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From page 363... ... Index A future challenges, 164, 246, 252–253 generic drugs, 9, 10, 159, 160 ABC approach, 100, 120, 123, 135–137, guidelines, 146–147, 148, 154 228–229 harmonization of procurement, 158–160 Abstinence, sexual, 64, 67, 100, 113, 120– host country program design, 147–148 121, 123. See also ABC approach human resources for delivery of, 14, Accountability 255–256, 257–258 directions of, 46 initiation, 149 PEPFAR funding and, 2, 11, 12, 82, 101 integration with prevention and care role of program monitoring and activities, 155, 200 evaluation, 46 laboratory services, 161 treatment delivery and, 144 nutritional support, 157–158 Adherence to treatment, 141, 149–150 obstacles to delivery, 141 African Network of Religious Leaders patient evaluation for, 148 Living with or Personally Affected by patient preparation for, 148–149, 154 HIV/AIDS, 135 pediatric care, 155–156 Age patterns of HIV infection, 23, 52 PEPFAR accomplishments, 5, 141, 164, Antiretroviral therapy 245 access for marginalized groups, 156–157 PEPFAR five-year performance targets, adherence, 141, 149–150 4, 58, 144 attribution for successful PEPFAR funding, 98–99, 252 implementation, 144–145 PEPFAR policies and programs, 141, 143 behavioral surveillance, 135 pregnancy during, 196–197 clinical care services and, 172 to prevent mother-to-child HIV costs, 98–99 transmission, 113, 127, 245, 268 current delivery, 18, 145–146, 153, 268 quality standard, 9–10, 142, 158–159, effectiveness, 155 160 eligibility, 148, 154 recommendations for improving follow-up, 149 availability, 13, 142, 153 Read the entire page →
From page 364... ... INDEX research needs, 155, 265 PEPFAR five-year performance targets, resistance monitoring, 150–151, 154 25–26, 58, 169, 173 stigma reduction, 150 PEPFAR transition to sustainability, 190 supply chain management, 162–164 planning, 180–181 training for health care workers, preventive interventions in, 116, 169, 145–146, 258 182–184 utilization, 141, 145 program performance evaluation, 265 Attributions for success, 144–145 psychosocial, 177, 192–193 quality assessment, 202 recommendations for, 13, 170, 200 B stigmatization effects, 56–57 volunteer workers, 193–194 Bacterial vaginosis, 53 See also Counseling and testing Behavioral surveillance, 7, 113, 114, 132, Centers for Disease Control and Prevention, 133, 134, 135 84–85, 104, 263 Bill and Melinda Gates Foundation, 41 Child caregivers, 55 Blood safety, 115, 128–129, 137 Children Breastfeeding, 125–126 AIDS mortality, 145 antiretroviral therapy utilization, 141, 145 immunization, 230 C infection patterns and trends, 125 pain management, 195 Capacity building initiatives, 252–259 sources of infection, 125 Care services testing for infants, 187–188, 230 budget allocations, 67, 99, 106–107 treatment, 152–153, 155–156 challenges, 200–201 See also Mother-to-child transmission of classification, 172–173 HIV; Orphans and other vulnerable community-based, family-centered, children 178–180, 201 Communication mechanisms and practices, comprehensive, 172, 174–175, 178, 179, 86–87, 97–98 191 Community-based approach contracting for, 178 capacity building, 253–254 definition and scope, 169, 171–172 care services, 201 delivery mechanisms, 169 characteristics, 178 effectiveness, 173 current service delivery, 46–47 harmonization of, 201 goals, 47 health care worker training, 169, 176, network model, 177, 178–179 188–190 prevention of mother-to-child home-based, 70, 177, 182, 191–192, transmission, 126 193–194 recommendations for, 13, 170, 200 integration with prevention and services for orphans and other treatment efforts, 13, 99–100, vulnerable children, 215, 219–222 134–136, 142, 155, 170, 200, 202 Community health worker model of care, major HIV/AIDS program elements, 48 189 needs of women and girls, 196–197 Comorbid infections nondiscrimination in, 14, 82, 91–92 in children, 156 opportunities for improvement, 190 implications for treatment, 157 pain management, 194–195 opportunistic infections, 184 palliative care, 171–172, 194–195, prevalence, 157 200–201 preventive interventions, 182–184 PEPFAR delivery, 169, 173–176, See also Malaria; Tuberculosis 181–188, 201–202, 245–246 Read the entire page →
From page 365... ... HIV/AIDS efforts, 3, 66, 71, Data collection 84–85 antiretroviral therapy delivery and See also Harmonization of efforts outcomes, 144, 150, 155 Corruption, 49 behavioral surveillance, 7, 113, 114, Counseling and testing 132, 133, 134, 135 barriers to, 197–198 birth registration, 222 classification in continuum of care, burden of, for health care facilities, 144 115–116, 169, 172, 173–176 care-related training, 188 components, 186 condom promotion, 122 ethical concerns, 197 Country Operational Plan and Reporting gender differences, 197 System, 93 integration of services, 134 Demographic and Health Surveys, 133 PEPFAR performance, 173–176, 245 obstacles to, 133 to prevent sexual transmission of HIV, PEPFAR activities and support, 133, 266 120, 135 PEPFAR network model of service preventing mother-to-child transmission delivery, 68–70 of HIV, 125–126, 127 for PEPFAR performance evaluation, 17, purpose, 185–187 29–31, 81, 95, 267 scaling up, 169, 188, 198 PEPFAR transition to sustainability, 1 settings for, 186 for prevention program design, 7, 131, strategies for improving, 198 132–134 testing for infants, 187–188, 230 quality improvement activities, 95–96 wait for test results, 198 recommendations for, 7, 134 Country Operational Plan and Reporting sentinel surveillance, 133 System, 93 services for orphans and other Country Operational Plans, 87–89, 93–94, vulnerable children, 205, 235 102 See also Research Country Teams Diet and nutrition, 183–184 accountability, 12, 82, 101 antiretroviral therapy and, 157–158 budget allocations and restrictions, 11, preventive interventions, 183–184, 231 12, 14, 15, 16, 73, 95, 99 Read the entire page →
From page 366... ... INDEX services for orphans and other outcomes data, 17, 81 vulnerable children, 223, 224 prevention effectiveness, 113, 264 Discrimination, 56–57 prevention of mother-to-child as obstacle to harmonization, 91–92 transmission, 127–128 participation of stigmatized groups in program management, 81, 102–103, 263 PEPFAR, 14, 82, 92 recommendations for, 17, 244, 266 research needs, 264–266 services for orphans and other E vulnerable children, 205, 208, 209, 235, 265–266 Educational system Evidence-based practice HIV/AIDS impact in, 49–50 future of PEPFAR, 12 teacher mortality, 49, 236 HIV transmission prevention, 7 vulnerabilities of orphaned children, Extranet, PEPFAR, 86–87, 266–267 54–55, 222–223, 235 Elderly caregivers, 55 End-of-life care, 13, 179–180, 200 F Epidemiology, 17–18, 23, 37–38, 49–50 age patterns, 23, 52 Faith-based organizations, 63–64, 67, 148, behavioral surveillance, 113, 114, 132, 163, 177, 178, 190, 208, 214, 219, 133, 134 228, 260–261 child infections, 125 Family-centered care, 46–47, 179 focus countries, 62 in care programs, 201 gender differences, 52–53 financial burden, 217–218 recommendations for surveillance, 7, gender differences in caretaking burden, 114, 134 53–54 Equitable access, 14, 82, 91–92 recommendations for, 13, 170, 200 Evaluation of national AIDS/HIV programs services for orphans and other current system for, 90–91 vulnerable children, 215, 217–219 obstacles to, 91 Family planning, 196–197 services for orphans and other Focus countries, 25, 64–66 vulnerable children, 225–226 characteristics, 58–62 Three Ones principles of harmonization, funding, 25, 58, 72–73, 104–106, 45–46, 90 107–109 Evaluation of PEPFAR implementation and orphans and other vulnerable children performance in, 211–212 care services, 173, 202, 265 See also Host-country programs and challenges, 31–32 policies conceptual approach, 26–28 Food and Drug Administration, U.S., 9, 10, data sources for, 29–31, 90–91 88, 158, 159–160 dissemination of findings, 266–267 Framework for the Protection, Care, and family capacity strengthening, 218–219 Support of Orphans and Vulnerable goals, 4, 17, 26, 32, 244 Children Liing in a World with HIV harmonization as basis for, 4–5, 27–28, and AIDS, 212, 214, 215–217 267 Funding human resources allocation, 15 ABC programs, 228–229 indicators, 101–102, 267 for capacity building, 252 integration of services, 260 care services, 67, 99, 106–107, 173 Leadership Act requirements, 7, 26–27, causes of HIV and distribution of, 137 66–67 centrally funded programs, 105–106 outcomes attribution, 101 coordination within U.S. government, 84–85, 86 Read the entire page →
From page 367... ... Global AIDS Initiative, 25, 104 See also President's Emergency Plan for Future challenges and opportunities, AIDS Relief (PEPFAR) 267–268 Global Fund to Fight AIDS, Tuberculosis antiretroviral therapy, 164, 246 and Malaria, 4, 25, 41, 62 capacity building, 252–259 Global Implementation Support Team, 43 care services, 200–201 Global Partners Forum for Children human resource supply, 14–15, 51, 255 Affected by HIV/AIDS, 212 integration of services, 12, 134, 259–261 Global Task Team, 43 research needs, 17, 57, 244, 264–266 services for orphans and other H vulnerable children, 237 See also Sustainability, PEPFAR Harmonization of efforts transition to antiretroviral drug purchase, 158–160 care services, 201 definition, 1. Read the entire page →
From page 368... ... INDEX services for orphans and other health care system capacity, 50–51, 253 vulnerable children, 221–222 human resource development, 15 U.S. role, 9 national AIDS authority, 45, 89–90 See also Coordination operational plans, 87–89, 93–94 Health care system capacity, 50–51 outcomes research, 17 eligibility for PEPFAR, 198–199 ownership of program planning and facilities, 253 execution, 45 future challenges, 252–253 services for orphans and other integration rationale, 199 vulnerable children, 224–226 national coordination, 254 strategic planning guidelines for, 46 network model, 177 See also Coordination; Evaluation of PEPFAR public health benefits, 254–255 national AIDS/HIV programs; Focus recommendations for expanding, 15, countries 244, 259 Human resources wrap-around services, 199 future challenges, 160, 255 Health care workers major HIV/AIDS program elements, 48 care services, 169, 188–190 recommendations for expanding doctor-to-population ratio, 58 capacity, 15, 259 injection practices, 63 retention of personnel, 256–257 in PEPFAR focus countries, 58 strategies for improving, 255–256 prevention of medical transmission of task shifting, 14–15, 189, 257–258 HIV, 128–130 See also Health care workers; Training quality improvement activities, 95–96 in HIV/AIDS care recommendations for recruitment and training, 15, 244, 259 I risk of HIV transmission, 257 supply concerns, 14–15, 51, 255 Infection patterns and trends, 17–18, 23, training, 5 37–40, 268 volunteers, 193–194, 259 children orphaned as a result of, See also Human resources; Training in 210–212 HIV/AIDS care gender patterns, 52 Highly-active antiretroviral therapy, 184 socioeconomic outcomes, 49–50 Home-based care, 70, 177, 182, 191–192, See also Transmission of HIV infection 193–194 Informed consent, 197 Host-country programs and policies Infrastructure support for AIDS/HIV access, 92 programs, 51, 62 antiretroviral drug purchases, 158–160 Inheritance law, 196 antiretroviral therapy, 146, 147–148 Injection drug use attributions for successful service medical transmission of HIV, 129–130, delivery, 144–145 137 capacity building, 252 prevention of HIV transmission in, 88, current Global AIDS Initiative 124–125, 137 implementation, 4 Integration of services customization of support for, 2, 12, 62, challenges, 134, 259–261 82, 87–88, 136, 147 goals, 2, 12, 25, 259–260 data collection for PEPFAR evaluation, opportunities for, 134–135, 260 29–30, 267 outcomes evaluation, 102 expansion of services under PEPFAR, 5 PEPFAR performance evaluation, 260 global coordination of donor actions rationale, 12, 134, 135, 198–200, 202, and, 85, 88–89 259 harmonization, 1, 8–10, 45, 87–88 Read the entire page →
From page 369... ... See Diet and nutrition Tuberculosis, and Malaria Act Learning organization, 16, 94–98, 109, 262 O M Office of U.S. Global AIDS Coordinator budget allocations, 99, 100 Malaria, 50, 183, 200 financial management, 103, 105–106 Marginalized populations as learning organization, 94, 262–263 access to care, 91–92, 156–157 policy guidance, 92–93 recommendations for PEPFAR programs quality improvement activities, 266 and policies, 14, 82, 92 research funding, 95, 263 See also Discrimination; Stigmatization responsibilities, 4, 84 of HIV-positive persons role in coordinating programs and Medications donors, 85, 86 expanded scope of practice for health service for orphans and other vulnerable workers, 189–190 children, 214–215, 217, 233 impediments to harmonization of structure and operations, 71, 83, 84 international efforts, 9, 88 Opportunistic infections, 184 obstacles to procurement, 51 Orphans and other vulnerable children pain management, 194–195 access to services, 222–224 quality standard, 1–2, 9–10, 88, 142, birth registration, 222 158–159, 160 challenges to care delivery, 217 See also Antiretroviral therapy community-based responses, 219–222 Microbicides, 123 core services model, 205, 222 Millennium Development Goals, 212 creating supportive environment for, 226 Model of care, 13, 189, 200. Read the entire page →
From page 370... ... See Evaluation of PEPFAR 13, 170, 200, 206, 234 implementation and performance scale-up efforts, 205 Extranet, 86–87, 266–267 scope of services for, 207 five-year performance targets, 4, 17, service needs, 13, 206, 234, 268 25–26, 58, 67, 113, 117, 144, 153, social welfare workforce issues, 235–237 169, 173 supplemental direct support, 208, 209 focus countries. See Focus countries support for national government fragmented service delivery, 199–200 services, 224–226 guiding principles, 25 training for service to, 210 host country relationships, 81, 88, 90 vulnerabilities of young girls, 231 Institute of Medicine evaluation, 3, 4, 26–31 as learning organization, 94–98, 109, P 262 network model of service delivery, Pain management, 172, 194–195 68–70, 176–178 Palliative care, 171–172, 194–195, 200–201 organizational structure and operations, Partnership for Supply Chain Management, 4, 71, 81 106, 162–164 origins, 3 PEPFAR. Read the entire page →
From page 371... ... INDEX See also Care services; Country Teams; services for orphans and other Future challenges and opportunities; vulnerable children, 227–231 Prevention; Treatment sexual transmission of HIV, 118, Prevalence, 23, 38 120–123 in focus countries, 62 strategic planning, 7, 113 integration with prevention and care strategies for improving, 131, 137 activities, 99–100 Private sector funding for HIV/AIDS recommendations for surveillance, 7, initiatives, 41 114, 132–134 Protease inhibitors, 150 Prevention Psychosocial services, 177, 192–193 abstinence programs, 64, 67, 100, 113, Public education 120–121, 123 HIV prevention, 123 among injection drug users, 124–125 HIV transmission in injection drug use, in care services, 116, 169, 182–184 125 comprehensive behavioral interventions, PEPFAR accomplishments to date, 5 123 See also Educational system condom use promotion, 122–123 counseling and testing services for, 186 Q data collection and management for, 7, 131, 132–134, 137 Quality improvement, 95–96, 266 education campaigns for, 123 evidence-based practice, 7 future of PEPFAR, 1, 7 R gender issues, 130–131 integration with care and treatment Religious beliefs, 63. See also Faith-based efforts, 13, 134–136, 142, 155, 170 organizations Leadership Act budget allocation, 67 Research major HIV/AIDS program elements, 48 antiretroviral therapy effectiveness, 155, medical transmission of HIV, 128–130 265 microbicide use, 123 Country Team activities, 95 mother-to-child transmission of HIV, 5, funding, 95 18, 113, 118, 125–128, 137, 197, goals, 2, 15–16 245 implications for program planning and nondiscrimination in, 14, 82, 92 implementation, 57 opportunistic infections, 184 needs, 17, 57, 244, 264–266 outcome measures, 113, 117–118, 264 pediatric therapy, 153 PEPFAR accomplishments, 5, 7, PEPFAR role, 16, 17, 261–262, 263 118–130 recommendations for, 17, 244, 266 PEPFAR activities, 115–117, 137 stigma, 56–57 PEPFAR budget allocations, 99, See also Data collection 106–107, 136–137 PEPFAR five-year performance targets, S 4, 25, 58, 113, 117 program performance evaluation, 113 SAVE program, 135 recommendations for improving, 7, 114, Sex workers, 14, 92, 124, 131, 156 134 Sexual transmission of HIV restrictions on funding, 88, 100–101, ABC prevention strategy, 100, 120, 123, 136 135–137, 228–229 role of counseling and testing, 135 gender differences, 53 scope of activities, 115–117 Read the entire page →
From page 372... ... INDEX patterns, 137 Training in HIV/AIDS care prevention program budget allocation, antiretroviral therapy, 145–146, 258 137 current efforts, 14 prevention program design, 131 for home-based care, 192 prevention program effectiveness, 118, PEPFAR accomplishments, 5, 176, 246, 120–123 258 recommendations for surveillance, 7, PEPFAR network model of service 114, 134 delivery, 68–70 See also Abstinence, sexual recommendations for, 15, 244, 259 Social security programs, 225 services for orphans and other Socioeconomic conditions vulnerable children, 210, 237 disease outcomes and, 50 spending, 14, 258 impact of HIV/AIDS, 49–50 for supportive care, 169, 188–190 PEPFAR focus countries, 58 twinning strategy, 258 poverty reduction, 214 Training in HIV/AIDS prevention vulnerabilities of orphaned children, blood safety procedures, 129 54–55 injection safety, 129–130 State Department, U.S., 72, 73, 104 mother-to-child transmission, 128 Stigmatization of HIV-positive persons, Transmission of HIV infection 56–57, 82 causes, 137 antiretroviral therapy and, 150 in focus countries, 62 See also Discrimination; Marginalized risk for health care workers, 257 populations See also Injection drug use; MotherSustainability, PEPFAR transition to to-child transmission of HIV; capacity building initiatives for, 252–259 Prevention; Sexual transmission of challenges, 243 HIV harmonization and coordination of Treatment efforts for, 8–10, 247–248 budget allocations, 67, 99, 106–107 integration of services for, 12 child patient, 152–153, 155–156 network model for, 177 clinical care services and, 172 PEPFAR commitment to, 248 human resources for, 160 prevention strategies in, 7 integration with prevention and care rationale, 18, 246–248, 268 activities, 13, 99–100, 134–136, 142, recommendations for, 6–7, 244, 248 155, 170 strategies for, 1–2, 190 major HIV/AIDS program elements, 48 women's issues in, 8, 249–252 nondiscrimination in, 14, 82, 91–92 workforce concerns, 14–15 PEPFAR definition, 141, 143 PEPFAR five-year performance targets, 4, 25, 58, 144, 153 T PEPFAR policies, 141, 145 recommendations for improving, 13, Three Ones principles of harmonization, 142 43, 87 voluntary counseling and testing in, 186 action framework, 45, 87–89 women's access, 52 coordinating authority, 45, 89–90 See also Antiretroviral therapy; Care monitoring and evaluation, 45–46, services 90–91 Tuberculosis, 141, 156, 157, 173, 176 origins, 44 prevention, 183, 185 purpose, 44 treatment, 185 Traditional healers, 195, 200 Read the entire page →
From page 373... ... 130–131 amendments, 63–64 recommendations for services, 8, 244, budget allocations, 67, 71–73 250 evaluation of PEPFAR and, 4, 7, 26–27, significance of, in PEPFAR transition to 66–67 sustainability, 8, 249–252 origins and purpose, 3, 6, 24, 62–63, 64, supportive care for, 196–197 246 vulnerabilities of young girls, 231 palliative care provisions, 173 See also Gender differences performance targets, 67 World Bank, 41 research goals, 261 World Health Organization restrictions on funding, 63, 64, 88 antiretroviral therapy guidelines, 144, services for orphans and other 146–147, 148, 154 vulnerable children, 67, 208, 210 health care workforce management, 257 significant HIV/AIDS provisions, 24, 64 medication quality standards, 1–2, 9–10, See also President's Emergency Plan for 142, 158–159, 160 AIDS Relief (PEPFAR) palliative care, 171, 172 Urban populations, 51 Wrap-around services, 199, 201 U.S. Read the entire page →

From page 363...

... Index A future challenges, 164, 246, 252–253 generic drugs, 9, 10, 159, 160 ABC approach, 100, 120, 123, 135–137, guidelines, 146–147, 148, 154 228–229 harmonization of procurement, 158–160 Abstinence, sexual, 64, 67, 100, 113, 120– host country program design, 147–148 121, 123. See also ABC approach human resources for delivery of, 14, Accountability 255–256, 257–258 directions of, 46 initiation, 149 PEPFAR funding and, 2, 11, 12, 82, 101 integration with prevention and care role of program monitoring and activities, 155, 200 evaluation, 46 laboratory services, 161 treatment delivery and, 144 nutritional support, 157–158 Adherence to treatment, 141, 149–150 obstacles to delivery, 141 African Network of Religious Leaders patient evaluation for, 148 Living with or Personally Affected by patient preparation for, 148–149, 154 HIV/AIDS, 135 pediatric care, 155–156 Age patterns of HIV infection, 23, 52 PEPFAR accomplishments, 5, 141, 164, Antiretroviral therapy 245 access for marginalized groups, 156–157 PEPFAR five-year performance targets, adherence, 141, 149–150 4, 58, 144 attribution for successful PEPFAR funding, 98–99, 252 implementation, 144–145 PEPFAR policies and programs, 141, 143 behavioral surveillance, 135 pregnancy during, 196–197 clinical care services and, 172 to prevent mother-to-child HIV costs, 98–99 transmission, 113, 127, 245, 268 current delivery, 18, 145–146, 153, 268 quality standard, 9–10, 142, 158–159, effectiveness, 155 160 eligibility, 148, 154 recommendations for improving follow-up, 149 availability, 13, 142, 153

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From page 364...

... INDEX research needs, 155, 265 PEPFAR five-year performance targets, resistance monitoring, 150–151, 154 25–26, 58, 169, 173 stigma reduction, 150 PEPFAR transition to sustainability, 190 supply chain management, 162–164 planning, 180–181 training for health care workers, preventive interventions in, 116, 169, 145–146, 258 182–184 utilization, 141, 145 program performance evaluation, 265 Attributions for success, 144–145 psychosocial, 177, 192–193 quality assessment, 202 recommendations for, 13, 170, 200 B stigmatization effects, 56–57 volunteer workers, 193–194 Bacterial vaginosis, 53 See also Counseling and testing Behavioral surveillance, 7, 113, 114, 132, Centers for Disease Control and Prevention, 133, 134, 135 84–85, 104, 263 Bill and Melinda Gates Foundation, 41 Child caregivers, 55 Blood safety, 115, 128–129, 137 Children Breastfeeding, 125–126 AIDS mortality, 145 antiretroviral therapy utilization, 141, 145 immunization, 230 C infection patterns and trends, 125 pain management, 195 Capacity building initiatives, 252–259 sources of infection, 125 Care services testing for infants, 187–188, 230 budget allocations, 67, 99, 106–107 treatment, 152–153, 155–156 challenges, 200–201 See also Mother-to-child transmission of classification, 172–173 HIV; Orphans and other vulnerable community-based, family-centered, children 178–180, 201 Communication mechanisms and practices, comprehensive, 172, 174–175, 178, 179, 86–87, 97–98 191 Community-based approach contracting for, 178 capacity building, 253–254 definition and scope, 169, 171–172 care services, 201 delivery mechanisms, 169 characteristics, 178 effectiveness, 173 current service delivery, 46–47 harmonization of, 201 goals, 47 health care worker training, 169, 176, network model, 177, 178–179 188–190 prevention of mother-to-child home-based, 70, 177, 182, 191–192, transmission, 126 193–194 recommendations for, 13, 170, 200 integration with prevention and services for orphans and other treatment efforts, 13, 99–100, vulnerable children, 215, 219–222 134–136, 142, 155, 170, 200, 202 Community health worker model of care, major HIV/AIDS program elements, 48 189 needs of women and girls, 196–197 Comorbid infections nondiscrimination in, 14, 82, 91–92 in children, 156 opportunities for improvement, 190 implications for treatment, 157 pain management, 194–195 opportunistic infections, 184 palliative care, 171–172, 194–195, prevalence, 157 200–201 preventive interventions, 182–184 PEPFAR delivery, 169, 173–176, See also Malaria; Tuberculosis 181–188, 201–202, 245–246

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From page 365...

... HIV/AIDS efforts, 3, 66, 71, Data collection 84–85 antiretroviral therapy delivery and See also Harmonization of efforts outcomes, 144, 150, 155 Corruption, 49 behavioral surveillance, 7, 113, 114, Counseling and testing 132, 133, 134, 135 barriers to, 197–198 birth registration, 222 classification in continuum of care, burden of, for health care facilities, 144 115–116, 169, 172, 173–176 care-related training, 188 components, 186 condom promotion, 122 ethical concerns, 197 Country Operational Plan and Reporting gender differences, 197 System, 93 integration of services, 134 Demographic and Health Surveys, 133 PEPFAR performance, 173–176, 245 obstacles to, 133 to prevent sexual transmission of HIV, PEPFAR activities and support, 133, 266 120, 135 PEPFAR network model of service preventing mother-to-child transmission delivery, 68–70 of HIV, 125–126, 127 for PEPFAR performance evaluation, 17, purpose, 185–187 29–31, 81, 95, 267 scaling up, 169, 188, 198 PEPFAR transition to sustainability, 1 settings for, 186 for prevention program design, 7, 131, strategies for improving, 198 132–134 testing for infants, 187–188, 230 quality improvement activities, 95–96 wait for test results, 198 recommendations for, 7, 134 Country Operational Plan and Reporting sentinel surveillance, 133 System, 93 services for orphans and other Country Operational Plans, 87–89, 93–94, vulnerable children, 205, 235 102 See also Research Country Teams Diet and nutrition, 183–184 accountability, 12, 82, 101 antiretroviral therapy and, 157–158 budget allocations and restrictions, 11, preventive interventions, 183–184, 231 12, 14, 15, 16, 73, 95, 99

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From page 366...

... INDEX services for orphans and other outcomes data, 17, 81 vulnerable children, 223, 224 prevention effectiveness, 113, 264 Discrimination, 56–57 prevention of mother-to-child as obstacle to harmonization, 91–92 transmission, 127–128 participation of stigmatized groups in program management, 81, 102–103, 263 PEPFAR, 14, 82, 92 recommendations for, 17, 244, 266 research needs, 264–266 services for orphans and other E vulnerable children, 205, 208, 209, 235, 265–266 Educational system Evidence-based practice HIV/AIDS impact in, 49–50 future of PEPFAR, 12 teacher mortality, 49, 236 HIV transmission prevention, 7 vulnerabilities of orphaned children, Extranet, PEPFAR, 86–87, 266–267 54–55, 222–223, 235 Elderly caregivers, 55 End-of-life care, 13, 179–180, 200 F Epidemiology, 17–18, 23, 37–38, 49–50 age patterns, 23, 52 Faith-based organizations, 63–64, 67, 148, behavioral surveillance, 113, 114, 132, 163, 177, 178, 190, 208, 214, 219, 133, 134 228, 260–261 child infections, 125 Family-centered care, 46–47, 179 focus countries, 62 in care programs, 201 gender differences, 52–53 financial burden, 217–218 recommendations for surveillance, 7, gender differences in caretaking burden, 114, 134 53–54 Equitable access, 14, 82, 91–92 recommendations for, 13, 170, 200 Evaluation of national AIDS/HIV programs services for orphans and other current system for, 90–91 vulnerable children, 215, 217–219 obstacles to, 91 Family planning, 196–197 services for orphans and other Focus countries, 25, 64–66 vulnerable children, 225–226 characteristics, 58–62 Three Ones principles of harmonization, funding, 25, 58, 72–73, 104–106, 45–46, 90 107–109 Evaluation of PEPFAR implementation and orphans and other vulnerable children performance in, 211–212 care services, 173, 202, 265 See also Host-country programs and challenges, 31–32 policies conceptual approach, 26–28 Food and Drug Administration, U.S., 9, 10, data sources for, 29–31, 90–91 88, 158, 159–160 dissemination of findings, 266–267 Framework for the Protection, Care, and family capacity strengthening, 218–219 Support of Orphans and Vulnerable goals, 4, 17, 26, 32, 244 Children Liing in a World with HIV harmonization as basis for, 4–5, 27–28, and AIDS, 212, 214, 215–217 267 Funding human resources allocation, 15 ABC programs, 228–229 indicators, 101–102, 267 for capacity building, 252 integration of services, 260 care services, 67, 99, 106–107, 173 Leadership Act requirements, 7, 26–27, causes of HIV and distribution of, 137 66–67 centrally funded programs, 105–106 outcomes attribution, 101 coordination within U.S. government, 84–85, 86

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From page 367...

... Global AIDS Initiative, 25, 104 See also President's Emergency Plan for Future challenges and opportunities, AIDS Relief (PEPFAR) 267–268 Global Fund to Fight AIDS, Tuberculosis antiretroviral therapy, 164, 246 and Malaria, 4, 25, 41, 62 capacity building, 252–259 Global Implementation Support Team, 43 care services, 200–201 Global Partners Forum for Children human resource supply, 14–15, 51, 255 Affected by HIV/AIDS, 212 integration of services, 12, 134, 259–261 Global Task Team, 43 research needs, 17, 57, 244, 264–266 services for orphans and other H vulnerable children, 237 See also Sustainability, PEPFAR Harmonization of efforts transition to antiretroviral drug purchase, 158–160 care services, 201 definition, 1.

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From page 368...

... INDEX services for orphans and other health care system capacity, 50–51, 253 vulnerable children, 221–222 human resource development, 15 U.S. role, 9 national AIDS authority, 45, 89–90 See also Coordination operational plans, 87–89, 93–94 Health care system capacity, 50–51 outcomes research, 17 eligibility for PEPFAR, 198–199 ownership of program planning and facilities, 253 execution, 45 future challenges, 252–253 services for orphans and other integration rationale, 199 vulnerable children, 224–226 national coordination, 254 strategic planning guidelines for, 46 network model, 177 See also Coordination; Evaluation of PEPFAR public health benefits, 254–255 national AIDS/HIV programs; Focus recommendations for expanding, 15, countries 244, 259 Human resources wrap-around services, 199 future challenges, 160, 255 Health care workers major HIV/AIDS program elements, 48 care services, 169, 188–190 recommendations for expanding doctor-to-population ratio, 58 capacity, 15, 259 injection practices, 63 retention of personnel, 256–257 in PEPFAR focus countries, 58 strategies for improving, 255–256 prevention of medical transmission of task shifting, 14–15, 189, 257–258 HIV, 128–130 See also Health care workers; Training quality improvement activities, 95–96 in HIV/AIDS care recommendations for recruitment and training, 15, 244, 259 I risk of HIV transmission, 257 supply concerns, 14–15, 51, 255 Infection patterns and trends, 17–18, 23, training, 5 37–40, 268 volunteers, 193–194, 259 children orphaned as a result of, See also Human resources; Training in 210–212 HIV/AIDS care gender patterns, 52 Highly-active antiretroviral therapy, 184 socioeconomic outcomes, 49–50 Home-based care, 70, 177, 182, 191–192, See also Transmission of HIV infection 193–194 Informed consent, 197 Host-country programs and policies Infrastructure support for AIDS/HIV access, 92 programs, 51, 62 antiretroviral drug purchases, 158–160 Inheritance law, 196 antiretroviral therapy, 146, 147–148 Injection drug use attributions for successful service medical transmission of HIV, 129–130, delivery, 144–145 137 capacity building, 252 prevention of HIV transmission in, 88, current Global AIDS Initiative 124–125, 137 implementation, 4 Integration of services customization of support for, 2, 12, 62, challenges, 134, 259–261 82, 87–88, 136, 147 goals, 2, 12, 25, 259–260 data collection for PEPFAR evaluation, opportunities for, 134–135, 260 29–30, 267 outcomes evaluation, 102 expansion of services under PEPFAR, 5 PEPFAR performance evaluation, 260 global coordination of donor actions rationale, 12, 134, 135, 198–200, 202, and, 85, 88–89 259 harmonization, 1, 8–10, 45, 87–88

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From page 369...

... See Diet and nutrition Tuberculosis, and Malaria Act Learning organization, 16, 94–98, 109, 262 O M Office of U.S. Global AIDS Coordinator budget allocations, 99, 100 Malaria, 50, 183, 200 financial management, 103, 105–106 Marginalized populations as learning organization, 94, 262–263 access to care, 91–92, 156–157 policy guidance, 92–93 recommendations for PEPFAR programs quality improvement activities, 266 and policies, 14, 82, 92 research funding, 95, 263 See also Discrimination; Stigmatization responsibilities, 4, 84 of HIV-positive persons role in coordinating programs and Medications donors, 85, 86 expanded scope of practice for health service for orphans and other vulnerable workers, 189–190 children, 214–215, 217, 233 impediments to harmonization of structure and operations, 71, 83, 84 international efforts, 9, 88 Opportunistic infections, 184 obstacles to procurement, 51 Orphans and other vulnerable children pain management, 194–195 access to services, 222–224 quality standard, 1–2, 9–10, 88, 142, birth registration, 222 158–159, 160 challenges to care delivery, 217 See also Antiretroviral therapy community-based responses, 219–222 Microbicides, 123 core services model, 205, 222 Millennium Development Goals, 212 creating supportive environment for, 226 Model of care, 13, 189, 200.

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From page 370...

... See Evaluation of PEPFAR 13, 170, 200, 206, 234 implementation and performance scale-up efforts, 205 Extranet, 86–87, 266–267 scope of services for, 207 five-year performance targets, 4, 17, service needs, 13, 206, 234, 268 25–26, 58, 67, 113, 117, 144, 153, social welfare workforce issues, 235–237 169, 173 supplemental direct support, 208, 209 focus countries. See Focus countries support for national government fragmented service delivery, 199–200 services, 224–226 guiding principles, 25 training for service to, 210 host country relationships, 81, 88, 90 vulnerabilities of young girls, 231 Institute of Medicine evaluation, 3, 4, 26–31 as learning organization, 94–98, 109, P 262 network model of service delivery, Pain management, 172, 194–195 68–70, 176–178 Palliative care, 171–172, 194–195, 200–201 organizational structure and operations, Partnership for Supply Chain Management, 4, 71, 81 106, 162–164 origins, 3 PEPFAR.

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From page 371...

... INDEX See also Care services; Country Teams; services for orphans and other Future challenges and opportunities; vulnerable children, 227–231 Prevention; Treatment sexual transmission of HIV, 118, Prevalence, 23, 38 120–123 in focus countries, 62 strategic planning, 7, 113 integration with prevention and care strategies for improving, 131, 137 activities, 99–100 Private sector funding for HIV/AIDS recommendations for surveillance, 7, initiatives, 41 114, 132–134 Protease inhibitors, 150 Prevention Psychosocial services, 177, 192–193 abstinence programs, 64, 67, 100, 113, Public education 120–121, 123 HIV prevention, 123 among injection drug users, 124–125 HIV transmission in injection drug use, in care services, 116, 169, 182–184 125 comprehensive behavioral interventions, PEPFAR accomplishments to date, 5 123 See also Educational system condom use promotion, 122–123 counseling and testing services for, 186 Q data collection and management for, 7, 131, 132–134, 137 Quality improvement, 95–96, 266 education campaigns for, 123 evidence-based practice, 7 future of PEPFAR, 1, 7 R gender issues, 130–131 integration with care and treatment Religious beliefs, 63. See also Faith-based efforts, 13, 134–136, 142, 155, 170 organizations Leadership Act budget allocation, 67 Research major HIV/AIDS program elements, 48 antiretroviral therapy effectiveness, 155, medical transmission of HIV, 128–130 265 microbicide use, 123 Country Team activities, 95 mother-to-child transmission of HIV, 5, funding, 95 18, 113, 118, 125–128, 137, 197, goals, 2, 15–16 245 implications for program planning and nondiscrimination in, 14, 82, 92 implementation, 57 opportunistic infections, 184 needs, 17, 57, 244, 264–266 outcome measures, 113, 117–118, 264 pediatric therapy, 153 PEPFAR accomplishments, 5, 7, PEPFAR role, 16, 17, 261–262, 263 118–130 recommendations for, 17, 244, 266 PEPFAR activities, 115–117, 137 stigma, 56–57 PEPFAR budget allocations, 99, See also Data collection 106–107, 136–137 PEPFAR five-year performance targets, S 4, 25, 58, 113, 117 program performance evaluation, 113 SAVE program, 135 recommendations for improving, 7, 114, Sex workers, 14, 92, 124, 131, 156 134 Sexual transmission of HIV restrictions on funding, 88, 100–101, ABC prevention strategy, 100, 120, 123, 136 135–137, 228–229 role of counseling and testing, 135 gender differences, 53 scope of activities, 115–117

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From page 372...

... INDEX patterns, 137 Training in HIV/AIDS care prevention program budget allocation, antiretroviral therapy, 145–146, 258 137 current efforts, 14 prevention program design, 131 for home-based care, 192 prevention program effectiveness, 118, PEPFAR accomplishments, 5, 176, 246, 120–123 258 recommendations for surveillance, 7, PEPFAR network model of service 114, 134 delivery, 68–70 See also Abstinence, sexual recommendations for, 15, 244, 259 Social security programs, 225 services for orphans and other Socioeconomic conditions vulnerable children, 210, 237 disease outcomes and, 50 spending, 14, 258 impact of HIV/AIDS, 49–50 for supportive care, 169, 188–190 PEPFAR focus countries, 58 twinning strategy, 258 poverty reduction, 214 Training in HIV/AIDS prevention vulnerabilities of orphaned children, blood safety procedures, 129 54–55 injection safety, 129–130 State Department, U.S., 72, 73, 104 mother-to-child transmission, 128 Stigmatization of HIV-positive persons, Transmission of HIV infection 56–57, 82 causes, 137 antiretroviral therapy and, 150 in focus countries, 62 See also Discrimination; Marginalized risk for health care workers, 257 populations See also Injection drug use; MotherSustainability, PEPFAR transition to to-child transmission of HIV; capacity building initiatives for, 252–259 Prevention; Sexual transmission of challenges, 243 HIV harmonization and coordination of Treatment efforts for, 8–10, 247–248 budget allocations, 67, 99, 106–107 integration of services for, 12 child patient, 152–153, 155–156 network model for, 177 clinical care services and, 172 PEPFAR commitment to, 248 human resources for, 160 prevention strategies in, 7 integration with prevention and care rationale, 18, 246–248, 268 activities, 13, 99–100, 134–136, 142, recommendations for, 6–7, 244, 248 155, 170 strategies for, 1–2, 190 major HIV/AIDS program elements, 48 women's issues in, 8, 249–252 nondiscrimination in, 14, 82, 91–92 workforce concerns, 14–15 PEPFAR definition, 141, 143 PEPFAR five-year performance targets, 4, 25, 58, 144, 153 T PEPFAR policies, 141, 145 recommendations for improving, 13, Three Ones principles of harmonization, 142 43, 87 voluntary counseling and testing in, 186 action framework, 45, 87–89 women's access, 52 coordinating authority, 45, 89–90 See also Antiretroviral therapy; Care monitoring and evaluation, 45–46, services 90–91 Tuberculosis, 141, 156, 157, 173, 176 origins, 44 prevention, 183, 185 purpose, 44 treatment, 185 Traditional healers, 195, 200

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From page 373...

... 130–131 amendments, 63–64 recommendations for services, 8, 244, budget allocations, 67, 71–73 250 evaluation of PEPFAR and, 4, 7, 26–27, significance of, in PEPFAR transition to 66–67 sustainability, 8, 249–252 origins and purpose, 3, 6, 24, 62–63, 64, supportive care for, 196–197 246 vulnerabilities of young girls, 231 palliative care provisions, 173 See also Gender differences performance targets, 67 World Bank, 41 research goals, 261 World Health Organization restrictions on funding, 63, 64, 88 antiretroviral therapy guidelines, 144, services for orphans and other 146–147, 148, 154 vulnerable children, 67, 208, 210 health care workforce management, 257 significant HIV/AIDS provisions, 24, 64 medication quality standards, 1–2, 9–10, See also President's Emergency Plan for 142, 158–159, 160 AIDS Relief (PEPFAR) palliative care, 171, 172 Urban populations, 51 Wrap-around services, 199, 201 U.S.

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Index Pages 363-374

Index
Pages 363-374