AIDS-specific indicators should be developed that track change of the following “three generations” of HIV/AIDS surveillance: measurement of prevalence and incidence of HIV infection using specific state-of-the-art methods; measurement of behavioral change, including risky behaviors and risk-reducing behaviors; and assessment of stigma and discrimination. Other indicators to be developed include measures of survival, quality of life, development of drug resistance, and the overall physical, mental, and social well-being of people affected by HIV/AIDS.
PEPFAR evaluation should also develop more general indicators, such as the empowerment of women and girls, general health (that is, infant mortality and overall mortality), capacity of community-based organizations to respond, and public health infrastructure and capacity (that is, supply chain and health care workforce). Among those indicators developed to track change in public health capacity, measures for monitoring the health care workforce are particularly important in light of the depletion of that workforce by the disease itself, the flux of health care workers to developed countries, and the sequestration of the health care workforce to vertical health programs. In addition, PEPFAR should also develop measures of the degree to which HIV/AIDS interventions are used to drive both desired improvements in the health system and incremental incorporation of other health priorities into national agendas. PEPFAR should contribute to the development of the knowledge base for how best to implement, scale up, and sustain prevention, care, and treatment services.