability, 13, 142, 153
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research needs, 155, 265
resistance monitoring, 150–151, 154
stigma reduction, 150
supply chain management, 162–164
training for health care workers, 145–146, 258
utilization, 141, 145
Attributions for success, 144–145
B
Bacterial vaginosis, 53
Behavioral surveillance, 7, 113, 114, 132, 133, 134, 135
Bill and Melinda Gates Foundation, 41
Blood safety, 115, 128–129, 137
Breastfeeding, 125–126
C
Capacity building initiatives, 252–259
Care services
budget allocations, 67, 99, 106–107
challenges, 200–201
classification, 172–173
community-based, family-centered, 178–180, 201
comprehensive, 172, 174–175, 178, 179, 191
contracting for, 178
definition and scope, 169, 171–172
delivery mechanisms, 169
effectiveness, 173
harmonization of, 201
health care worker training, 169, 176, 188–190
home-based, 70, 177, 182, 191–192, 193–194
integration with prevention and treatment efforts, 13, 99–100, 134–136, 142, 155, 170, 200, 202
major HIV/AIDS program elements, 48
needs of women and girls, 196–197
nondiscrimination in, 14, 82, 91–92
opportunities for improvement, 190
pain management, 194–195
palliative care, 171–172, 194–195, 200–201
PEPFAR delivery, 169, 173–176, 181–188, 201–202, 245–246
PEPFAR five-year performance targets, 25–26, 58, 169, 173
PEPFAR transition to sustainability, 190
planning, 180–181
preventive interventions in, 116, 169, 182–184
program performance evaluation, 265
psychosocial, 177, 192–193
quality assessment, 202
recommendations for, 13, 170, 200
stigmatization effects, 56–57
volunteer workers, 193–194
See also Counseling and testing
Centers for Disease Control and Prevention, 84–85, 104, 263
Child caregivers, 55
Children
AIDS mortality, 145
antiretroviral therapy utilization, 141, 145
immunization, 230
infection patterns and trends, 125
pain management, 195
sources of infection, 125
testing for infants, 187–188, 230
treatment, 152–153, 155–156
See also Mother-to-child transmission of HIV;
Orphans and other vulnerable children
Communication mechanisms and practices, 86–87, 97–98
Community-based approach
capacity building, 253–254
care services, 201
characteristics, 178
current service delivery, 46–47
goals, 47
network model, 177, 178–179
prevention of mother-to-child transmission, 126
recommendations for, 13, 170, 200
services for orphans and other vulnerable children, 215, 219–222
Community health worker model of care, 189
Comorbid infections
in children, 156
implications for treatment, 157
opportunistic infections, 184
prevalence, 157
preventive interventions, 182–184
See also Malaria;
Tuberculosis
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Condom promotion, 122–123, 228–229, 261.
See also ABC approach
Congress, U.S.
PEPFAR budget allocations, 2, 12, 82, 101
in PEPFAR transition to sustainability, 6–7, 249
Coordination
communication mechanisms, 86–87
Country Teams, 8–9, 85–86
development of national action framework, 45, 88–89
global efforts to improve, 43
goals, 254
impediments to, 9
international donors, 9, 43, 86, 88–89
Leadership Act requirements, 24, 68, 84
rationale, 85, 254
recommendations for U.S. Global AIDS Coordinator, 9, 82
of U.S. HIV/AIDS efforts, 3, 66, 71, 84–85
See also Harmonization of efforts
Corruption, 49
Counseling and testing
barriers to, 197–198
classification in continuum of care, 115–116, 169, 172, 173–176
components, 186
ethical concerns, 197
gender differences, 197
integration of services, 134
PEPFAR performance, 173–176, 245
to prevent sexual transmission of HIV, 120, 135
preventing mother-to-child transmission of HIV, 125–126, 127
purpose, 185–187
scaling up, 169, 188, 198
settings for, 186
strategies for improving, 198
testing for infants, 187–188, 230
wait for test results, 198
Country Operational Plan and Reporting System, 93
Country Operational Plans, 87–89, 93–94, 102
Country Teams
accountability, 12, 82, 101
budget allocations and restrictions, 11, 12, 14, 15, 16, 73, 95, 99
communication mechanisms and practices, 86–87
coordination and harmonization efforts, 8–9, 81, 85–86, 87–89, 91
financial management, 102
flexibility in prevention program design, 136, 262
funding, 104–106
organizational structure and operations, 71
planning cycle, 93–94
policy guidance, 92–93
research activities, 95
strategies for improving performance of, 262
support for, 71, 262
technical support, 94
D
Data collection
antiretroviral therapy delivery and outcomes, 144, 150, 155
behavioral surveillance, 7, 113, 114, 132, 133, 134, 135
birth registration, 222
burden of, for health care facilities, 144
care-related training, 188
condom promotion, 122
Country Operational Plan and Reporting System, 93
Demographic and Health Surveys, 133
obstacles to, 133
PEPFAR activities and support, 133, 266
PEPFAR network model of service delivery, 68–70
for PEPFAR performance evaluation, 17, 29–31, 81, 95, 267
PEPFAR transition to sustainability, 1
for prevention program design, 7, 131, 132–134
quality improvement activities, 95–96
recommendations for, 7, 134
sentinel surveillance, 133
services for orphans and other vulnerable children, 205, 235
See also Research
Diet and nutrition, 183–184
antiretroviral therapy and, 157–158
preventive interventions, 183–184, 231
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services for orphans and other vulnerable children, 223, 224
Discrimination, 56–57
as obstacle to harmonization, 91–92
participation of stigmatized groups in PEPFAR, 14, 82, 92
E
Educational system
HIV/AIDS impact in, 49–50
teacher mortality, 49, 236
vulnerabilities of orphaned children, 54–55, 222–223, 235
Elderly caregivers, 55
End-of-life care, 13, 179–180, 200
Epidemiology, 17–18, 23, 37–38, 49–50
age patterns, 23, 52
behavioral surveillance, 113, 114, 132, 133, 134
child infections, 125
focus countries, 62
gender differences, 52–53
recommendations for surveillance, 7, 114, 134
Equitable access, 14, 82, 91–92
Evaluation of national AIDS/HIV programs
current system for, 90–91
obstacles to, 91
services for orphans and other vulnerable children, 225–226
Three Ones principles of harmonization, 45–46, 90
Evaluation of PEPFAR implementation and performance
care services, 173, 202, 265
challenges, 31–32
conceptual approach, 26–28
data sources for, 29–31, 90–91
dissemination of findings, 266–267
family capacity strengthening, 218–219
goals, 4, 17, 26, 32, 244
harmonization as basis for, 4–5, 27–28, 267
human resources allocation, 15
indicators, 101–102, 267
integration of services, 260
Leadership Act requirements, 7, 26–27, 66–67
outcomes attribution, 101
outcomes data, 17, 81
prevention effectiveness, 113, 264
prevention of mother-to-child transmission, 127–128
program management, 81, 102–103, 263
recommendations for, 17, 244, 266
research needs, 264–266
services for orphans and other vulnerable children, 205, 208, 209, 235, 265–266
Evidence-based practice
future of PEPFAR, 12
HIV transmission prevention, 7
Extranet, PEPFAR, 86–87, 266–267
F
Faith-based organizations, 63–64, 67, 148, 163, 177, 178, 190, 208, 214, 219, 228, 260–261
Family-centered care, 46–47, 179
in care programs, 201
financial burden, 217–218
gender differences in caretaking burden, 53–54
recommendations for, 13, 170, 200
services for orphans and other vulnerable children, 215, 217–219
Family planning, 196–197
Focus countries, 25, 64–66
characteristics, 58–62
funding, 25, 58, 72–73, 104–106, 107–109
orphans and other vulnerable children in, 211–212
See also Host-country programs and policies
Food and Drug Administration, U.S., 9, 10, 88, 158, 159–160
Framework for the Protection, Care, and Support of Orphans and Vulnerable Children Living in a World with HIV and AIDS, 212, 214, 215–217
Funding
ABC programs, 228–229
for capacity building, 252
care services, 67, 99, 106–107, 173
causes of HIV and distribution of, 137
centrally funded programs, 105–106
coordination within U.S. government, 84–85, 86
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data collection for PEPFAR evaluation, 30–31
distribution by category, 106–107
flexibility in program and intervention design and, 2, 100–101, 136
focus country distribution, 25, 58, 72–73, 104–106, 107–109
global efforts, 40–43
for health worker training, 14, 258
Leadership Act budget allocations, 67
Partnership for Supply Chain Management, 162
PEPFAR distribution, 40–41, 58, 71–73, 98–101, 104–109
PEPFAR financial management evaluation, 102–103
per capita, 108–109
prevention activities, 115, 136–137
provisions of Leadership Act, 63–64
recommendations for improving, 2, 12, 82, 101
research, 95, 263
services for orphans and other vulnerable children, 67, 208, 210, 217, 228–229
U.S. Global AIDS Initiative, 25, 104
Future challenges and opportunities, 267–268
antiretroviral therapy, 164, 246
capacity building, 252–259
care services, 200–201
human resource supply, 14–15, 51, 255
integration of services, 12, 134, 259–261
research needs, 17, 57, 244, 264–266
services for orphans and other vulnerable children, 237
See also Sustainability, PEPFAR transition to
G
Gender differences
antiretroviral therapy utilization, 141, 145, 151
infection patterns, 52
prevention program considerations, 130–131
treatment delivery considerations, 151
volunteer counseling and testing, 197
See also Women and girls
Girls. See Women and girls
Global AIDS Coordinator, U.S.
current research effort, 16
as learning organization, 16
performance evaluation, 16
recommendations for, 6, 7, 9, 10, 13, 14, 17, 82, 89, 92, 114, 134, 142, 153, 160, 170, 200, 206, 234, 244, 248, 266
responsibilities, 3, 24, 66, 70–71, 84
role in harmonization and coordination, 9, 82, 89
Global AIDS Initiative, U.S.
accomplishments, 5, 17, 243, 245
budget allocations, 25, 104
current implementation, 4, 25
future prospects, 109
gender issues, 250
origins and purpose, 3, 24
recommendations for, 6, 7, 8, 10, 13, 15, 17, 114, 134, 142, 160, 234, 244, 250, 259, 266
research role, 15–16, 17, 263
transition to PEPFAR sustainability, 243
See also President’s Emergency Plan for AIDS Relief (PEPFAR)
Global Fund to Fight AIDS, Tuberculosis and Malaria, 4, 25, 41, 62
Global Implementation Support Team, 43
Global Partners Forum for Children Affected by HIV/AIDS, 212
Global Task Team, 43
H
Harmonization of efforts
antiretroviral drug purchase, 158–160
care services, 201
definition, 1.
See also Three Ones principles of harmonization
equitable access to programs and, 91–92
evaluation of PEPFAR implementation, 4–5, 27–28, 267
impediments to, 9, 88, 91–92
outcomes measurement and, 101
PEPFAR commitment to, 4, 25, 81, 87
PEPFAR transition to sustainability, 1–2, 8–10, 247–248
recommendations for, 10, 142, 160
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services for orphans and other vulnerable children, 221–222
U.S. role, 9
See also Coordination
Health care system capacity, 50–51
eligibility for PEPFAR, 198–199
facilities, 253
future challenges, 252–253
integration rationale, 199
national coordination, 254
network model, 177
PEPFAR public health benefits, 254–255
recommendations for expanding, 15, 244, 259
wrap-around services, 199
Health care workers
care services, 169, 188–190
doctor-to-population ratio, 58
injection practices, 63
in PEPFAR focus countries, 58
prevention of medical transmission of HIV, 128–130
quality improvement activities, 95–96
recommendations for recruitment and training, 15, 244, 259
risk of HIV transmission, 257
supply concerns, 14–15, 51, 255
training, 5
volunteers, 193–194, 259
See also Human resources;
Training in HIV/AIDS care
Highly-active antiretroviral therapy, 184
Home-based care, 70, 177, 182, 191–192, 193–194
Host-country programs and policies
access, 92
antiretroviral drug purchases, 158–160
antiretroviral therapy, 146, 147–148
attributions for successful service delivery, 144–145
capacity building, 252
current Global AIDS Initiative implementation, 4
customization of support for, 2, 12, 62, 82, 87–88, 136, 147
data collection for PEPFAR evaluation, 29–30, 267
expansion of services under PEPFAR, 5
global coordination of donor actions and, 85, 88–89
harmonization, 1, 8–10, 45, 87–88
health care system capacity, 50–51, 253
human resource development, 15
national AIDS authority, 45, 89–90
operational plans, 87–89, 93–94
outcomes research, 17
ownership of program planning and execution, 45
services for orphans and other vulnerable children, 224–226
strategic planning guidelines for, 46
See also Coordination;
Evaluation of national AIDS/HIV programs;
Focus countries
Human resources
future challenges, 160, 255
major HIV/AIDS program elements, 48
recommendations for expanding capacity, 15, 259
retention of personnel, 256–257
strategies for improving, 255–256
task shifting, 14–15, 189, 257–258
See also Health care workers;
Training in HIV/AIDS care
I
Infection patterns and trends, 17–18, 23, 37–40, 268
children orphaned as a result of, 210–212
gender patterns, 52
socioeconomic outcomes, 49–50
See also Transmission of HIV infection
Informed consent, 197
Infrastructure support for AIDS/HIV programs, 51, 62
Inheritance law, 196
Injection drug use
medical transmission of HIV, 129–130, 137
prevention of HIV transmission in, 88, 124–125, 137
Integration of services
challenges, 134, 259–261
goals, 2, 12, 25, 259–260
opportunities for, 134–135, 260
outcomes evaluation, 102
PEPFAR performance evaluation, 260
rationale, 12, 134, 135, 198–200, 202, 259
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recommendations for, 13, 142, 170, 200
services for orphans and other vulnerable children, 224
wrap-around services and, 199
Interagency Technical Working Groups, 94
International Infectious Diseases Control Act, 62
K
Kerry-Frist Global AIDS bill, 62–63
L
Laboratory services, 161
Leadership Act. See United States Leadership against HIV/AIDS, Tuberculosis, and Malaria Act
Learning organization, 16, 94–98, 109, 262
M
Malaria, 50, 183, 200
Marginalized populations
access to care, 91–92, 156–157
recommendations for PEPFAR programs and policies, 14, 82, 92
See also Discrimination;
Stigmatization of HIV-positive persons
Medications
expanded scope of practice for health workers, 189–190
impediments to harmonization of international efforts, 9, 88
obstacles to procurement, 51
pain management, 194–195
quality standard, 1–2, 9–10, 88, 142, 158–159, 160
See also Antiretroviral therapy
Microbicides, 123
Millennium Development Goals, 212
Model of care, 13, 189, 200.
See also Network model
Mortality, 23, 38, 39
children, 145, 182–183
demographic patterns, 49–50
preventive interventions, 182–183
Mother-to-child transmission of HIV
access to antiretroviral therapy to prevent, 18, 113, 127, 268
incidence, 125
PEPFAR interventions to prevent, 5, 113, 118, 126–128, 137, 245
prevention strategies, 125–126, 197
risk, 125
N
National Institutes of Health, 263
Needle exchange programs, 124
Network model, 68–70, 145, 176–178
New Partners Initiative, 106
Nongovernmental organizations, 178
services for orphans and other vulnerable children, 208, 218, 226
See also Faith-based organizations
Nurses, 189–190
Nutrition. See Diet and nutrition
O
Office of U.S. Global AIDS Coordinator
budget allocations, 99, 100
financial management, 103, 105–106
as learning organization, 94, 262–263
policy guidance, 92–93
quality improvement activities, 266
research funding, 95, 263
responsibilities, 4, 84
role in coordinating programs and donors, 85, 86
service for orphans and other vulnerable children, 214–215, 217, 233
structure and operations, 71, 83, 84
Opportunistic infections, 184
Orphans and other vulnerable children
access to services, 222–224
birth registration, 222
challenges to care delivery, 217
community-based responses, 219–222
core services model, 205, 222
creating supportive environment for, 226
definition, 207, 231–234
direct support, 208–209
education, 222–223
evaluation of service delivery, 205, 208, 209, 235, 265–266
evolution of care goals and strategies, 212–217
family-based care, 217–219
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Framework for the Protection, Care, and Support of Orphans and Vulnerable Children Living in a World with HIV and AIDS, 212, 214, 215–217
funding for services and programs, 67, 208, 210, 217, 228–229
HIV/AIDS-associated vulnerabilities, 54–55
HIV infection prevention among, 227–230
indirect support, 208, 209
institutional care, 220
integration of services for, 224
opportunities for improving services, 231–237
PEPFAR care services and strategies, 210, 218–219, 221–222, 225–226, 227–229, 231, 245–246
PEPFAR targets, 13, 205, 206, 208–209, 214–215, 234
population patterns and trends, 18, 54, 210–212, 268
preventive care services, 230–231
recommendations for service delivery, 13, 170, 200, 206, 234
scale-up efforts, 205
scope of services for, 207
service needs, 13, 206, 234, 268
social welfare workforce issues, 235–237
supplemental direct support, 208, 209
support for national government services, 224–226
training for service to, 210
vulnerabilities of young girls, 231
P
Pain management, 172, 194–195
Palliative care, 171–172, 194–195, 200–201
Partnership for Supply Chain Management, 106, 162–164
PEPFAR. See President’s Emergency Plan for AIDS Relief
PEPFAR ExtraNet, 86–87, 266–267
Performance targets, PEPFAR
care services, 25–26, 58, 169, 173
origin of, 67
for orphans and other vulnerable children, 13, 205, 206, 208–209, 214–215, 234
prevention, 4, 25, 58, 113, 117
progress to date, 17
treatment delivery, 4, 25, 58, 144, 153
Plus-up plans, 102
Poverty reduction, 214
President’s Emergency Plan for AIDS Relief (PEPFAR)
accomplishments, 5, 17, 81, 109, 245–246
allocation of funds, 71–73, 104–109
annual meetings, 96–97
annual report, 98
blood safety activities, 115, 128–129, 137
budget, 40–41, 58, 71, 98–101
commitment to harmonization, 4, 25, 81, 87
communication mechanisms and practices, 97–98
coordination with other donors, 43, 81, 85
data collection activities and support, 133
evaluation. See Evaluation of PEPFAR implementation and performance
Extranet, 86–87, 266–267
five-year performance targets, 4, 17, 25–26, 58, 67, 113, 117, 144, 153, 169, 173
focus countries. See Focus countries
fragmented service delivery, 199–200
guiding principles, 25
host country relationships, 81, 88, 90
Institute of Medicine evaluation, 3, 4, 26–31
as learning organization, 94–98, 109, 262
network model of service delivery, 68–70, 176–178
organizational structure and operations, 4, 71, 81
origins, 3
participation of stigmatized groups in, 82
policy documents, 92–93
quality improvement support, 96
research role, 16, 17, 261–262, 263
strategic objectives, 67–68
transition to sustainability. See Sustainability, PEPFAR transition to
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See also Care services;
Country Teams;
Future challenges and opportunities;
Prevention;
Treatment
Prevalence, 23, 38
in focus countries, 62
integration with prevention and care activities, 99–100
recommendations for surveillance, 7, 114, 132–134
Prevention
abstinence programs, 64, 67, 100, 113, 120–121, 123
among injection drug users, 124–125
in care services, 116, 169, 182–184
comprehensive behavioral interventions, 123
condom use promotion, 122–123
counseling and testing services for, 186
data collection and management for, 7, 131, 132–134, 137
education campaigns for, 123
evidence-based practice, 7
future of PEPFAR, 1, 7
gender issues, 130–131
integration with care and treatment efforts, 13, 134–136, 142, 155, 170
Leadership Act budget allocation, 67
major HIV/AIDS program elements, 48
medical transmission of HIV, 128–130
microbicide use, 123
mother-to-child transmission of HIV, 5, 18, 113, 118, 125–128, 137, 197, 245
nondiscrimination in, 14, 82, 92
opportunistic infections, 184
outcome measures, 113, 117–118, 264
PEPFAR accomplishments, 5, 7, 118–130
PEPFAR activities, 115–117, 137
PEPFAR budget allocations, 99, 106–107, 136–137
PEPFAR five-year performance targets, 4, 25, 58, 113, 117
program performance evaluation, 113
recommendations for improving, 7, 114, 134
restrictions on funding, 88, 100–101, 136
role of counseling and testing, 135
scope of activities, 115–117
services for orphans and other vulnerable children, 227–231
sexual transmission of HIV, 118, 120–123
strategic planning, 7, 113
strategies for improving, 131, 137
Private sector funding for HIV/AIDS initiatives, 41
Protease inhibitors, 150
Psychosocial services, 177, 192–193
Public education
HIV prevention, 123
HIV transmission in injection drug use, 125
PEPFAR accomplishments to date, 5
See also Educational system
Q
Quality improvement, 95–96, 266
R
Religious beliefs, 63.
See also Faith-based organizations
Research
antiretroviral therapy effectiveness, 155, 265
Country Team activities, 95
funding, 95
goals, 2, 15–16
implications for program planning and implementation, 57
needs, 17, 57, 244, 264–266
pediatric therapy, 153
PEPFAR role, 16, 17, 261–262, 263
recommendations for, 17, 244, 266
stigma, 56–57
See also Data collection
S
SAVE program, 135
Sex workers, 14, 92, 124, 131, 156
Sexual transmission of HIV
ABC prevention strategy, 100, 120, 123, 135–137, 228–229
gender differences, 53
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patterns, 137
prevention program budget allocation, 137
prevention program design, 131
prevention program effectiveness, 118, 120–123
recommendations for surveillance, 7, 114, 134
See also Abstinence, sexual
Social security programs, 225
Socioeconomic conditions
disease outcomes and, 50
impact of HIV/AIDS, 49–50
PEPFAR focus countries, 58
poverty reduction, 214
vulnerabilities of orphaned children, 54–55
State Department, U.S., 72, 73, 104
Stigmatization of HIV-positive persons, 56–57, 82
antiretroviral therapy and, 150
See also Discrimination;
Marginalized populations
Sustainability, PEPFAR transition to
capacity building initiatives for, 252–259
challenges, 243
harmonization and coordination of efforts for, 8–10, 247–248
integration of services for, 12
network model for, 177
PEPFAR commitment to, 248
prevention strategies in, 7
rationale, 18, 246–248, 268
recommendations for, 6–7, 244, 248
strategies for, 1–2, 190
women’s issues in, 8, 249–252
workforce concerns, 14–15
T
Three Ones principles of harmonization, 43, 87
action framework, 45, 87–89
coordinating authority, 45, 89–90
monitoring and evaluation, 45–46, 90–91
origins, 44
purpose, 44
Traditional healers, 195, 200
Training in HIV/AIDS care
antiretroviral therapy, 145–146, 258
current efforts, 14
for home-based care, 192
PEPFAR accomplishments, 5, 176, 246, 258
PEPFAR network model of service delivery, 68–70
recommendations for, 15, 244, 259
services for orphans and other vulnerable children, 210, 237
spending, 14, 258
for supportive care, 169, 188–190
twinning strategy, 258
Training in HIV/AIDS prevention
blood safety procedures, 129
injection safety, 129–130
mother-to-child transmission, 128
Transmission of HIV infection
causes, 137
in focus countries, 62
risk for health care workers, 257
See also Injection drug use;
Mother-to-child transmission of HIV;
Prevention;
Sexual transmission of HIV
Treatment
budget allocations, 67, 99, 106–107
child patient, 152–153, 155–156
clinical care services and, 172
human resources for, 160
integration with prevention and care activities, 13, 99–100, 134–136, 142, 155, 170
major HIV/AIDS program elements, 48
nondiscrimination in, 14, 82, 91–92
PEPFAR definition, 141, 143
PEPFAR five-year performance targets, 4, 25, 58, 144, 153
PEPFAR policies, 141, 145
recommendations for improving, 13, 142
voluntary counseling and testing in, 186
women’s access, 52
See also Antiretroviral therapy;
Care services
Tuberculosis, 141, 156, 157, 173, 176
prevention, 183, 185
treatment, 185
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U
Unemployment levels, 58
United Nations, 41, 43, 46, 48, 212, 214, 220
United States
current HIV/AIDS program budget, 2, 12, 40–41
interagency coordination, 84–85
leadership role, in HIV/AIDS programs, 18
role in harmonization and coordination, 9
See also specific government entity;
specific government program
United States Leadership against HIV/AIDS, Tuberculosis, and Malaria Act (Leadership Act)
amendments, 63–64
budget allocations, 67, 71–73
evaluation of PEPFAR and, 4, 7, 26–27, 66–67
origins and purpose, 3, 6, 24, 62–63, 64, 246
palliative care provisions, 173
performance targets, 67
research goals, 261
restrictions on funding, 63, 64, 88
services for orphans and other
vulnerable children, 67, 208, 210
significant HIV/AIDS provisions, 24, 64
See also President’s Emergency Plan for AIDS Relief (PEPFAR)
Urban populations, 51
U.S. Agency for International Development, 84–85, 104, 263
U.S. Leadership against HIV/AIDS, TB and Malaria Act of 2002, 62–63
V
Voluntary counseling and testing. See Counseling and testing
W
Women and girls
access to care, 52, 249–250
burden of HIV/AIDS, 53–54
caregiving role, 193, 196, 217, 218
HIV/AIDS manifestations, 53
infection patterns, 52, 53
infection risk, 52–53
Leadership Act provisions, 63
PEPFAR programs and services, 8, 249
prevention program considerations, 130–131
recommendations for services, 8, 244, 250
significance of, in PEPFAR transition to sustainability, 8, 249–252
supportive care for, 196–197
vulnerabilities of young girls, 231
See also Gender differences
World Bank, 41
World Health Organization
antiretroviral therapy guidelines, 144, 146–147, 148, 154
health care workforce management, 257
medication quality standards, 1–2, 9–10, 142, 158–159, 160
palliative care, 171, 172
Wrap-around services, 199, 201
OCR for page 374
PEPFAR Implementation: Progress and Promise
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Representative terms from entire chapter:
antiretroviral therapy
