of each country and the HIV prevalence grouping as a reflection of the disease burden.

The funding per PLHIV varied significantly, from $11.84 in Thailand to $3,842.71 in Guyana (see Table 4-4). Guyana received by far the most funding per PLHIV. Seven other countries received greater than $250 per PLHIV, including two countries from the East Asia and Pacific region with concentrated epidemics (Vietnam and Cambodia). Seven countries received between $100 and $250 per PLHIV, 11 countries received between $20 and $100 per PLHIV, and 5 countries received less than $20 per PLHIV. Based on the committee’s assessment and the perspectives expressed by stakeholders interviewed for this evaluation, there are a number of factors worth discussing that may contribute to the distribution of funding per PLHIV, although it is not possible to draw causal conclusions about the relationship between the funding and these factors.

Although there are exceptions, many of the largest countries (by population) have received less funding per PLHIV, while many smaller African countries with high disease burden have received higher investments per PLHIV. Some small countries may require higher investments per PLHIV for a similar level of programming and services because, although initial startup costs to initiate a robust response to HIV may be either greater in larger countries or similar regardless of population size, larger countries subsequently have more opportunities to achieve economies of scale and to reduce per-person costs of the provision of services. Not all small countries are in the higher grouping, however, which may be because in some countries the available infrastructure had more initial readiness to support service delivery at lower per-person costs. In addition, regardless of size, the country’s own resources, capacity, and infrastructure may affect the necessary balance between PEPFAR’s support for higher-cost direct service delivery programs versus lower-cost technical assistance programs.

Countries with different prevalence groupings are distributed across different levels of funding per PLHIV. Some countries in lower prevalence groupings receive among the highest levels of funding. Lower-prevalence countries may receive high levels of funding per PLHIV for various reasons, including political or foreign policy considerations; availability of other external donor and country resources for the HIV/AIDS response, which in some cases may be influenced by how active a role the country government takes in the response; lack of economies of scale for service delivery; and initial or existing capacity levels and infrastructure development that affect the costs of service delivery.

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