critical for a more comprehensive strategy to achieve successful execution of prevention programs:

•   PEPFAR should continue to enhance its efforts to involve partner country stakeholders and incorporate country-specific epidemiology, context, and priorities in planning appropriately matched prevention programs that achieve a balanced approach to HIV prevention across the available modalities. To provide greater technical and operational clarity, the Office of the U.S. Global AIDS Coordinator (OGAC)2 should provide mechanisms to support the development, implementation, and monitoring of comprehensive prevention portfolios, including how to determine what populations need which directed prevention activities in which settings. Areas of prevention where current interventions are successful and effective, such as prevention of mother-to-child transmission (PMTCT), should be continued and scaled up to ensure access, coverage, and quality. As new PEPFAR-supported prevention activities are adopted, OGAC should communicate its objectives and the methods for introducing or scaling up with specified populations.

•    OGAC should improve mechanisms to collect and incorporate evidence on the effectiveness of prevention activities implemented in partner countries. The key components for future assessment and evaluation of HIV prevention should include need, coverage of need, quality of services provided, and behavioral and epidemiological outcomes. OGAC should provide clearly defined process and outcome measures as well as impact assessment methods to evaluate progress.

•    PEPFAR’s prevention strategy should include balanced support for innovation, research, and evaluation to contribute to the evolving evidence base and advance understanding of the effectiveness of interventions within all prevention modalities. To define and ensure this balance, OGAC should, through its existing mechanisms, convene and use expertise spanning behavioral, structural, and biomedical prevention intervention approaches. PEPFAR-supported research and evaluation activities should employ appropriate methodologies and study designs, without unduly emphasizing random assignment designs. PEPFAR should support innovations in preven-

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2 It is the committee’s intent that actions recommended to be taken by 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 (USG) implementing agencies.



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