On May 27, 2003, the U.S. Congress passed the United States Leadership against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (the Leadership Act) and launched the U.S. Global AIDS Initiative. Among other things, this broad legislation required the President to establish a comprehensive, integrated 5-year strategy to combat global HIV/AIDS. The initiative is commonly known by the title of this strategy: “The President’s Emergency Plan for AIDS Relief,” or PEPFAR. The legislation also required the President to establish the position of U.S. Global AIDS Coordinator (the Coordinator) within the U.S. Department of State, with primary responsibility for oversight and coordination of all U.S. international activities to combat the HIV/AIDS pandemic.

As mandated by the Leadership Act, the U.S. Institute of Medicine (IOM) undertook a short-term evaluation of the implementation of PEPFAR to inform Congress about the initiative’s progress 3 years after passage of the legislation. The IOM Committee for the Evaluation of PEPFAR Implementation (the Committee) began its work on this short-term evaluation in February 2005. Although the Leadership Act was passed in May 2003, Congress first appropriated funds for the program in January 2004, and the majority of the first year’s funding was not obligated until September 2004. Thus at the close of the Committee’s short-term evaluation, PEPFAR had been supporting the implementation of programs in the focus countries for less than 2 years.