Global HIV/AIDS,
PEPFAR, and
FBOs
Office of the US Global AIDS Coordinator
Department of State
Before PEPFAR
• From 1981-2001, nearly 58 million people had
become infected with HIV worldwide
• In 2001: 16,000 new infections daily
• At the end of 2002, only 50,000 on treatment in subSaharan Africa
• Health systems overwhelmed by the sheer scope of
the epidemic
Changing the Course of the Epidemic
• PEPFAR is saving lives with comprehensive
service delivery in prevention, care and
treatment
–
–
–
–
Saving mothers
Protecting children from being orphaned
Preventing infections among the most vulnerable
Reaching communities and individuals with awareness
of how to prevent HIV infection
• Through PEPFAR, the US Government,
together with partner countries and international
partners, has changed the course of the
HIV/AIDS epidemic in nearly every country that
has a generalized epidemic
PEPFAR Funding & Declining HIV/AIDS Mortality
A new story
$20,000,000,000
1,650,000
1,600,000
PEPFAR Funding
1,500,000
1,450,000
$10,000,000,000
1,400,000
1,350,000
$5,000,000,000
1,300,000
1,250,000
$0
1,200,000
FY04
FY05
FY06
Total PEPFAR Funding, All Program Areas
Data source : UNAIDS Global Report 2010
FY07
FY08
FY09
FY10
Deaths/year in Sub-Saharan Africa
HIV/AIDS-Attributable
Attributable Deaths
in Sub-Saharan
Saharan Africa
1,550,000
$15,000,000,000
Trends in New Infections
From an estimated 16,000 new infections/day
globally in 2001 to 7000 new infections/day in 2009
Example: Change in New Infections in African Countries, 2001-2009
-40
-60
-80
-100
Data source : UNAIDS Global Report 2010
Uganda
Nigeria
Kenya
Angola
Cameroon
Lesotho
Tanzania
Malawi
Zambia
Mozambique
Swaziland
South Africa
Rwanda
Botswana
Zimbabwe
CAR
Cote D'Ivoire
-20
Namibia
% Change in Incidence
0
New Infections: Trends in Highest Prevalence
African Countries
Countries with HIV Prevalence > 10% in 2009
2001
2009
Countries
2001-2009
Incidence
Incidence
% Change (Incidence)
Swaziland
4.07
2.66
- 35%
Botswana
3.03
1.56
- 49%
Lesotho
2.88
2.58
-10%
South Africa
2.35
1.49
- 37%
Zimbabwe
1.94
0.84
- 57%
Zambia
1.72
1.17
- 32%
Namibia
2.29
0.43
- 81%
Mozambique
1.77
1.19
- 33%
Malawi
1.35
0.95
- 30%
Data source : UNAIDS Global Report 2010
New Infections: Trends in Other African Countries
Countries with HIV Prevalence < 10% in 2009
2001
2009
2001-2009
Incidence
Incidence
% Change (Incidence)
Cote d’Ivoire
0.39
0.11
- 72%
Uganda
0.71
0.74
+4%
Tanzania
0.64
0.45
- 30%
Kenya
0.55
0.53
- 4%
CAR
0.56
0.17
- 70%
Cameroon
0.59
0.53
- 10%
Countries
Data source : UNAIDS Global Report 2010
Treatment, Care, OVC, and PMTCT Scale-Up
PEPFAR,15 original focus countries, 2004-2010
12000000
Number of Individuals Reached
10000000
8000000
Treatment
Total Care
6000000
OVC
PMTCT T&C
PMTCT ARV
4000000
2000000
0
FY04
FY05
FY06
FY07
Fiscal Year
Data source : PEPFAR Annual Program Results
FY08
FY09
FY10
Estimated Infant Infections Averted
PEPFAR direct support for PMTCT, 2004-2010
Estimated Infant Infections averted through
PEPFAR direct support for PMTCT ARV
Cumulative total:
385,536 infant infections averted
Data source : US Census Bureau
Fiscal Year
Treatment: Increasing Efficiency & Decreasing Cost
$3,000
3,000,000
$2,500
2,500,000
$2,000
2,000,000
$1,500
1,500,000
$1,000
1,000,000
$500
$-
500,000
2004
2004
2005
2005
2006
2006
2007
2007
2008
2008
2009
2009
All Countries
$1,053
$836
$658
$673
$647
$453
Tanzania
$2,796
$1,107
$704
$688
$705
$490
Mozambique
$2,397
$966
$802
$880
$827
$500
$1,041
$843
$703
$606
$498
211,196
340,122
488,792
1,091,674
1,743,673
2,485,317
Uganda
Volume-Selected
28,238
65,085
105,095
Volume-All
66,550
249,197
541,479
Data source : Country costing analysis, PEPFAR/CDC
Year
Note: Cost per patient is estimated as the FY country COP allocation to treatment budget codes divided by treatment outputs, lagged by one year.
0
Total Number of Patients
PEPFAR Cost per Direct Patient
PEPFAR 2004-2009
Overall Treatment Coverage: 2004
Original 15 PEPFAR focus countries, based on CD4 count < 200
Note: The national estimate of coverage is from the UNAIDS Report on the Global AIDS Epidemic, 2008
Overall Treatment Coverage: 2009
Original 15 PEPFAR focus countries, based on CD4 count < 200
Note: The national estimate of coverage is from the UNAIDS Report on the Global AIDS Epidemic, 2010.
Data for Ethiopia were not available.
Impact of Move to CD4 Count < 350
Overall treatment coverage in original 15 PEPFAR focus countries (2009)
Note: The national estimate of coverage is from the UNAIDS Report on the Global AIDS Epidemic, 2010.
Data for Ethiopia were not available.
Treatment Scale-Up Trajectories (2004-2010)
PEPFAR, in countries with greater than 50% coverage (CD4<350) as of 2010
450000
Number of indviduals on Direct Treatment support
400000
350000
300000
Botswana (83%)
250000
Ethiopia (52%)
Guyana (95%)
200000
Kenya (50%)
Namibia (75%)
Rwanda (95%)
150000
Zambia (68%)
100000
50000
0
FY04
FY05
FY06
FY07
Fiscal Year
Data source : PEPFAR Annual Program Results
FY08
FY09
FY10
Treatment Scale-Up Trajectories (2004-2010)
PEPFAR, in countries with less than 50% coverage (CD4<350) as of 2010
South Africa (36%)
Number of Individuals on Direct Treatment Support
400000
350000
300000
1000000
800000
600000
400000
200000
0
FY04 FY05 FY06 FY07 FY08 FY09 FY10
250000
Cote d'Ivoire (29%)
Haiti (48%)
200000
Mozambique (32%)
Nigeria (23%)
Tanzania (32%)
150000
Uganda (43%)
Vietnam (33%)
100000
50000
0
FY04
FY05
FY06
FY07
Fiscal Year
Data source : PEPFAR Annual Program Results
FY08
FY09
FY10
Orphans and Vulnerable Children in Care
PEPFAR, original 15 focus countries, 2004-2010
Total Orphans and Vulnerable Children under Care
700000
600000
Botswana
Cote d'Ivoire
Ethiopia
500000
Guyana
Haiti
Kenya
400000
Mozambique
Namibia
Nigeria
300000
Rwanda
South Africa
200000
Tanzania
Uganda
Vietnam
100000
Zambia
0
FY04
FY05
FY06
FY07
Fiscal Year
Data source : PEPFAR Annual Program Results
FY08
FY09
FY10
Support for Country Ownership of the Continuum of
Response
• 21 Partnership Frameworks signed, with more to come
– 5-year joint strategic frameworks for collaboration on HIV/AIDS,
including
– service delivery
– policy reform
– financing
• Support for health systems
– Example: Blood Safety
– PEPFAR has supported 14 Ministries of Health to develop and strengthen
national blood transfusion services (NBTS)
– Safe blood is benefiting patients with a range of health issues beyond HIV
• Strengthening civil society & community response
• Focus on women, girls, and gender equality
– Gender-Based Violence prevention and treatment
– Together For Girls public-private partnership
Building the Capacity of African Institutions
• Medical and Nursing Education
Partnership Initiative (MEPI/NEPI)
– Grants awarded directly to African institutions
to transform healthcare work force through
partnerships with U.S. and international
medical schools and universities
• African Society for Laboratory Medicine
(ASLM)
– Advances the processes for accreditation of
laboratories
– Launches the African Journal of Laboratory
Medicine, improves South-to-South
communications
– Provides quality medical care with correct
diagnoses and monitoring, preventive
medicine, surveillance and disease control
Smart Investments to Increase Impact and Efficiency
• Accelerating high-impact, cost-effective prevention, e.g.
PMTCT and male circumcision
• Better TB and CD4 diagnostics
• Generic ARVs - 98% of the approximately 20 million
ARV packs purchased with PEPFAR funds are generic,
up from 15% in 2005
• Cost savings through pooled procurement via the
Supply Chain Management System (SCMS)
• Use of land & sea routes for commodity delivery,
allowing PEPFAR to avoid the high costs of air freight
• Revitalized Implementation Science agenda to identify
what works & adjust programs accordingly
Working Together to Meet the Need
A Key to PEPFAR’s Success
Collaboration is key to PEPFAR’s
enormous success:
– Leadership of the Office of the
Global AIDS Coordinator
– Model of the One USG approach
– Combined strengths of all USG
agencies, working with countries
and other partners
– Commitment to a comprehensive
response
THANK YOU
For further information, please visit:
www.PEPFAR.gov
www.facebook.com/PEPFAR
www.twitter.com/USPEPFAR
Commitment to work with FBOs: by Congress…
• PEPFAR reauthorization (2008):
Faith-based organizations are making an important contribution
to HIV prevention and AIDS treatment programs around the
world. Successful HIV prevention programs in Uganda,
Jamaica, and elsewhere have included local churches and
faith-based groups in efforts to promote behavior changes to
prevent HIV, to reduce stigma associated with HIV infection, to
treat those afflicted with the disease, and to care for orphans.
The Catholic Church alone currently cares for one in four
people being treated for AIDS worldwide. Faith-based
organizations possess infrastructure, experience, and
knowledge that will be needed to carry out these programs in
the future and should be an integral part of United States
efforts.
… and by the Obama Administration
PEPFAR Five-Year Strategy (2009):
PEPFAR integrates HIV prevention, treatment, and care
services in a manner that supports an inclusive, multisectoral
response. Its work draws upon the knowledge, access, and
talents of local community- and faith-based organizations.
GHI Strategy (2010):
GHI takes into account and leverages the health and
development efforts of partner countries, other bilateral donors,
multilateral organizations, civil society, private sector, and faithbased and non-governmental organizations to achieve the
greatest possible impact with U.S. investments.
How do FBOs help PEPFAR meet its goals?
• Durable, high-trust relationships with populations in need
• Local FBOs key to country ownership - often function as
part of government health systems, playing role of district
hospitals, clinics etc.
– Role acknowledged by many PEPFAR Partnership Frameworks
• Experienced at contributing to overall continuum of care
by linking across HIV program areas – e.g. connecting
PMTCT/treatment/OVC/prevention
• Ability to link HIV activities to other USG health &
development activities – e.g. maternal & child health,
nutrition, education
– Major emphasis of Global Health Initiative
FBOs in PEPFAR: Prevention
• PMTCT
– Both international (e.g. CRS) & local (e.g. McCord
Hospital in South Africa) partners
– PEPFAR-wide total: 114,000 infant infections averted in
2010
– New Global Plan for elmination by 2015
• Behavior change
– International and local FBOs among initial ABY grantees
– some now part of ongoing prevention programming
• Male circumcision
– FBO clinics contributing to rapid scale-up in Southern &
Eastern Africa
FBOs in PEPFAR: Treatment
• 3.2 million supported on treatment to date –
signature PEPFAR achievement
• CRS was among PEPFAR’s large treatment
partners during initial scale-up
• As part of overall move toward local partners,
local FBOs now increasingly provide treatment
• International partners play key role providing TA
to local partners
FBOs in PEPFAR: Care and Support
• Care for Orphans and Vulnerable Children
– PEPFAR supports over 3.8 million – one of the
world’s largest efforts for children
– FBOs – both international (e.g. World Vision)
and local (e.g. Churches Health Assn. of
Zambia) are key partners
• Care for PLWH
– Home-based care, e.g. ICOBI in Uganda