in laboratory services, and support for the adoption and implementation of national policies and guidelines in partner countries.

Despite such remarkable and substantial progress, ongoing challenges across the continuum of clinical care and treatment services must be addressed to achieve positive health outcomes for people living with HIV and to ensure that care and treatment programs are contributing to a sustainable HIV response. One critical need is to improve linkages from HIV counseling and testing to care and treatment and also to prevention services aimed at reducing HIV transmission. Another essential need is to improve retention and adherence among patients in care and treatment.

In addition to clinical care and treatment services, PEPFAR has also supported nonclinical care and support services for adults and has provided unprecedented support for programs for orphans and vulnerable children infected with or affected by HIV. However, these services span a diffuse array of activities and often lack the strategic development in program portfolios necessary to maximize contributions to defined outcomes.

To contribute to sustainable care and treatment programs in partner countries, PEPFAR should build on its experience and support efforts to develop, implement, and scale up more effective and efficient facility- and community-based service delivery models for the continuum of adult and pediatric testing, care, and treatment. These efforts should aim to enhance equitable access, improve retention, increase clinical and laboratory monitoring, ensure quality, and implement cost efficiencies. (Chapter 6)

To assess PEPFAR-supported HIV care and treatment programs and to evaluate new service delivery models, the Office of the U.S. Global AIDS Coordinator5 should support an enhanced, nested program monitoring effort in which additional longitudinal data on core outcomes for HIV-positive adults and children enrolled in care and treatment are collected and centrally reported from a coordinated representative sample across multiple countries and implementing partners. (Chapter 6)

This effort would serve as a nested evaluation within routine program monitoring systems to allow for long-term operational assessment of performance and outcomes for care and treatment across a representative


5 It is the committee’s intent that actions recommended to be taken by the Office of the U.S. Global AIDS Coordinator (OGAC) should be carried out through PEPFAR’s interagency coordination mechanism, which involves not only the OGAC staff but also the leadership and technical staff of the U.S. government implementing agencies.

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