from the current requirement to use medications approved by the U.S. Food and Drug Administration to support for World Health Organization prequalification as the accepted global standard for assuring the quality of generic medications.

  • Enhanced ability to tailor interventions to the nature of the epidemic in each country and the countries’ national plans through removal of the limitations imposed by congressional budget allocations for particular activities. Alternative mechanisms that allow for spending to be directly linked with the efforts necessary to achieve performance targets would improve the necessary accountability for results.

  • Expansion and better integration of services to meet the needs of all people living with HIV/AIDS, and to both improve prevention, treatment, and care interventions and capitalize on the synergy among them.

  • Strengthened and expanded country capacity to provide services—particularly the necessary human resources—through implementation of HIV/AIDS programs in a manner that strengthens systems overall.

  • Enhanced knowledge about what works against the pandemic, to be gained by increasing the emphasis on learning from experience with the program and on conducting operations research and program evaluations.

The Committee concludes that PEPFAR has made a promising start, but the need for U.S. leadership in the effort to control the HIV/AIDS pandemic continues.

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