PEPFAR Implementation Progress and Promise (2007) / Chapter Skim
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4 PEPFAR's Prevention Category
4 PEPFAR's Prevention Category
Pages 113-140
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From page 113... ...
Despite the efforts of the Office of the U.S. Global AIDS Coordinator to administer the allocation judiciously, it has greatly limited the ability of Country Teams to develop and implement comprehensive prevention programs that are well integrated with each other and with counseling and testing, care, and treatment programs and that target those populations at greatest risk.
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From page 114... ...
The Coordinator should support country plans to identify where infections are to be averted to achieve prevention targets and should track progress toward achieving prevention goals by measuring risk behaviors, the prevalence and incidence of other sexually transmitted infections, and ultimately the prevalence and incidence of HIV.
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From page 115... ...
: promotion of behavior change aimed at risk avoidance and risk reduction, provision of comprehensive programs for people who engage in high-risk behavior, prevention of mother-to-child transmission of HIV, and reduction of medical transmission of HIV by ensuring safe blood supplies and safe medical injections and providing training in universal medical precautions (see Table 4-2)
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From page 116... ...
Likewise, prevention activities specifically targeting orphans TABLE 4-2 PEPFAR Activities Corresponding to Funding and Reporting Subcategories Prevention Activities Prevention Funding and Reporting Categories Promotion of behavior change aimed at Abstinence/be faithful; condoms and other risk avoidance and risk reduction prevention Provision of comprehensive programs for Condoms and other prevention people who engage in high-risk behavior Prevention of mother-to-child transmission Prevention of mother-to-child transmission of HIV of HIV Reduction of medical transmission of HIV Blood safety; injection safety by ensuring safe blood supplies and safe medical injections and providing training in universal medical precautions SOURCE: OGAC, 2004, 2005a, 2006a.
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From page 117... ...
The latter estimates are based on HIV prevalence in antenatal clinics and in general populations-based surveys, such as the Demographic and Health Surveys, as well as in generalized HIV epidemics. In concentrated epidemics, the size of high-risk groups and the prevalence of HIV in these groups is estimated.
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From page 118... ...
The study found that, with regard to indicators for activities related to prevention of sexual transmission, PEPFAR was the only initiative to collect program data based on the components of the ABC model.1 While many of the initiatives did collect information on condom distribution and outlets separately, none of the other initiative separated A, B, and C in the tracking of prevention activities (Morrison et al., 2005)
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From page 119... ...
PEPFAR'S PREVENTION CATEGORY TABLE 4-3 PEPFAR Prevention Results by Fiscal Year, 2004–2006 Fiscal Year Fiscal Year Fiscal Year Subcategory 2004 2005 2006 Abstinence/Be Faithful Number of people reached by PEPFAR-supported 11,530,400 Not Not abstinence-only community outreach programs available available for HIV/AIDS prevention Number of people reached by PEPFAR-supported 24,041,800 24,861,700 40,247,500 abstinence/be faithful community outreach programs for HIV/AIDS prevention Number of people receiving PEPFAR-supported 116,600 174,400 299,300 training or retraining to promote HIV/AIDS prevention through abstinence and/or being faithful Condoms and Other Prevention Number of people reached with community 11,899,900 17,941,100 21,203,300 outreach programs that promote HIV/AIDS prevention through condom promotion, related, and other services Number of people receiving PEPFAR-supported 51,200 93,200 129,300 training or retraining to provide condoms and related services Prevention of Mother-to-Child Transmission Number of women receiving prevention of mother- 1,271,300 1,957,900 2,814,700 to-child transmission services Number of women receiving a complete course 125,100 122,600 285,600 of antiretroviral prophylaxis for prevention of mother-to-child transmission Number of infant infections averted 23,800 23,400 54,400 Number of people receiving PEPFAR-supported 24,600 28,600 32,600 training or retraining in prevention of mother to-child transmission Number of service outlets supported by PEPFAR 2,200 2,500 4,863 providing the minimum package of prevention of mother-to-child transmission services according to national or international standards Blood Safety Number of service outlets related to blood safety 249 585 3,848 supported by PEPFAR Number of people receiving PEPFAR-supported 2,200 8,000 6,600 training or retraining in blood safety Injection Safety Number of people receiving PEPFAR-supported 4,300 12,300 52,100 training or retraining in injection safety SOURCE: OGAC, 2005b, 2006b, 2007a, 2007b.
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From page 120... ...
These interventions include providing counseling and testing; encouraging risk reduction in people who are both HIV-positive and HIV-negative; and reducing HIV risk cofactors, such as the presence of another sexually transmitted infection (JHU AIDS Service, 2006)
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From page 121... ...
BOX 4-1 Selected Examples of PEPFAR-Supported Abstinence/Be Faithful Activities In Ethiopia, PEPFAR is funding programs that address negative social norms that lead to increased risk of HIV infection for young girls. Behavior change activities are directed at older men who seek sexual relationships with younger girls and the communities that explicitly or implicitly condone such relationships.
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From page 122... ...
According to discussions with OGAC and Country Teams, USAID programs in countries other than the PEPFAR focus countries typically pool worldwide condom orders and procure the condoms centrally for both family planning and HIV prevention programs. Because the focus countries are reportedly not eligible to receive condoms from the commodities fund because of the interpretation of legislative intent, a number of PEPFAR-supported programs use their PEPFAR funds to purchase condoms.
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From page 123... ...
The U.S. Global AIDS Initiative, through the National Institutes of Health, supports scaling up for clinical trials of three microbicide candidates as well as the HIV Prevention Trials Network, a worldwide collaborative that develops and tests the safety and efficacy of nonvaccine interventions designed to prevent HIV transmission (OGAC, 2005b)
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From page 124... ...
. However, the PEPFAR strategy acknowledges the need for comprehensive HIV prevention and care programs for people who use injection drugs, especially in countries such as Vietnam where HIV infection
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From page 125... ...
. PEPFAR-supported activities targeted to people who use injection drugs include working with ministries of health on relevant national policies and supporting assessments of the contribution of substance use to the HIV epidemic globally; development of culturally appropriate 12-step programs to decrease drug use; education of health professionals and policy makers regarding best practices for HIV prevention strategies for people who abuse substances; peer-to-peer counseling on HIV; confidential, routine HIV counseling and testing in substance abuse programs; community-based outreach that addresses HIV prevention, risk reduction, and substance use with links to appropriate care services; prevention education on the risks of injecting drugs and sharing syringes; education and counseling on how to reduce or stop injecting drugs; HIV treatment or referral to treatment for an HIV-infected person who uses drugs; and substance abuse treatment programs for HIV-infected people, including medication-assisted treatment with methadone, buprenorphine, and naltrexone.
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From page 126... ...
Such services are crucial in settings where relatively few women give birth in health care facilities and would otherwise miss the opportunity to receive prophylactic antiretroviral medications at birth and reduce the risk of transmission to their infants. PEPFAR programs are working with national leaders and local health care workers to find ways of providing the medications and of offering follow-up and postpartum care in nontraditional settings, including giving the medications to pregnant women to take home and training traditional birth attendants in prevention of mother-to-child transmission.
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From page 127... ...
stage III and IV disease will be referred to comprehensive care centers for ART as a strategy for preventing mother-to-child transmission; these services will be provided in provincial, district, and high-volume health centers. In Rwanda, PEPFAR is supporting the national program through interpersonal and mass media communications that promote early antenatal clinic attendance, delivery in health care facilities, safe infant feeding practices, early infant diagnosis, and male involvement.
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From page 128... ...
. PEPFAR's blood safety activities have included supporting the development of associated governance structures, increasing laboratory capacity to screen blood supplies for HIV and other diseases, training health care workers in safe blood transfusion methods, increasing the number of voluntary donors through awareness campaigns, and conducting quality evaluations to ensure the effective implementation of blood safety procedures.
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From page 129... ...
Related activities provide a wide range of support to host countries, including the development of improved policies for safe injection practices and medical waste management, enhanced training of health workers, procurement of safe injection supplies, and support for the development and dissemination of communications addressing safe medical practices for both medical professionals and the public. OGAC reports that PEPFAR has supported the training of more than 68,000 people in injection BOX 4-4 Selected Examples of PEPFAR-Supported Blood Safety Activities In South Africa, PEPFAR supports the National Blood Service Program, which is coordinating with the National Department of Health and the Department of Education to provide prevention education to potential young donors to assist them in protecting themselves from infection and enable them to be "certified" as safe donors.
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From page 130... ...
Increased Focus on Gender Issues in Prevention OGAC has provided Country Teams with guidance on ways to address gender issues in prevention programming appropriate to the context of each country. The Gender Technical Working Group identified review criteria for PEPFAR-supported prevention activities for the fiscal year 2007 Country Operational Plans.
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From page 131... ...
The fiscal year 2006 Country Operational Plans contain many examples of PEPFAR prevention programs that include gender components. Without specific gender indicators or good data on which gender-focused interventions work best, however, OGAC will be unable to report what impact these programs are having on women's risk of contracting HIV (OGAC GTWG, 2006; OGAC, 2006e)
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From page 132... ...
For PEPFAR, such data are necessary to identify and target programs to those most at risk of contracting HIV. PEPFAR highlights the need to incorporate these data in the planning of prevention programs in each focus country in its guidance to the Country Teams.
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From page 133... ...
. In accordance with its own guidance, PEPFAR will need to use all available information on key risk behaviors and vulnerable populations in planning and implementing tailored prevention programs that address the needs of each focus country.
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From page 134... ...
Health care settings, including HIV treatment sites, should deliver HIV prevention services that will train health care workers in the delivery of HIV prevention interventions. There should be significant expansion and aggressive promotion of voluntary HIV testing and counseling, which should be universally offered in all health care settings.
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From page 135... ...
, which assumes increased prevention activity, projects a decline in HIV/AIDS deaths as of 2030 from an estimated baseline of 6.5 million to 3.7 million. Likewise, a conference of Christian Aid HIV partners underscored the need to shift the focus of HIV interventions from a prevention-specific ABC approach to a comprehensive approach developed by the African Network of Religious Leaders Living with or Personally Affected by HIV/AIDS called SAVE (Safer practices, Available medications, Voluntary counseling and testing, and Empowerment)
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From page 136... ...
Greater Flexibility to Select Country-Appropriate Prevention Activities In addition to epidemiologic data and evidence on specific interventions typically used in the development of prevention programs, PEPFAR's prevention planning is controlled in part by budgetary allocations outlined in its authorizing legislation. The variability of the epidemics in the focus countries underscores the need for specific and timely information in designing prevention programs that address the most important needs and can result in the most infections averted.
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From page 137... ...
, account for approximately 52 percent of PEPFAR's prevention funding, well below the estimated contribution of sexual transmission to new infections. In contrast, the blood safety and safe injection subcategories make up 25 percent of PEPFAR prevention funding but are responsible for a much smaller proportion of new infections.
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From page 138... ...
The effect of HIV prevention interventions on behavior change. Studies in Family Planning 35(1)
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From page 139... ...
2005e. ABC guidance # for United States goernment in-country staff and imple menting partners applying the ABC approach to preenting sexually-transmitted HIV infections within the President's Emergency Plan for AIDS Relief.
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From page 140... ...
2002b. Blood safety: Aide-memoire for national blood programmes.
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