PEPFAR has made remarkable progress in meeting its aims, reflecting the U.S. government’s commitment and capability to respond to humanitarian crises through the use of health and development assistance and health diplomacy. PEPFAR’s efforts have saved and improved the lives of millions of people by supporting HIV prevention, care, and treatment services; meeting the needs of children affected by the epidemic; building capacity; strengthening systems; engaging with partner country governments and other stakeholders; increasing knowledge about the epidemic in partner countries; and ensuring that attention be paid to vulnerable populations in the response to HIV.

While PEPFAR has achieved great things, its work is unfinished. The committee offers several recommendations to improve the U.S. government’s support for the global response to HIV. They appear below in bold text, each followed by an indication of the chapter in the report in which it appears, and where additional considerations for its implementation are also described.3,4 The recommendations are presented in this summary in four main areas: scaling up HIV programs, strengthening systems for the HIV response in partner countries, transitioning to a sustainable response in partner countries, and transforming knowledge management to improve effectiveness.

Scaling Up HIV Programs

PEPFAR has provided a “proof of principle” that HIV services can be successfully delivered on a large scale in countries with a high burden of disease and limited available resources and infrastructure.

PEPFAR has increased the availability of and access to HIV testing, counseling, and diagnosis; as a result, many individuals have learned their HIV status. PEPFAR has also made it possible for an increasing number of adults and children living with HIV to receive clinical care and treatment, including antiretroviral therapy, through an expansion of the number and geographic distribution of clinical care and treatment sites, training and support for providers, procurement and delivery of drugs, improvements


3 The recommendations with their implementation considerations are compiled in Appendix B.

4 The report is structured in four parts. Part I presents background information and details the evaluation’s scope and approach. Part II discusses PEPFAR’s organization and investment. Part III assesses programmatic activities serving both general and key populations as well as health systems strengthening. For pragmatic reasons the different program areas are discussed in separate chapters (Prevention, Care and Treatment, Children and Adolescents, Gender, and Health Systems Strengthening). However, each chapter also recognizes the inherent relatedness of these program areas in a continuum of services. Part IV examines the future role of the U.S. government in the global response, with themes of sustainability and knowledge management.

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