input and outputs. As a result, the program monitoring system has limited utility for determining the effectiveness of PEPFAR’s efforts.

•    The need to quickly measure results at the onset of PEPFAR contributed to the development of PEPFAR-specific data collection systems, which has limited harmonization with partner countries and the global HIV/AIDS community. More recently, the Office of the U.S. Global AIDS Coordinator (OGAC) has worked with other global actors to harmonize indicators and validate reporting. OGAC has modified the PEPFAR monitoring system to reduce reporting burden and improve alignment with partner country programs; however, further modifications could be made by eliminating PEPFAR-specific language in the indicator guidance; further reducing the reporting burden; improving indicator harmonization with global indicators; and advancing alignment with partner country data collection at the program level.

•    There are some good examples of PEPFAR data use at the implementing partner, mission team, and headquarters (HQ) levels, but the preponderance of data collected does not seem to be routinely utilized. PEPFAR’s requirement for collection and reporting of a large amount of program monitoring data places a large burden on implementing partners and mission teams that has limited the ability to analyze and use data.

•    PEPFAR has invested in building the capacity of partner countries to plan for, collect, manage, and use HIV data, which has implications for the larger health system. As a result, PEPFAR has contributed to fostering a culture of evidence among partner countries.

PEPFAR-Supported Evaluation and Research

•    The manner in which PEPFAR initially approached research activities was a missed opportunity to establish, from its inception, mechanisms to evaluate programs, assess impact, contribute to the global knowledge base, and develop in-country research capacity.

•    PEPFAR has made progress in carrying out evaluation and research activities over time: moving from an early proscription against research, to using Targeted Evaluations and Public Health Evaluations to work within research restrictions, to the recent creation of what holds promise as a more useful process for establishing priorities, managing activities, documenting “what works,” expanding PEPFAR’s technical leadership, disseminating findings, and continually improving the effectiveness and impact of PEPFAR. Defining appropriate and allowable research activities within PEPFAR, however, was and remains a challenge, specifically clarity around the activities and aims for evaluation and research within PEPFAR.

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