National Academies Press: OpenBook

Evaluation of PEPFAR (2013)

Chapter: Front Matter

Suggested Citation:"Front Matter." Institute of Medicine. 2013. Evaluation of PEPFAR. Washington, DC: The National Academies Press. doi: 10.17226/18256.
×

EVALUATION OF

PEPFAR

Committee on the Outcome and Impact Evaluation of Global HIV/AIDS
Programs Implemented Under the Lantos-Hyde Act of 2008

Board on Global Health
Board on Children, Youth, and Families

INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

Washington, D.C.

www.nap.edu

Suggested Citation:"Front Matter." Institute of Medicine. 2013. Evaluation of PEPFAR. Washington, DC: The National Academies Press. doi: 10.17226/18256.
×

THE NATIONAL ACADEMIES PRESS      500 Fifth Street, NW      Washington, DC 20001

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

This study was supported by Contract/Grant No. SAQMMA09M0693 between the National Academy of Sciences and the U.S. Department of State. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the organizations or agencies that provided support for the project.

International Standard Book Number-13: 978-0-309-26780-9
International Standard Book Number-10: 0-309-26780-3
Library of Congress Control Number: 2013939517

Additional copies of this report are available for sale from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu.

For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu.

Copyright 2013 by the National Academy of Sciences. All rights reserved.

Printed in the United States of America

The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.

Suggested citation: IOM (Institute of Medicine). 2013. Evaluation of PEPFAR. Washington, DC: The National Academies Press.

Suggested Citation:"Front Matter." Institute of Medicine. 2013. Evaluation of PEPFAR. Washington, DC: The National Academies Press. doi: 10.17226/18256.
×

Knowing is not enough; we must apply.
Willing is not enough; we must do.

—Goethe

image

INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES

Advising the Nation. Improving Health.

Suggested Citation:"Front Matter." Institute of Medicine. 2013. Evaluation of PEPFAR. Washington, DC: The National Academies Press. doi: 10.17226/18256.
×

THE NATIONAL ACADEMIES

Advisers to the Nation on Science, Engineering, and Medicine

The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences.

The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is president of the National Academy of Engineering.

The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine.

The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council.

www.national-academies.org

Suggested Citation:"Front Matter." Institute of Medicine. 2013. Evaluation of PEPFAR. Washington, DC: The National Academies Press. doi: 10.17226/18256.
×

COMMITTEE ON THE OUTCOME AND IMPACT EVALUATION OF GLOBAL HIV/AIDS PROGRAMS IMPLEMENTED UNDER THE LANTOS-HYDE ACT OF 2008

ROBERT E. BLACK (Chair), Johns Hopkins University, Baltimore, MD

JUDITH D. AUERBACH, Consultant, San Francisco AIDS Foundation, CA

MARY T. BASSETT, Doris Duke Charitable Foundation, New York, NY

RONALD BROOKMEYER, University of California, Los Angeles

LOLA DARE, Center for Health Sciences Training, Research and Development International, Ibadan, Nigeria

ALEX C. EZEH, African Population and Health Research Center, Nairobi, Kenya

SOFIA GRUSKIN, University of Southern California, Los Angeles

ANGELINA KAKOOZA, Makerere University College of Health Sciences, Kampala, Uganda

JENNIFER KATES, Henry J. Kaiser Family Foundation, Washington, DC

ANN KURTH, New York University, New York

ANNE C. PETERSEN, University of Michigan and Global Philanthropy Alliance, Ann Arbor

DOUGLAS D. RICHMAN, VA San Diego Healthcare System and University of California, San Diego

JENNIFER PRAH RUGER, Yale University, New Haven, CT

DEBORAH L. RUGG, United Nations Inspection and Evaluation Division, New York, NY

DAWN K. SMITH, U.S. Centers for Disease Control and Prevention, Atlanta, GA

PAPA SALIF SOW, Bill & Melinda Gates Foundation, Seattle, WA

SALLY K. STANSFIELD,1 Independent Consultant, Geneva, Switzerland

TAHA E. TAHA, Johns Hopkins University, Baltimore, MD

KATHRYN WHETTEN, Duke University, Durham, NC

CATHERINE M. WILFERT, Retired, Elizabeth Glaser Pediatric AIDS Foundation, Durham, NC

Consultants

SHARON KNIGHT, East Carolina University, Greenville, NC

KATHRYN TUCKER, Statistics Collaborative, Inc., Washington, DC

JANET WITTES, Statistics Collaborative, Inc., Washington, DC

__________________

1 Committee member through August 2012.

Suggested Citation:"Front Matter." Institute of Medicine. 2013. Evaluation of PEPFAR. Washington, DC: The National Academies Press. doi: 10.17226/18256.
×

Staff

KIMBERLY A. SCOTT, Study Co-Director

BRIDGET B. KELLY, Study Co-Director

MARGARET HAWTHORNE, Program Officer

LIVIA NAVON, Program Officer

CARMEN CECILIA MUNDACA, Postdoctoral Fellow

IJEOMA EMENANJO, Senior Program Associate (through January 2011)

MILA C. GONZÁLEZ DÁVILA, Associate Program Officer (through August 2012)

KRISTEN DANFORTH, Research Associate

REBECCA MARKSAMER, Research Associate (from August 2012)

KATE MECK, Research Associate

COLLIN WEINBERGER, Research Associate (April 2011 through June 2012)

LEIGH CARROLL, Research Assistant (from October 2011)

TESSA BURKE, Senior Program Assistant (through May 2011)

ANGELA CHRISTIAN, Program Associate

WENDY E. KEENAN, Program Associate

JULIE WILTSHIRE, Financial Associate

KIMBER BOGARD, Board Director, Board on Children, Youth, and Families (from October 2011)

ROSEMARY CHALK, Board Director, Board on Children, Youth, and Families (through July 2011)

PATRICK KELLEY, Senior Board Director, Boards on Global Health and African Science Academy Development

Suggested Citation:"Front Matter." Institute of Medicine. 2013. Evaluation of PEPFAR. Washington, DC: The National Academies Press. doi: 10.17226/18256.
×

Reviewers

This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report:

PIERRE BARKER, Institute for Healthcare Improvement

CHRIS BEYRER, Johns Hopkins University

ANASTASIA TZAVARAS CATSAMBAS, EnCompass LLC

DAVID CELENTANO, Johns Hopkins University

PAUL DE LAY, Joint United Nations Programme on HIV/AIDS

WAFAA M. EL-SADR, Columbia University

KURT FIRNHABER, Right to Care

MITCHELL H. GAIL, National Institutes of Health

ROBERT GROSS, University of Pennsylvania

JOHN E. LANGE, Bill & Melinda Gates Foundation

CHEWE LUO, United Nations Children’s Fund

JONATHON LEE SIMON, Boston University

RJ SIMONDS, Elizabeth Glaser Pediatric AIDS Foundation

Page viii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2013. Evaluation of PEPFAR. Washington, DC: The National Academies Press. doi: 10.17226/18256.
×

SHOSHANNA SOFAER, City University of New York

MIRIAM WERE, University of Nairobi

Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations, nor did they see the final draft of the report before its release. The review of this report was overseen by Kristine M. Gebbie, Flinders University School of Nursing and Midwifery, and Ann M. Arvin, Stanford University. Appointed by the National Research Council and Institute of Medicine, they were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

Suggested Citation:"Front Matter." Institute of Medicine. 2013. Evaluation of PEPFAR. Washington, DC: The National Academies Press. doi: 10.17226/18256.
×

Acknowledgments

The committee, project staff, and consultants are deeply appreciative of the diverse and valuable contributions made by so many who assisted with this study.

For information and support provided throughout the project, we thank the staff of the Office of the U.S. Global AIDS Coordinator, with particular gratitude to Paul Bouey and Tiffany Parker, who facilitated our engagement during the study, as well as staff from other President’s Emergency Plan for AIDS Relief (PEPFAR) implementing agencies. We are also grateful to the leadership of the U.S. missions and the PEPFAR staff in the countries visited for this evaluation, whose hospitable and gracious assistance was essential to the success of our country visits. We also thank the many other individuals in the countries visited who assisted us with logistics and support during our visits.

We are grateful to Eran Bendavid from Stanford University for his valuable consultation during the study. We appreciate the essential technical support provided to the project by Danielle Beaulieu, Jessica Case, Megan Somerday, Jeff Steen, and Neil Wohlford from Statistics Collaborative, Inc. We thank Kathryn Stadeli from University of California, San Diego, School of Medicine for her assistance with research for the study. We also thank Megan Perez and Meredith Cantwell for their excellent work on this study as interns at the Institute of Medicine as well as Wyatt Smith and Peter Dull, who provided temporary assistance during the project. We are grateful to Teresa Bergen and Diane Wellman for their diligent work as transcriptionists. We appreciate the creativity and effort of Jay Christian

Suggested Citation:"Front Matter." Institute of Medicine. 2013. Evaluation of PEPFAR. Washington, DC: The National Academies Press. doi: 10.17226/18256.
×

and LeAnn Locher for their design work. In addition, we convey our deep gratitude and appreciation for the hard work of the many staff in various offices of the Institute of Medicine and the National Academies who lent their support to the project.

There are a number of other individuals who were crucial for the administrative and logistical success of this project. For help with scheduling and communication for the committee, we thank Sharon Abbruscato, Lola Adedokun, Philomena Agaloi, Jillian Albertolli, Michele Augustus, Nkiru Azikiwe, Anna Both, Cindy Chu, Kyle Hamilton, Jennifer Heflin, Maria Male, Sheila Mwero, Catherine Nyawire, Audrey Palix, Jessica Raback, Mary Rybczynski, Fortuna Salinas, Abir Shady, Cassie Toner, Rachel Upton, Kevin Vavasseur, Jackylene Wegoki, and Marie Young. We are also immensely grateful to Anthony Mavrogiannis and the staff at Kentlands Travel for their assistance with the complex travel needs of this project.

Finally, although we cannot name them here for reasons of confidentiality, we offer our most profound thanks to the hundreds of individuals who participated in interviews and site visits as part of the evaluation data collection effort. Their generosity with their time and their willingness to share their insights were fundamental to the evaluation; it was a privilege and an inspiration to hear directly from those whose dedication and tremendous effort underlie the successes of the response to HIV globally and in PEPFAR partner countries.

Suggested Citation:"Front Matter." Institute of Medicine. 2013. Evaluation of PEPFAR. Washington, DC: The National Academies Press. doi: 10.17226/18256.
×
Suggested Citation:"Front Matter." Institute of Medicine. 2013. Evaluation of PEPFAR. Washington, DC: The National Academies Press. doi: 10.17226/18256.
×

This page intentionally left blank.

Page xviii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2013. Evaluation of PEPFAR. Washington, DC: The National Academies Press. doi: 10.17226/18256.
×

5-1    Interventions Included in PEPFAR Guidance Over Time for Prevention of Sexual Transmission of HIV

5-2    OGAC Indicator 2.1—Number of Individuals Reached Through Community Outreach That Promotes HIV/AIDS Prevention Through Abstinence and/or Being Faithful (in Millions)

5-3    OGAC Indicator 5.2—Number of Individuals Reached Through Community Outreach That Promotes HIV/AIDS Prevention Through Other Behavior Change Beyond Abstinence and/or Being Faithful (in Millions)

5-4    Number of HIV-Positive Pregnant Women Receiving ARV Prophylaxis for PMTCT (PEPFAR and National) (in Thousands)

6-1    Number of Individuals Who Received Counseling and Testing for HIV and Received Test Results (in Millions)

6-2    Number of Individuals Provided with Care (in Millions)

6-3    Number of HIV-Positive Adults and Children Receiving a Minimum of One Clinical Service (in Millions)

6-4    Number of HIV-Positive Patients in HIV Care Who Started TB Treatment (in Thousands)

6-5    Number of USG-Supported Service Outlets Providing Treatment for TB to HIV-Infected Individuals (in Thousands)

6-6    HIV-Positive Patients Who Were Screened for TB in HIV Care or Treatment Settings (in Millions)

6-7    Number of Registered TB Patients Who Received HIV Counseling, Testing, and Their Test Results at a USG-Supported TB Service Outlet (in Thousands)

6-8    Number of HIV-Positive Persons Receiving Cotrimoxazole Prophylaxis (in Millions)

6-9    Number of HIV-Positive Clinically Malnourished Clients Who Received Therapeutic or Supplementary Food (in Thousands)

6-10    Adult and Pediatric Treatment Guidelines Adoption by Country

6-11    Care and Treatment Budgetary Allocation Requirement: Documented Planned/Approved Funding Over Time (in USD Millions)

6-12    Number of Adults and Children with Advanced HIV Infection Receiving ART (in Millions)

6-13    Currently Enrolled Adults in ART, in Thousands (Annual, FY 2005–FY 2010)

6-14    Newly Enrolled Adults in ART by Sex (Annual, FY 2005–FY 2011) (in Thousands)

Suggested Citation:"Front Matter." Institute of Medicine. 2013. Evaluation of PEPFAR. Washington, DC: The National Academies Press. doi: 10.17226/18256.
×

6-15    Newly Enrolled Children in ART (FY 2005–FY 2011) (in Thousands)

7-1    Tracking the Legislative Budgetary Requirement for OVC Programming (in USD Millions)

7-2    PEPFAR Age Categories for Programs for Orphans and Vulnerable Children

7-3    OVC Indicator Targets and Results (in Millions)

8-1    Inclusion of Gender in PEPFAR Guidance Documents Over Time, 2003–2012

8-2    Sex-Disaggregated Indicators Routinely Reported to OGAC

9-1    Health System Constraints with Potential Disease-Specific and Health System Responses

9-2    PEPFAR Indicators Related to Leadership and Governance (Organizations)

9-3    PEPFAR Indicators Related to Leadership and Governance (Individuals)

9-4    Total Expenditure on Health per Capita at Exchange Rate

9-5    PEPFAR Indicators Related to Strategic Information and Information Systems

9-6    PEPFAR Indicators Related to Workforce Training (FY 2004–FY 2009)

9-7    PEPFAR Indicators Related to Workforce Training (FY 2010)

10-1    OGAC-Identified Dimensions and Operational Definitions for Country Ownership

10-2    PEPFAR-identified Insights from an Internal Study Commissioned by OGAC on the Principles of Country Ownership

11-1    Key PEPFAR Targets Under Legislation and Strategy Mandates

11-2    Number of PEPFAR Indicators by Reporting Status and Year of Indicator Guidance

11-3    PEPFAR Indicators Consistent Across the Duration of PEPFAR

11-4    Level of Harmonization of Next Generation Indicators with Global Indicators

11-5    Evolution of PEPFAR-Supported Evaluation and Research Activities

Suggested Citation:"Front Matter." Institute of Medicine. 2013. Evaluation of PEPFAR. Washington, DC: The National Academies Press. doi: 10.17226/18256.
×

11-6    Types of Knowledge Transferred in PEPFAR, Beyond Routine Reporting

11-7    Mechanisms of Knowledge Transfer in PEPFAR

C-1    Country-Level Indicators Reported During FY 2004–FY 2009

C-2    Primary Indicators for PEPFAR Next Generation Indicators (FY 2010–Present)

C-3    Overlapping Country-Level Phase 1 and Primary Phase 2 Indicators

C-4    Country Visit Interviews by Stakeholder Type

FIGURES

2-1    Program impact pathway for evaluation of PEPFAR’s effects on HIV-related health impact for children and adults

2-2    Context for PEPFAR contribution in partner countries

2-3    Overall data collection and analysis process

3-1    PEPFAR overall organization and implementation

3-2    Organizational structure of OGAC (last updated November 14, 2011)

3-3    Example structure of PEPFAR mission team

4-1    Total donor disbursements for HIV/AIDS in PEPFAR partner countries (constant 2010 USD billions)

4-2    PEPFAR overall funding flows framework

4-3    Congressional appropriations for PEPFAR, FY 2004–FY 2011 (current USD billions)

4-4    Cumulative obligations and outlays, FY 2004–FY 2011 (current USD billions)

4-5    Proportion of cumulative available PEPFAR funding by obligation and outlay status at the end of each fiscal year (bars) and the cumulative total of funding that has not been outlaid (line) (current USD billions)

4-6    Planned/approved funding for USG implementing agencies, FY 2005–FY 2011 (constant 2010 USD billions)

4-7    Proportion of planned/approved funding for PEPFAR operational plan programs, FY 2005–FY 2011

4-8    FY 2011    PEPFAR operational plan program funding summary

Suggested Citation:"Front Matter." Institute of Medicine. 2013. Evaluation of PEPFAR. Washington, DC: The National Academies Press. doi: 10.17226/18256.
×

4-9    Planned/approved funding for PEPFAR country activities in current USD millions (left axis and bars) and as a percentage of total planned/approved funding (right axis and lines)

4-10    Planned/approved funding for PEPFAR HQ programs in current USD millions (left axis and bars) and as a percentage of total planned/approved funding (right axis and lines)

4-11    Planned/approved funding for multilateral partners in current USD millions (left axis and bars) and as a percentage of total planned/approved funding (right axis and lines)

4-12a  Planned/approved funding by technical area (constant 2010 USD millions)

4-12b  Proportion of planned/approved funding by technical area

4-13    Proportion of PEPFAR funding by origin of prime partner in 13 PEPFAR partner countries

4-14    Percentage of PEPFAR funding by type of prime partner in 13 PEPFAR partner countries

4-15    PEPFAR funding for local prime partners

4-16    PEPFAR planned/approved funding by 2009 prevalence groupings in 31 PEPFAR partner countries (current USD millions)

4-17    PEPFAR planned/approved funding by income level in 31 PEPFAR partner countries (current USD millions)

5-1    PEPFAR’s planned/approved funding over time for prevention (FY 2005–FY 2011)

5-2    AIDS diagnoses among perinatally infected persons, 1985–2010, in the United States and six U.S.-dependent areas

5-3    PMTCT cascade

5-4    PEPFAR’s contribution to PMTCT coverage, 2006 to 2009 (aggregate data from 31 countries)

6-1    Implementation cascade for the continuum of care

6-2    Planned/approved funding over time for counseling and testing services

6-3    PEPFAR care and support services

6-4    Planned/approved funding over time for care and support services

6-5    Planned/approved funding over time for treatment

6-6    Total enrolled and newly enrolled individuals (adults and children) in ART (quarterly, FY 2005–FY 2011)

6-7    Number of newly enrolled adults in ART by sex (FY 2005–FY 2011)

Page xxii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2013. Evaluation of PEPFAR. Washington, DC: The National Academies Press. doi: 10.17226/18256.
×

6-8    Proportion of newly enrolled children in ART by age groups (FY 2008–FY 2011)

6-9    Twelve-month retention (alive and in care) by population and by the year ART was started in a subset of patients in nine PEPFAR partner countries

6-10    Proportion of patients on ART that remain in care on ART over time by population in a subset of patients in nine PEPFAR countries

6-11    Proportion of patients on ART that remain in care over time by year of ART initiation in a subset of patients in nine PEPFAR partner countries

6-12    Survival by population (2004–2011) in a subset of patients in nine PEPFAR partner countries

6-13    Survival by year of ART initiation (2004–2011) in a subset of patients in nine PEPFAR partner countries

6-14a  Differences between men and women on ART in survival (7 countries, 165 clinics), 2004–2011

6-14b  Differences between men and women on ART in baseline characteristics (7 countries, 165 clinics), 2004–2011

6-15    2006 estimated HIV prevalence and ART coverage

6-16    2009 estimated HIV prevalence and ART coverage

6-17    Number of adults (>15 years) eligible for ART in low-and middle-income countries, by region, according to WHO 2006 (CD4<200) and 2010 (CD4<350) guidelines

7-1    Planned/approved funding over time for services for children and adolescents

7-2    All-cause and AIDS deaths for children under 5 years, in select high-child-mortality-burden PEPFAR countries

8-1    Gender-based violence and HIV

8-2    HIV prevalence in MSM compared to HIV prevalence in all adults in 2010

9-1    Representation of WHO’s six building blocks for effective health systems

9-2    PEPFAR funding for HSS (country activities) (constant 2010    USD millions)

9-3    External resources for health as percent of total health expenditure, 2010

9-4    Components of a health information system (HIS)

9-5    Data needs and sources at different levels of the health care system

Page xxiii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2013. Evaluation of PEPFAR. Washington, DC: The National Academies Press. doi: 10.17226/18256.
×

9-6    Select indicators related to PEPFAR’s laboratory activities

9-7    Health system building blocks represented as a house

11-1    PEPFAR funding for country-level strategic information in constant 2010 dollars and as percentage of total PEPFAR funding

11-2    Number of indicators routinely reported to OGAC by Next Generation Indicator (NGI) reporting category and guidance year

11-3    Ongoing PEPFAR Public Health Evaluation (PHE) studies, by country, December 2011

11-4    Organizations implementing ongoing PEPFAR Public Health Evaluation (PHE) studies, by implementing organizations’ country, December 2011

11-5    Implementation science awards, by country

11-6    Organizations implementing PEPFAR Implementation Science studies, by implementing organizations’ country, October 2012

11-7    Potential pathways of knowledge transfer within PEPFAR

11-8    PEPFAR-supported journal publications, by year, 2004–2011

11-9    Suggested elements of a PEPFAR comprehensive knowledge management framework

11-10  Recommended PEPFAR tiered reporting in the context of partner country and global reporting systems

C-1    Country visit qualitative data collection process

BOXES

3-1    Examples of Vulnerable Populations Identified from Country Visit Interview Data

4-1    Definitions for Selected Financial Terms

4-2    FY 2011    PEPFAR Budget Code Definitions by Technical Area

5-1    PEPFAR’s Adoption and Scale Up of Voluntary Medical Male Circumcision

5-2    Centrally Reported Next Generation Indicators for Prevention of Sexual Transmission

Page xxiv Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2013. Evaluation of PEPFAR. Washington, DC: The National Academies Press. doi: 10.17226/18256.
×
Suggested Citation:"Front Matter." Institute of Medicine. 2013. Evaluation of PEPFAR. Washington, DC: The National Academies Press. doi: 10.17226/18256.
×

Preface

The HIV/AIDS pandemic has beleaguered the world for more than three decades. The countries most affected continue to be in sub-Saharan Africa, home to an estimated two-thirds of people living with HIV. There have been major increases in international aid assistance as well as in national commitments to and investments in HIV prevention, treatment, care, and capacity building activities, yet funding remains insufficient to meet the estimated immediate and projected needs.

In 2003, in response to the devastating consequences of the HIV pandemic, the U.S. Congress funded a major new U.S. global health initiative, which became known as the President’s Emergency Plan for AIDS Relief, or PEPFAR.1 PEPFAR remains the largest bilateral initiative aimed at addressing HIV/AIDS. At the time of its initial authorization, PEPFAR was seen as a bold initiative, testing, among other strategies, whether treatment could be successfully and intensively scaled up in low-resource settings. The initial authorizing language mandated that the Institute of Medicine (IOM) assess the progress of PEPFAR implementation to help guide the future directions of this innovative program. The findings and recommendations of that IOM study, published in 2007, informed PEPFAR processes, policies, and activi-

__________________

1United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003, P.L. 108-25, 108th Cong., 1st sess. (May 27, 2003).

Page xxvi Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2013. Evaluation of PEPFAR. Washington, DC: The National Academies Press. doi: 10.17226/18256.
×

ties as well as the legislation that reauthorized the initiative, known as the Lantos-Hyde Act of 2008.2

The reauthorization legislation mandated that the IOM assess the performance of U.S.-assisted global HIV/AIDS programs and evaluate the impact on health of prevention, treatment, and care efforts supported by U.S. funding (see Appendix A for the statement of task). This report is intended to provide a rigorous, evidence-based, multidisciplinary, and independent evaluation of PEPFAR to Congress and the Department of State as well as to the scientific community, program implementers, policy makers, civil society, people living with and affected by HIV/AIDS, and international stakeholders in global public health.

In response to its mandate, IOM first convened a planning committee to develop a strategic approach for conducting the evaluation. This approach, published in a 2010 report, addressed the complexities of evaluating an initiative with the scale and diversity of programs that PEPFAR supports and with the range of countries in which it operates. The dynamism of an initiative that was operating and evolving over the course of the evaluation presented additional complexity.

To carry out the evaluation, the IOM convened a diverse expert committee that included considerable overlap with the members of the planning committee. Guided by the strategic approach, the committee, IOM staff, and consultants carried out a mixed-methods approach. The qualitative data that were collected included extensive document review and more than 400 semi-structured interviews conducted from 2010 to 2012. Each member of the committee visited at least one PEPFAR partner country, and in total the evaluation team conducted 13 data collection visits to partner countries, hearing the perspectives of a wide range of stakeholders. PEPFAR headquarters and mission staff, partner country stakeholders, and global partners all generously contributed their time and experience to the committee. Quantitative data included financial data, program and clinical monitoring data, and epidemiological information. The committee struggled to find quantitative data to address some of the elements of the statement of task. Beyond the specific issues of available data to address the legislated task, however, there is also the critical imperative that PEPFAR be able to determine the key questions to ask in order to assess its own performance and effectiveness and to plan in advance for the collection of meaningful data to answer those questions and guide the ongoing evolution of PEPFAR.

__________________

2 Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008, P.L. 110-293, 110th Cong., 2nd sess. (July 30, 2008).

Page xxvii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2013. Evaluation of PEPFAR. Washington, DC: The National Academies Press. doi: 10.17226/18256.
×

The 2008 reauthorization of PEPFAR emphasized that the program must transition from its initial goal of providing an emergency response to longer-term goals of enhancing sustainability, promoting country ownership, and strengthening health systems. One of the clear findings that emerged from this evaluation is that as PEPFAR evolves in this way, major dilemmas are emerging that create tensions for decision making related to a country’s HIV response; these dilemmas will require attention as the program moves forward. As the HIV response becomes more country-driven, PEPFAR—and any other external donor effort—will need to focus its contributions on national efforts rather than on the direct provision of services and attribution of results. This will have consequences for program planning, implementation, and evaluation. Furthermore, focusing on country ownership will require relinquishing some control over the response, which in turn will have unknown consequences for quality and access to services; PEPFAR and its partner countries will have to grapple with these issues together.

PEPFAR has been globally transformative—changing in many ways the paradigm of global health and what can be accomplished with ambitious goals, ample funding, and humanitarian commitment to a public health crisis. As it moves forward, PEPFAR must continue to be bold in its vision, implementation, and global leadership, but now toward its aims of continuing to strengthen the capacity of partner countries to respond to the pandemic. The committee hopes that this evaluation will serve as a tool to achieve these aims.

The committee extends its gratitude to all those who provided information to assist in the evaluation. The committee has continuing deep admiration for those carrying out the difficult work of responding to the pandemic. I was privileged to serve as the chair for both the planning committee and the evaluation committee. I would like to express my appreciation to the members of both committees for the expertise and perspective they contributed, for their robust participation in discourse and deliberation, and for the immeasurable time and energy they volunteered. The IOM committee staff, very ably led by study co-directors Bridget Kelly and Kimberly Scott, have been highly professional, thoughtful, and committed to ensuring the most responsive and rigorous evaluation possible. I thank the entire staff and the committee consultants for their tireless efforts in support of the committee.

Robert E. Black, Chair
Committee on the Outcome and Impact Evaluation of Global
HIV/AIDS Programs Implemented Under the Lantos-Hyde Act of 2008

Page xxviii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2013. Evaluation of PEPFAR. Washington, DC: The National Academies Press. doi: 10.17226/18256.
×

This page intentionally left blank.

Page xxix Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2013. Evaluation of PEPFAR. Washington, DC: The National Academies Press. doi: 10.17226/18256.
×

Acronyms and Abbreviations

AIDS

acquired immune deficiency syndrome

ANC

antenatal care

APR

annual program results

ART

antiretroviral therapy

ARV

antiretroviral

AZT

zidovudine

BCC

behavior change communication

BPE

basic program evaluation

CBO

community-based organization

CCM

country coordinating mechanism

CD4

cluster of differentiation 4

CDC

U.S. Centers for Disease Control and Prevention

CGD

Center for Global Development

CHERG

Child Health Epidemiology Reference Group

CHSW

community health or para-social worker

COP

country operational plan

COPRS

Country Operational Plan Reporting System

CPT

cotrimoxazole preventive therapy

CRC

Committee on the Rights of the Child

CSO

civil society organization

CTX

cotrimoxazole

Suggested Citation:"Front Matter." Institute of Medicine. 2013. Evaluation of PEPFAR. Washington, DC: The National Academies Press. doi: 10.17226/18256.
×

DAH

development assistance for health

DHAP

Division of HIV/AIDS Prevention (at CDC)

DHS

Demographic and Health Surveys

DoD

U.S. Department of Defense

DoL

U.S. Department of Labor

DoS

U.S. Department of State

EA

expenditure analysis

EID

early infant diagnosis of HIV

FBO

faith-based organization

FELTP

Field Epidemiology and Laboratory Training Program

FETP

Field Epidemiology Training Program

FY

fiscal year

GAO

U.S. Government Accountability Office

GBV

gender-based violence

GHI

U.S. Global Health Initiative

Global Fund

Global Fund to Fight AIDS, Tuberculosis, and Malaria

GMS

Grants Management Solutions

GNI

gross national income

HAPSAT

HIV/AIDS Program Sustainability Analysis Tool

HHS

U.S. Department of Health and Human Services

HIPC

heavily indebted poor country

HIS

health information system

HIV

human immunodeficiency virus

HMIS

health management information system

HQ

headquarters

HRH

human resources for health

HRSA

Health Resources and Services Administration

HSS

health systems strengthening

IeDEA

International Epidemiological Database to Evaluate AIDS

IGA

income-generating activity

IOM

Institute of Medicine

IPT

isoniazid preventive therapy

IPTp

intermittent preventive treatment of malaria for pregnant women

ITN

insecticide-treated net

LIMS

laboratory information management system

LTFu

loss to follow-up

Page xxxi Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2013. Evaluation of PEPFAR. Washington, DC: The National Academies Press. doi: 10.17226/18256.
×

M&E

monitoring and evaluation

MAT

medication-assisted treatment

MCC

Millennium Challenge Corporation

MCH

maternal and child health

MDG

Millennium Development Goal

MEPI

Medical Education Partnership Initiative

MERG

Monitoring and Evaluation Reference Group

MICS

Multiple Indicator Cluster Survey

MOH

ministry of health

MSM

men who have sex with men

MTCT

mother-to-child transmission

NAC

National AIDS Commission/Committee/Council/Control Agency

NAS

National Academies of Science

NASA

national AIDS spending assessment

NDOH

National Department of Health (South Africa)

NEPI

Nursing/Midwifery Education Partnership Initiative

NGI

next generation indicator

NGO

nongovernmental organization

NHA

national health account

NIH

U.S. National Institutes of Health

NRC

National Research Council

NSF

National Science Foundation

OECD

Organisation for Economic Co-operation and Development

OGAC

Office of the U.S. Global AIDS Coordinator

OI

opportunistic infection

OMB

Office of Management and Budget

OVC

orphans and vulnerable children

PCR

polymerase chain reaction

PEP

post-exposure prophylaxis

PEPFAR

The President’s Emergency Plan for AIDS Relief

PEPFAR I

The President’s Emergency Plan for AIDS Relief (2004–2008)

PEPFAR II

The President’s Emergency Plan for AIDS Relief (2009–2013)

PEQ

priority evaluation question

PF

Partnership Framework

PFIP

Partnership Framework implementation plan

PHE

public health evaluation

Page xxxii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2013. Evaluation of PEPFAR. Washington, DC: The National Academies Press. doi: 10.17226/18256.
×

PI

principal investigator

PICT

provider-initiated counseling and testing

PIP

Program Impact Pathway

PLHIV

people living with HIV/AIDS

PMI

President’s Malaria Initiative

PMTCT

prevention of mother-to-child transmission

PPP

public–private partnership

PrEP

pre-exposure prophylaxis

QA

quality assurance

QI

quality improvement

RFA

request for application

SAB

Scientific Advisory Board (of PEPFAR)

SAMHSA

Substance Abuse and Mental Health Services

Administration

SANAC

South African National AIDS Council

SAPR

semi-annual program results

SCMS

Supply Chain Management System

SGBV

sexual and gender-based violence

SI

strategic information

SOPA

State of the Program Area

STD

sexually transmitted disease

STI

sexually transmitted infection

TA

technical assistance

TAB

technical advisory board

TB

tuberculosis

TDR

transmitted drug resistance

TE

targeted evaluation

TWG

technical working group

UN

United Nations

UNAIDS

Joint United Nations Programme on HIV/AIDS

UNGASS

United Nations General Assembly Special Session

UNICEF

United Nations Children’s Fund

UNODC

United Nations Office on Drugs and Crime

USAID

United States Agency for International Development

USG

U.S. government

VMMC

voluntary medical male circumcision

WHO

World Health Organization

Page xxxiii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2013. Evaluation of PEPFAR. Washington, DC: The National Academies Press. doi: 10.17226/18256.
×

INTERVIEW CITATION ABBREVIATIONS

Country Visit Exit Synthesis: Country # + ES

Country Visit Interview: Country # + Interview # + Organization Type

Non-Country Visit Interview: “NCV” + Interview # + Organization Type

Organization Types

USG

U.S. government

USNGO

U.S. nongovernmental organization

USPS

U.S. private sector

USACA

U.S. academia

PCGOV

partner country government

PCNGO

partner country nongovernmental organization

PCPS

partner country private sector

PCACA

partner country academia

CCM

country coordinating mechanism

ML

multilateral organization

OBL

other (non-U.S. and non-partner country) bilateral

OGOV

other government

ONGO

other (non-U.S. and non-partner country) nongovernmental organization

Page xxxiv Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2013. Evaluation of PEPFAR. Washington, DC: The National Academies Press. doi: 10.17226/18256.
×

This page intentionally left blank.

Suggested Citation:"Front Matter." Institute of Medicine. 2013. Evaluation of PEPFAR. Washington, DC: The National Academies Press. doi: 10.17226/18256.
×
Page R1
Suggested Citation:"Front Matter." Institute of Medicine. 2013. Evaluation of PEPFAR. Washington, DC: The National Academies Press. doi: 10.17226/18256.
×
Page R2
Suggested Citation:"Front Matter." Institute of Medicine. 2013. Evaluation of PEPFAR. Washington, DC: The National Academies Press. doi: 10.17226/18256.
×
Page R3
Suggested Citation:"Front Matter." Institute of Medicine. 2013. Evaluation of PEPFAR. Washington, DC: The National Academies Press. doi: 10.17226/18256.
×
Page R4
Suggested Citation:"Front Matter." Institute of Medicine. 2013. Evaluation of PEPFAR. Washington, DC: The National Academies Press. doi: 10.17226/18256.
×
Page R5
Suggested Citation:"Front Matter." Institute of Medicine. 2013. Evaluation of PEPFAR. Washington, DC: The National Academies Press. doi: 10.17226/18256.
×
Page R6
Suggested Citation:"Front Matter." Institute of Medicine. 2013. Evaluation of PEPFAR. Washington, DC: The National Academies Press. doi: 10.17226/18256.
×
Page R7
Page viii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2013. Evaluation of PEPFAR. Washington, DC: The National Academies Press. doi: 10.17226/18256.
×
Page R8
Suggested Citation:"Front Matter." Institute of Medicine. 2013. Evaluation of PEPFAR. Washington, DC: The National Academies Press. doi: 10.17226/18256.
×
Page R9
Suggested Citation:"Front Matter." Institute of Medicine. 2013. Evaluation of PEPFAR. Washington, DC: The National Academies Press. doi: 10.17226/18256.
×
Page R10
Suggested Citation:"Front Matter." Institute of Medicine. 2013. Evaluation of PEPFAR. Washington, DC: The National Academies Press. doi: 10.17226/18256.
×
Page R11
Suggested Citation:"Front Matter." Institute of Medicine. 2013. Evaluation of PEPFAR. Washington, DC: The National Academies Press. doi: 10.17226/18256.
×
Page R12
Page xiii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2013. Evaluation of PEPFAR. Washington, DC: The National Academies Press. doi: 10.17226/18256.
×
Page R13
Suggested Citation:"Front Matter." Institute of Medicine. 2013. Evaluation of PEPFAR. Washington, DC: The National Academies Press. doi: 10.17226/18256.
×
Page R14
Suggested Citation:"Front Matter." Institute of Medicine. 2013. Evaluation of PEPFAR. Washington, DC: The National Academies Press. doi: 10.17226/18256.
×
Page R15
Suggested Citation:"Front Matter." Institute of Medicine. 2013. Evaluation of PEPFAR. Washington, DC: The National Academies Press. doi: 10.17226/18256.
×
Page R16
Page xvii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2013. Evaluation of PEPFAR. Washington, DC: The National Academies Press. doi: 10.17226/18256.
×
Page R17
Page xviii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2013. Evaluation of PEPFAR. Washington, DC: The National Academies Press. doi: 10.17226/18256.
×
Page R18
Suggested Citation:"Front Matter." Institute of Medicine. 2013. Evaluation of PEPFAR. Washington, DC: The National Academies Press. doi: 10.17226/18256.
×
Page R19
Suggested Citation:"Front Matter." Institute of Medicine. 2013. Evaluation of PEPFAR. Washington, DC: The National Academies Press. doi: 10.17226/18256.
×
Page R20
Suggested Citation:"Front Matter." Institute of Medicine. 2013. Evaluation of PEPFAR. Washington, DC: The National Academies Press. doi: 10.17226/18256.
×
Page R21
Page xxii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2013. Evaluation of PEPFAR. Washington, DC: The National Academies Press. doi: 10.17226/18256.
×
Page R22
Page xxiii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2013. Evaluation of PEPFAR. Washington, DC: The National Academies Press. doi: 10.17226/18256.
×
Page R23
Page xxiv Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2013. Evaluation of PEPFAR. Washington, DC: The National Academies Press. doi: 10.17226/18256.
×
Page R24
Suggested Citation:"Front Matter." Institute of Medicine. 2013. Evaluation of PEPFAR. Washington, DC: The National Academies Press. doi: 10.17226/18256.
×
Page R25
Page xxvi Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2013. Evaluation of PEPFAR. Washington, DC: The National Academies Press. doi: 10.17226/18256.
×
Page R26
Page xxvii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2013. Evaluation of PEPFAR. Washington, DC: The National Academies Press. doi: 10.17226/18256.
×
Page R27
Page xxviii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2013. Evaluation of PEPFAR. Washington, DC: The National Academies Press. doi: 10.17226/18256.
×
Page R28
Page xxix Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2013. Evaluation of PEPFAR. Washington, DC: The National Academies Press. doi: 10.17226/18256.
×
Page R29
Suggested Citation:"Front Matter." Institute of Medicine. 2013. Evaluation of PEPFAR. Washington, DC: The National Academies Press. doi: 10.17226/18256.
×
Page R30
Page xxxi Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2013. Evaluation of PEPFAR. Washington, DC: The National Academies Press. doi: 10.17226/18256.
×
Page R31
Page xxxii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2013. Evaluation of PEPFAR. Washington, DC: The National Academies Press. doi: 10.17226/18256.
×
Page R32
Page xxxiii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2013. Evaluation of PEPFAR. Washington, DC: The National Academies Press. doi: 10.17226/18256.
×
Page R33
Page xxxiv Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2013. Evaluation of PEPFAR. Washington, DC: The National Academies Press. doi: 10.17226/18256.
×
Page R34
Next: Summary »
Evaluation of PEPFAR Get This Book
×
Buy Paperback | $98.00 Buy Ebook | $79.99
MyNAP members save 10% online.
Login or Register to save!
Download Free PDF

The U.S. government supports programs to combat global HIV/AIDS through an initiative that is known as the President's Emergency Plan for AIDS Relief (PEPFAR). This initiative was originally authorized in the U.S. Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 and focused on an emergency response to the HIV/AIDS pandemic to deliver lifesaving care and treatment in low- and middle-income countries (LMICs) with the highest burdens of disease. It was subsequently reauthorized in the Tom Lantos and Henry J. Hyde U.S. Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008 (the Lantos-Hyde Act).

Evaluation of PEPFAR makes recommendations for improving the U.S. government's bilateral programs as part of the U.S. response to global HIV/AIDS. The overall aim of this evaluation is a forward-looking approach to track and anticipate the evolution of the U.S. response to global HIV to be positioned to inform the ability of the U.S. government to address key issues under consideration at the time of the report release.

  1. ×

    Welcome to OpenBook!

    You're looking at OpenBook, NAP.edu's online reading room since 1999. Based on feedback from you, our users, we've made some improvements that make it easier than ever to read thousands of publications on our website.

    Do you want to take a quick tour of the OpenBook's features?

    No Thanks Take a Tour »
  2. ×

    Show this book's table of contents, where you can jump to any chapter by name.

    « Back Next »
  3. ×

    ...or use these buttons to go back to the previous chapter or skip to the next one.

    « Back Next »
  4. ×

    Jump up to the previous page or down to the next one. Also, you can type in a page number and press Enter to go directly to that page in the book.

    « Back Next »
  5. ×

    Switch between the Original Pages, where you can read the report as it appeared in print, and Text Pages for the web version, where you can highlight and search the text.

    « Back Next »
  6. ×

    To search the entire text of this book, type in your search term here and press Enter.

    « Back Next »
  7. ×

    Share a link to this book page on your preferred social network or via email.

    « Back Next »
  8. ×

    View our suggested citation for this chapter.

    « Back Next »
  9. ×

    Ready to take your reading offline? Click here to buy this book in print or download it as a free PDF, if available.

    « Back Next »
Stay Connected!