and affected by HIV/AIDS. This chapter includes the primary presentation of the committee’s assessment of PEPFAR’s activities that fall under the specific category of programming for orphans and vulnerable children (OVC), following the program impact pathway framework of assessing inputs, activities, and, to the extent possible, outcomes and impact. PEPFAR also supports services for children and adolescents through prevention, treatment, and care programs, and although findings about these programmatic areas are covered in more detail in other chapters, the major conclusions that are specific to children and adolescents are summarized at the end of this chapter in order to bring together a comprehensive picture of PEPFAR’s efforts to improve the health and well-being of children and adolescents.

To meet its charge, the IOM committee assessed PEPFAR’s investment in programming for children and adolescents, including its progress in meeting fiscal targets; reviewed PEPFAR’s guidance and the activities it has supported for these populations; and examined PEPFAR’s progress toward programmatic targets and goals for children and adolescents, specifically its efforts to increase the number of HIV-positive children receiving treatment (discussed in Chapter 6) and to increase the number of orphans and vulnerable children receiving care and support services. To the extent possible, the committee also reviewed the available evidence to assess the effects of services provided to children and adolescents, efforts to support family-centered programs and community-led initiatives, and efforts to support countries to strengthen country policies and systems for supporting this population. The presentation of the committee’s assessment in these areas is followed by a discussion of the future directions most recently articulated by PEPFAR in new guidance. This chapter also includes some discussion of child survival in PEPFAR partner countries, including the limitations on directly evaluating the effect of PEPFAR on child mortality.


The HIV pandemic has severely affected the lives of millions of children and adolescents across the globe, endangering their health, well-being, and development. The population of children and adolescents affected by HIV varies by geographic, demographic, social, and cultural factors, and their needs and the responses to these needs vary according to these factors as well as to their developmental stage and gender. Globally, approximately 3.3 million children younger than 15 years of age were living with HIV in 2011, and 330,000 children acquired new HIV infections that year


vulnerable children (OVC) programs and 0 to 14 years for pediatric HIV care and treatment. Throughout this report, the specific age ranges used by PEPFAR or by the cited data source are indicated whenever feasible.

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