tion and sought to determine how effectively the program is meeting its commitment to support the focus countries’ responses to their HIV/AIDS epidemics (IOM, 2005b).

THE PROGRESS OF PEPFAR

PEPFAR Has Supported the Expansion of HIV/AIDS Services in the Focus Countries

In the 15 focus countries, the U.S. Global AIDS Initiative has, as intended, supported HIV/AIDS activities and programs on a national scale, and OGAC reports substantial early progress toward its targets. In roughly 2 years, OGAC reports that PEPFAR has supported ART for more than 800,000 adults and children; HIV testing and counseling for nearly 19 million people; services to prevent mother-to-child transmission of HIV to women during more than 6 million pregnancies, including preventive antiretroviral medications (ARVs) for more than half a million women found to be HIV-positive (estimated by OGAC to have resulted in the prevention of HIV infection in more than 100,000 infants); public education campaigns, school curricula, and other types of information and education community outreach that are estimated to have reached more than 140 million adults and children; care and support services for approximately 4.5 million adults, orphans, and other vulnerable children; training in HIV/AIDS care and support services for well over a million people, including physicians, nurses, clinical officers, pharmacists, laboratory workers, epidemiologists, community workers, teachers, midwives, birth attendants, and traditional healers; and expansion and strengthening of clinical laboratories, supply chain management systems, blood supply systems, safe medical practices, and monitoring and evaluation systems (OGAC, 2005b, 2006a,b, 2007). Although data are not yet available with which to determine the quality or impact of these services, the Committee believes this substantial expansion of services represents inroads into the HIV/AIDS epidemics in the focus countries. Thus 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, 2005a).



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