The Role of Research from PEPFAR I to PEPFAR II
The first phase of PEPFAR (PEPFAR I) was initiated as an emergency response to HIV/AIDS that was focused on the rapid implementation and scale-up of prevention, treatment, and care programs (OGAC, 2009f); as such, basic infrastructure for monitoring and evaluation existed (USAID, 2011b), but “state-of the art monitoring, evaluation and research methodologies were not fully integrated or systematically performed” (Padian et al., 2011, p. 1). In PEPFAR I, research was seen as having two roles: to produce new knowledge about HIV/AIDS interventions and implementation, and to assess PEPFAR programs and inform policies through targeted research (OGAC, 2004). As the primary focus of PEPFAR I was the rapid scale-up and implementation of programs, leadership felt that PEPFAR efforts would be better spent on implementation, while other USG organizations better suited to conduct research focused on creating new knowledge (OGAC, 2005b).
At the time, the USG supported a wide variety of HIV/AIDS research through NIH, CDC, and USAID from which PEPFAR could draw new knowledge ranging from basic clinical and social science research to applied and operations research; studies focused on multiple topics, including therapeutic and preventative regimens, microbicides, vaccines, ART, prevention of mother-to-child transmission (PMTCT), ABC, male circumcision, injection safety, nutrition, and psychosocial issues for OVC (IOM, 2007a). The intention was for OGAC to work closely with the leadership at NIH, HHS, and USAID to ensure that their research priorities aligned with PEPFAR’s goals and needs in order to leverage these external research efforts to inform PEPFAR policy and program decisions (OGAC, 2004, 2005b).
Beyond this collaboration, PEPFAR did, in some special cases, fund targeted evaluations and research to address PEPFAR-specific questions (OGAC, 2005b). For many PEPFAR stakeholders, however, it was unclear what research, if any, was allowed with PEPFAR I funding. Descriptions of research in the PEPFAR I legislation and strategy seemed to proscribe against using PEPFAR funds for research, and many country mission teams and implementing partners perceived a ban on using PEPFAR funds for research (IOM, 2007a). This perceived research proscription was frequently mentioned during interviews with HQ and implementing partners involved in PEFPAR from the inception. In the words of one interviewee, “[Y]ou couldn’t use the word research or operational research” (NCV-4-USACA). Another interviewee described how people were “baffled as to why there was no research components in the first years of this program, and why it was absolutely disallowed because we did all this work and we’re not able to really learn from it or do anything” (NCV-8-USACA). Finally, one interviewee described how research and evaluation became conflated by OGAC to get