Ensure that in countries with a major PEPFAR investment (greater than $5 million), the partner government leads efforts to evaluate and define needs and roles in the national response
Ensure that every partner country with a Partnership Framework will change policies to address larger structural conditions, such as gender-based violence, stigma, or low male partner involvement that contribute to the epidemic

a United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003, P.L. 108-25, 108th Cong., 1st sess. (May 27, 2003).

b Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008, P.L. 110-293, 110th Cong., 2nd sess. (July 30, 2008).

c New prevention technologies or modalities (e.g., male circumcision) are not included when calculating this funding breakdown.

SOURCES: Obama, 2011; OGAC, 2004, 2009a.

have taken place. The number of partner countries in which the intensity of PEPFAR implementation warrants management through the annual Country Operational Plan (COP) process has expanded from the original 15 focus countries. In 2009, when the scope of this evaluation was established, an additional 16 countries were preparing COPs for a total of 31 countries; by FY 2011, this had increased to 33. There are also 3 regions for which one COP is submitted for operations in multiple countries (GAO, 2011).

Several new initiatives have been instituted that are targeted at aims articulated in the reauthorization legislation and the second Five-Year Strategy. As part of the effort to meet the goals of training a new health care workforce, PEPFAR established the Medical Education Partnership Initiative and the Nursing Education Partnership Initiative (described further in Chapter 9) (Palen et al., 2012). In addition, a New Partners Initiative was launched to encourage a greater emphasis on capacity building for partner organizations in partner countries (described further in Chapter 10) (USAID OIG, 2007).

In addition, new scientific evidence has emerged that has affected or will affect decisions about the programs supported and implemented through PEPFAR, for example, in areas such as voluntary male circumcision and the use of antiretrovirals as prevention in serodiscordant couples.

There have also been newly articulated commitments and goals. Building on the evolving implementation of PEPFAR and the evolving evidence base, Secretary Clinton articulated PEPFAR’s commitment to the goal of

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