Index

A

ABC approach, 100, 120, 123, 135137, 228229

Abstinence, sexual, 64, 67, 100, 113, 120121, 123.

See also ABC approach

Accountability

directions of, 46

PEPFAR funding and, 2, 11, 12, 82, 101

role of program monitoring and evaluation, 46

treatment delivery and, 144

Adherence to treatment, 141, 149150

African Network of Religious Leaders Living with or Personally Affected by HIV/AIDS, 135

Age patterns of HIV infection, 23, 52

Antiretroviral therapy

access for marginalized groups, 156157

adherence, 141, 149150

attribution for successful implementation, 144145

behavioral surveillance, 135

clinical care services and, 172

costs, 9899

current delivery, 18, 145146, 153, 268

effectiveness, 155

eligibility, 148, 154

follow-up, 149

future challenges, 164, 246, 252253

generic drugs, 9, 10, 159, 160

guidelines, 146147, 148, 154

harmonization of procurement, 158160

host country program design, 147148

human resources for delivery of, 14, 255256, 257258

initiation, 149

integration with prevention and care activities, 155, 200

laboratory services, 161

nutritional support, 157158

obstacles to delivery, 141

patient evaluation for, 148

patient preparation for, 148149, 154

pediatric care, 155156

PEPFAR accomplishments, 5, 141, 164, 245

PEPFAR five-year performance targets, 4, 58, 144

PEPFAR funding, 9899, 252

PEPFAR policies and programs, 141, 143

pregnancy during, 196197

to prevent mother-to-child HIV transmission, 113, 127, 245, 268

quality standard, 910, 142, 158159, 160

recommendations for improving availability, 13, 142, 153



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement



Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.

OCR for page 363
PEPFAR Implementation: Progress and Promise Index A ABC approach, 100, 120, 123, 135–137, 228–229 Abstinence, sexual, 64, 67, 100, 113, 120–121, 123. See also ABC approach Accountability directions of, 46 PEPFAR funding and, 2, 11, 12, 82, 101 role of program monitoring and evaluation, 46 treatment delivery and, 144 Adherence to treatment, 141, 149–150 African Network of Religious Leaders Living with or Personally Affected by HIV/AIDS, 135 Age patterns of HIV infection, 23, 52 Antiretroviral therapy access for marginalized groups, 156–157 adherence, 141, 149–150 attribution for successful implementation, 144–145 behavioral surveillance, 135 clinical care services and, 172 costs, 98–99 current delivery, 18, 145–146, 153, 268 effectiveness, 155 eligibility, 148, 154 follow-up, 149 future challenges, 164, 246, 252–253 generic drugs, 9, 10, 159, 160 guidelines, 146–147, 148, 154 harmonization of procurement, 158–160 host country program design, 147–148 human resources for delivery of, 14, 255–256, 257–258 initiation, 149 integration with prevention and care activities, 155, 200 laboratory services, 161 nutritional support, 157–158 obstacles to delivery, 141 patient evaluation for, 148 patient preparation for, 148–149, 154 pediatric care, 155–156 PEPFAR accomplishments, 5, 141, 164, 245 PEPFAR five-year performance targets, 4, 58, 144 PEPFAR funding, 98–99, 252 PEPFAR policies and programs, 141, 143 pregnancy during, 196–197 to prevent mother-to-child HIV transmission, 113, 127, 245, 268 quality standard, 9–10, 142, 158–159, 160 recommendations for improving availability, 13, 142, 153

OCR for page 363
PEPFAR Implementation: Progress and Promise research needs, 155, 265 resistance monitoring, 150–151, 154 stigma reduction, 150 supply chain management, 162–164 training for health care workers, 145–146, 258 utilization, 141, 145 Attributions for success, 144–145 B Bacterial vaginosis, 53 Behavioral surveillance, 7, 113, 114, 132, 133, 134, 135 Bill and Melinda Gates Foundation, 41 Blood safety, 115, 128–129, 137 Breastfeeding, 125–126 C Capacity building initiatives, 252–259 Care services budget allocations, 67, 99, 106–107 challenges, 200–201 classification, 172–173 community-based, family-centered, 178–180, 201 comprehensive, 172, 174–175, 178, 179, 191 contracting for, 178 definition and scope, 169, 171–172 delivery mechanisms, 169 effectiveness, 173 harmonization of, 201 health care worker training, 169, 176, 188–190 home-based, 70, 177, 182, 191–192, 193–194 integration with prevention and treatment efforts, 13, 99–100, 134–136, 142, 155, 170, 200, 202 major HIV/AIDS program elements, 48 needs of women and girls, 196–197 nondiscrimination in, 14, 82, 91–92 opportunities for improvement, 190 pain management, 194–195 palliative care, 171–172, 194–195, 200–201 PEPFAR delivery, 169, 173–176, 181–188, 201–202, 245–246 PEPFAR five-year performance targets, 25–26, 58, 169, 173 PEPFAR transition to sustainability, 190 planning, 180–181 preventive interventions in, 116, 169, 182–184 program performance evaluation, 265 psychosocial, 177, 192–193 quality assessment, 202 recommendations for, 13, 170, 200 stigmatization effects, 56–57 volunteer workers, 193–194 See also Counseling and testing Centers for Disease Control and Prevention, 84–85, 104, 263 Child caregivers, 55 Children AIDS mortality, 145 antiretroviral therapy utilization, 141, 145 immunization, 230 infection patterns and trends, 125 pain management, 195 sources of infection, 125 testing for infants, 187–188, 230 treatment, 152–153, 155–156 See also Mother-to-child transmission of HIV; Orphans and other vulnerable children Communication mechanisms and practices, 86–87, 97–98 Community-based approach capacity building, 253–254 care services, 201 characteristics, 178 current service delivery, 46–47 goals, 47 network model, 177, 178–179 prevention of mother-to-child transmission, 126 recommendations for, 13, 170, 200 services for orphans and other vulnerable children, 215, 219–222 Community health worker model of care, 189 Comorbid infections in children, 156 implications for treatment, 157 opportunistic infections, 184 prevalence, 157 preventive interventions, 182–184 See also Malaria; Tuberculosis

OCR for page 363
PEPFAR Implementation: Progress and Promise Condom promotion, 122–123, 228–229, 261. See also ABC approach Congress, U.S. PEPFAR budget allocations, 2, 12, 82, 101 in PEPFAR transition to sustainability, 6–7, 249 Coordination communication mechanisms, 86–87 Country Teams, 8–9, 85–86 development of national action framework, 45, 88–89 global efforts to improve, 43 goals, 254 impediments to, 9 international donors, 9, 43, 86, 88–89 Leadership Act requirements, 24, 68, 84 rationale, 85, 254 recommendations for U.S. Global AIDS Coordinator, 9, 82 of U.S. HIV/AIDS efforts, 3, 66, 71, 84–85 See also Harmonization of efforts Corruption, 49 Counseling and testing barriers to, 197–198 classification in continuum of care, 115–116, 169, 172, 173–176 components, 186 ethical concerns, 197 gender differences, 197 integration of services, 134 PEPFAR performance, 173–176, 245 to prevent sexual transmission of HIV, 120, 135 preventing mother-to-child transmission of HIV, 125–126, 127 purpose, 185–187 scaling up, 169, 188, 198 settings for, 186 strategies for improving, 198 testing for infants, 187–188, 230 wait for test results, 198 Country Operational Plan and Reporting System, 93 Country Operational Plans, 87–89, 93–94, 102 Country Teams accountability, 12, 82, 101 budget allocations and restrictions, 11, 12, 14, 15, 16, 73, 95, 99 communication mechanisms and practices, 86–87 coordination and harmonization efforts, 8–9, 81, 85–86, 87–89, 91 financial management, 102 flexibility in prevention program design, 136, 262 funding, 104–106 organizational structure and operations, 71 planning cycle, 93–94 policy guidance, 92–93 research activities, 95 strategies for improving performance of, 262 support for, 71, 262 technical support, 94 D Data collection antiretroviral therapy delivery and outcomes, 144, 150, 155 behavioral surveillance, 7, 113, 114, 132, 133, 134, 135 birth registration, 222 burden of, for health care facilities, 144 care-related training, 188 condom promotion, 122 Country Operational Plan and Reporting System, 93 Demographic and Health Surveys, 133 obstacles to, 133 PEPFAR activities and support, 133, 266 PEPFAR network model of service delivery, 68–70 for PEPFAR performance evaluation, 17, 29–31, 81, 95, 267 PEPFAR transition to sustainability, 1 for prevention program design, 7, 131, 132–134 quality improvement activities, 95–96 recommendations for, 7, 134 sentinel surveillance, 133 services for orphans and other vulnerable children, 205, 235 See also Research Diet and nutrition, 183–184 antiretroviral therapy and, 157–158 preventive interventions, 183–184, 231

OCR for page 363
PEPFAR Implementation: Progress and Promise services for orphans and other vulnerable children, 223, 224 Discrimination, 56–57 as obstacle to harmonization, 91–92 participation of stigmatized groups in PEPFAR, 14, 82, 92 E Educational system HIV/AIDS impact in, 49–50 teacher mortality, 49, 236 vulnerabilities of orphaned children, 54–55, 222–223, 235 Elderly caregivers, 55 End-of-life care, 13, 179–180, 200 Epidemiology, 17–18, 23, 37–38, 49–50 age patterns, 23, 52 behavioral surveillance, 113, 114, 132, 133, 134 child infections, 125 focus countries, 62 gender differences, 52–53 recommendations for surveillance, 7, 114, 134 Equitable access, 14, 82, 91–92 Evaluation of national AIDS/HIV programs current system for, 90–91 obstacles to, 91 services for orphans and other vulnerable children, 225–226 Three Ones principles of harmonization, 45–46, 90 Evaluation of PEPFAR implementation and performance care services, 173, 202, 265 challenges, 31–32 conceptual approach, 26–28 data sources for, 29–31, 90–91 dissemination of findings, 266–267 family capacity strengthening, 218–219 goals, 4, 17, 26, 32, 244 harmonization as basis for, 4–5, 27–28, 267 human resources allocation, 15 indicators, 101–102, 267 integration of services, 260 Leadership Act requirements, 7, 26–27, 66–67 outcomes attribution, 101 outcomes data, 17, 81 prevention effectiveness, 113, 264 prevention of mother-to-child transmission, 127–128 program management, 81, 102–103, 263 recommendations for, 17, 244, 266 research needs, 264–266 services for orphans and other vulnerable children, 205, 208, 209, 235, 265–266 Evidence-based practice future of PEPFAR, 12 HIV transmission prevention, 7 Extranet, PEPFAR, 86–87, 266–267 F Faith-based organizations, 63–64, 67, 148, 163, 177, 178, 190, 208, 214, 219, 228, 260–261 Family-centered care, 46–47, 179 in care programs, 201 financial burden, 217–218 gender differences in caretaking burden, 53–54 recommendations for, 13, 170, 200 services for orphans and other vulnerable children, 215, 217–219 Family planning, 196–197 Focus countries, 25, 64–66 characteristics, 58–62 funding, 25, 58, 72–73, 104–106, 107–109 orphans and other vulnerable children in, 211–212 See also Host-country programs and policies Food and Drug Administration, U.S., 9, 10, 88, 158, 159–160 Framework for the Protection, Care, and Support of Orphans and Vulnerable Children Living in a World with HIV and AIDS, 212, 214, 215–217 Funding ABC programs, 228–229 for capacity building, 252 care services, 67, 99, 106–107, 173 causes of HIV and distribution of, 137 centrally funded programs, 105–106 coordination within U.S. government, 84–85, 86

OCR for page 363
PEPFAR Implementation: Progress and Promise data collection for PEPFAR evaluation, 30–31 distribution by category, 106–107 flexibility in program and intervention design and, 2, 100–101, 136 focus country distribution, 25, 58, 72–73, 104–106, 107–109 global efforts, 40–43 for health worker training, 14, 258 Leadership Act budget allocations, 67 Partnership for Supply Chain Management, 162 PEPFAR distribution, 40–41, 58, 71–73, 98–101, 104–109 PEPFAR financial management evaluation, 102–103 per capita, 108–109 prevention activities, 115, 136–137 provisions of Leadership Act, 63–64 recommendations for improving, 2, 12, 82, 101 research, 95, 263 services for orphans and other vulnerable children, 67, 208, 210, 217, 228–229 U.S. Global AIDS Initiative, 25, 104 Future challenges and opportunities, 267–268 antiretroviral therapy, 164, 246 capacity building, 252–259 care services, 200–201 human resource supply, 14–15, 51, 255 integration of services, 12, 134, 259–261 research needs, 17, 57, 244, 264–266 services for orphans and other vulnerable children, 237 See also Sustainability, PEPFAR transition to G Gender differences antiretroviral therapy utilization, 141, 145, 151 infection patterns, 52 prevention program considerations, 130–131 treatment delivery considerations, 151 volunteer counseling and testing, 197 See also Women and girls Girls. See Women and girls Global AIDS Coordinator, U.S. current research effort, 16 as learning organization, 16 performance evaluation, 16 recommendations for, 6, 7, 9, 10, 13, 14, 17, 82, 89, 92, 114, 134, 142, 153, 160, 170, 200, 206, 234, 244, 248, 266 responsibilities, 3, 24, 66, 70–71, 84 role in harmonization and coordination, 9, 82, 89 Global AIDS Initiative, U.S. accomplishments, 5, 17, 243, 245 budget allocations, 25, 104 current implementation, 4, 25 future prospects, 109 gender issues, 250 origins and purpose, 3, 24 recommendations for, 6, 7, 8, 10, 13, 15, 17, 114, 134, 142, 160, 234, 244, 250, 259, 266 research role, 15–16, 17, 263 transition to PEPFAR sustainability, 243 See also President’s Emergency Plan for AIDS Relief (PEPFAR) Global Fund to Fight AIDS, Tuberculosis and Malaria, 4, 25, 41, 62 Global Implementation Support Team, 43 Global Partners Forum for Children Affected by HIV/AIDS, 212 Global Task Team, 43 H Harmonization of efforts antiretroviral drug purchase, 158–160 care services, 201 definition, 1. See also Three Ones principles of harmonization equitable access to programs and, 91–92 evaluation of PEPFAR implementation, 4–5, 27–28, 267 impediments to, 9, 88, 91–92 outcomes measurement and, 101 PEPFAR commitment to, 4, 25, 81, 87 PEPFAR transition to sustainability, 1–2, 8–10, 247–248 recommendations for, 10, 142, 160

OCR for page 363
PEPFAR Implementation: Progress and Promise services for orphans and other vulnerable children, 221–222 U.S. role, 9 See also Coordination Health care system capacity, 50–51 eligibility for PEPFAR, 198–199 facilities, 253 future challenges, 252–253 integration rationale, 199 national coordination, 254 network model, 177 PEPFAR public health benefits, 254–255 recommendations for expanding, 15, 244, 259 wrap-around services, 199 Health care workers care services, 169, 188–190 doctor-to-population ratio, 58 injection practices, 63 in PEPFAR focus countries, 58 prevention of medical transmission of HIV, 128–130 quality improvement activities, 95–96 recommendations for recruitment and training, 15, 244, 259 risk of HIV transmission, 257 supply concerns, 14–15, 51, 255 training, 5 volunteers, 193–194, 259 See also Human resources; Training in HIV/AIDS care Highly-active antiretroviral therapy, 184 Home-based care, 70, 177, 182, 191–192, 193–194 Host-country programs and policies access, 92 antiretroviral drug purchases, 158–160 antiretroviral therapy, 146, 147–148 attributions for successful service delivery, 144–145 capacity building, 252 current Global AIDS Initiative implementation, 4 customization of support for, 2, 12, 62, 82, 87–88, 136, 147 data collection for PEPFAR evaluation, 29–30, 267 expansion of services under PEPFAR, 5 global coordination of donor actions and, 85, 88–89 harmonization, 1, 8–10, 45, 87–88 health care system capacity, 50–51, 253 human resource development, 15 national AIDS authority, 45, 89–90 operational plans, 87–89, 93–94 outcomes research, 17 ownership of program planning and execution, 45 services for orphans and other vulnerable children, 224–226 strategic planning guidelines for, 46 See also Coordination; Evaluation of national AIDS/HIV programs; Focus countries Human resources future challenges, 160, 255 major HIV/AIDS program elements, 48 recommendations for expanding capacity, 15, 259 retention of personnel, 256–257 strategies for improving, 255–256 task shifting, 14–15, 189, 257–258 See also Health care workers; Training in HIV/AIDS care I Infection patterns and trends, 17–18, 23, 37–40, 268 children orphaned as a result of, 210–212 gender patterns, 52 socioeconomic outcomes, 49–50 See also Transmission of HIV infection Informed consent, 197 Infrastructure support for AIDS/HIV programs, 51, 62 Inheritance law, 196 Injection drug use medical transmission of HIV, 129–130, 137 prevention of HIV transmission in, 88, 124–125, 137 Integration of services challenges, 134, 259–261 goals, 2, 12, 25, 259–260 opportunities for, 134–135, 260 outcomes evaluation, 102 PEPFAR performance evaluation, 260 rationale, 12, 134, 135, 198–200, 202, 259

OCR for page 363
PEPFAR Implementation: Progress and Promise recommendations for, 13, 142, 170, 200 services for orphans and other vulnerable children, 224 wrap-around services and, 199 Interagency Technical Working Groups, 94 International Infectious Diseases Control Act, 62 K Kerry-Frist Global AIDS bill, 62–63 L Laboratory services, 161 Leadership Act. See United States Leadership against HIV/AIDS, Tuberculosis, and Malaria Act Learning organization, 16, 94–98, 109, 262 M Malaria, 50, 183, 200 Marginalized populations access to care, 91–92, 156–157 recommendations for PEPFAR programs and policies, 14, 82, 92 See also Discrimination; Stigmatization of HIV-positive persons Medications expanded scope of practice for health workers, 189–190 impediments to harmonization of international efforts, 9, 88 obstacles to procurement, 51 pain management, 194–195 quality standard, 1–2, 9–10, 88, 142, 158–159, 160 See also Antiretroviral therapy Microbicides, 123 Millennium Development Goals, 212 Model of care, 13, 189, 200. See also Network model Mortality, 23, 38, 39 children, 145, 182–183 demographic patterns, 49–50 preventive interventions, 182–183 Mother-to-child transmission of HIV access to antiretroviral therapy to prevent, 18, 113, 127, 268 incidence, 125 PEPFAR interventions to prevent, 5, 113, 118, 126–128, 137, 245 prevention strategies, 125–126, 197 risk, 125 N National Institutes of Health, 263 Needle exchange programs, 124 Network model, 68–70, 145, 176–178 New Partners Initiative, 106 Nongovernmental organizations, 178 services for orphans and other vulnerable children, 208, 218, 226 See also Faith-based organizations Nurses, 189–190 Nutrition. See Diet and nutrition O Office of U.S. Global AIDS Coordinator budget allocations, 99, 100 financial management, 103, 105–106 as learning organization, 94, 262–263 policy guidance, 92–93 quality improvement activities, 266 research funding, 95, 263 responsibilities, 4, 84 role in coordinating programs and donors, 85, 86 service for orphans and other vulnerable children, 214–215, 217, 233 structure and operations, 71, 83, 84 Opportunistic infections, 184 Orphans and other vulnerable children access to services, 222–224 birth registration, 222 challenges to care delivery, 217 community-based responses, 219–222 core services model, 205, 222 creating supportive environment for, 226 definition, 207, 231–234 direct support, 208–209 education, 222–223 evaluation of service delivery, 205, 208, 209, 235, 265–266 evolution of care goals and strategies, 212–217 family-based care, 217–219

OCR for page 363
PEPFAR Implementation: Progress and Promise Framework for the Protection, Care, and Support of Orphans and Vulnerable Children Living in a World with HIV and AIDS, 212, 214, 215–217 funding for services and programs, 67, 208, 210, 217, 228–229 HIV/AIDS-associated vulnerabilities, 54–55 HIV infection prevention among, 227–230 indirect support, 208, 209 institutional care, 220 integration of services for, 224 opportunities for improving services, 231–237 PEPFAR care services and strategies, 210, 218–219, 221–222, 225–226, 227–229, 231, 245–246 PEPFAR targets, 13, 205, 206, 208–209, 214–215, 234 population patterns and trends, 18, 54, 210–212, 268 preventive care services, 230–231 recommendations for service delivery, 13, 170, 200, 206, 234 scale-up efforts, 205 scope of services for, 207 service needs, 13, 206, 234, 268 social welfare workforce issues, 235–237 supplemental direct support, 208, 209 support for national government services, 224–226 training for service to, 210 vulnerabilities of young girls, 231 P Pain management, 172, 194–195 Palliative care, 171–172, 194–195, 200–201 Partnership for Supply Chain Management, 106, 162–164 PEPFAR. See President’s Emergency Plan for AIDS Relief PEPFAR ExtraNet, 86–87, 266–267 Performance targets, PEPFAR care services, 25–26, 58, 169, 173 origin of, 67 for orphans and other vulnerable children, 13, 205, 206, 208–209, 214–215, 234 prevention, 4, 25, 58, 113, 117 progress to date, 17 treatment delivery, 4, 25, 58, 144, 153 Plus-up plans, 102 Poverty reduction, 214 President’s Emergency Plan for AIDS Relief (PEPFAR) accomplishments, 5, 17, 81, 109, 245–246 allocation of funds, 71–73, 104–109 annual meetings, 96–97 annual report, 98 blood safety activities, 115, 128–129, 137 budget, 40–41, 58, 71, 98–101 commitment to harmonization, 4, 25, 81, 87 communication mechanisms and practices, 97–98 coordination with other donors, 43, 81, 85 data collection activities and support, 133 evaluation. See Evaluation of PEPFAR implementation and performance Extranet, 86–87, 266–267 five-year performance targets, 4, 17, 25–26, 58, 67, 113, 117, 144, 153, 169, 173 focus countries. See Focus countries fragmented service delivery, 199–200 guiding principles, 25 host country relationships, 81, 88, 90 Institute of Medicine evaluation, 3, 4, 26–31 as learning organization, 94–98, 109, 262 network model of service delivery, 68–70, 176–178 organizational structure and operations, 4, 71, 81 origins, 3 participation of stigmatized groups in, 82 policy documents, 92–93 quality improvement support, 96 research role, 16, 17, 261–262, 263 strategic objectives, 67–68 transition to sustainability. See Sustainability, PEPFAR transition to

OCR for page 363
PEPFAR Implementation: Progress and Promise See also Care services; Country Teams; Future challenges and opportunities; Prevention; Treatment Prevalence, 23, 38 in focus countries, 62 integration with prevention and care activities, 99–100 recommendations for surveillance, 7, 114, 132–134 Prevention abstinence programs, 64, 67, 100, 113, 120–121, 123 among injection drug users, 124–125 in care services, 116, 169, 182–184 comprehensive behavioral interventions, 123 condom use promotion, 122–123 counseling and testing services for, 186 data collection and management for, 7, 131, 132–134, 137 education campaigns for, 123 evidence-based practice, 7 future of PEPFAR, 1, 7 gender issues, 130–131 integration with care and treatment efforts, 13, 134–136, 142, 155, 170 Leadership Act budget allocation, 67 major HIV/AIDS program elements, 48 medical transmission of HIV, 128–130 microbicide use, 123 mother-to-child transmission of HIV, 5, 18, 113, 118, 125–128, 137, 197, 245 nondiscrimination in, 14, 82, 92 opportunistic infections, 184 outcome measures, 113, 117–118, 264 PEPFAR accomplishments, 5, 7, 118–130 PEPFAR activities, 115–117, 137 PEPFAR budget allocations, 99, 106–107, 136–137 PEPFAR five-year performance targets, 4, 25, 58, 113, 117 program performance evaluation, 113 recommendations for improving, 7, 114, 134 restrictions on funding, 88, 100–101, 136 role of counseling and testing, 135 scope of activities, 115–117 services for orphans and other vulnerable children, 227–231 sexual transmission of HIV, 118, 120–123 strategic planning, 7, 113 strategies for improving, 131, 137 Private sector funding for HIV/AIDS initiatives, 41 Protease inhibitors, 150 Psychosocial services, 177, 192–193 Public education HIV prevention, 123 HIV transmission in injection drug use, 125 PEPFAR accomplishments to date, 5 See also Educational system Q Quality improvement, 95–96, 266 R Religious beliefs, 63. See also Faith-based organizations Research antiretroviral therapy effectiveness, 155, 265 Country Team activities, 95 funding, 95 goals, 2, 15–16 implications for program planning and implementation, 57 needs, 17, 57, 244, 264–266 pediatric therapy, 153 PEPFAR role, 16, 17, 261–262, 263 recommendations for, 17, 244, 266 stigma, 56–57 See also Data collection S SAVE program, 135 Sex workers, 14, 92, 124, 131, 156 Sexual transmission of HIV ABC prevention strategy, 100, 120, 123, 135–137, 228–229 gender differences, 53

OCR for page 363
PEPFAR Implementation: Progress and Promise patterns, 137 prevention program budget allocation, 137 prevention program design, 131 prevention program effectiveness, 118, 120–123 recommendations for surveillance, 7, 114, 134 See also Abstinence, sexual Social security programs, 225 Socioeconomic conditions disease outcomes and, 50 impact of HIV/AIDS, 49–50 PEPFAR focus countries, 58 poverty reduction, 214 vulnerabilities of orphaned children, 54–55 State Department, U.S., 72, 73, 104 Stigmatization of HIV-positive persons, 56–57, 82 antiretroviral therapy and, 150 See also Discrimination; Marginalized populations Sustainability, PEPFAR transition to capacity building initiatives for, 252–259 challenges, 243 harmonization and coordination of efforts for, 8–10, 247–248 integration of services for, 12 network model for, 177 PEPFAR commitment to, 248 prevention strategies in, 7 rationale, 18, 246–248, 268 recommendations for, 6–7, 244, 248 strategies for, 1–2, 190 women’s issues in, 8, 249–252 workforce concerns, 14–15 T Three Ones principles of harmonization, 43, 87 action framework, 45, 87–89 coordinating authority, 45, 89–90 monitoring and evaluation, 45–46, 90–91 origins, 44 purpose, 44 Traditional healers, 195, 200 Training in HIV/AIDS care antiretroviral therapy, 145–146, 258 current efforts, 14 for home-based care, 192 PEPFAR accomplishments, 5, 176, 246, 258 PEPFAR network model of service delivery, 68–70 recommendations for, 15, 244, 259 services for orphans and other vulnerable children, 210, 237 spending, 14, 258 for supportive care, 169, 188–190 twinning strategy, 258 Training in HIV/AIDS prevention blood safety procedures, 129 injection safety, 129–130 mother-to-child transmission, 128 Transmission of HIV infection causes, 137 in focus countries, 62 risk for health care workers, 257 See also Injection drug use; Mother-to-child transmission of HIV; Prevention; Sexual transmission of HIV Treatment budget allocations, 67, 99, 106–107 child patient, 152–153, 155–156 clinical care services and, 172 human resources for, 160 integration with prevention and care activities, 13, 99–100, 134–136, 142, 155, 170 major HIV/AIDS program elements, 48 nondiscrimination in, 14, 82, 91–92 PEPFAR definition, 141, 143 PEPFAR five-year performance targets, 4, 25, 58, 144, 153 PEPFAR policies, 141, 145 recommendations for improving, 13, 142 voluntary counseling and testing in, 186 women’s access, 52 See also Antiretroviral therapy; Care services Tuberculosis, 141, 156, 157, 173, 176 prevention, 183, 185 treatment, 185

OCR for page 363
PEPFAR Implementation: Progress and Promise U Unemployment levels, 58 United Nations, 41, 43, 46, 48, 212, 214, 220 United States current HIV/AIDS program budget, 2, 12, 40–41 interagency coordination, 84–85 leadership role, in HIV/AIDS programs, 18 role in harmonization and coordination, 9 See also specific government entity; specific government program United States Leadership against HIV/AIDS, Tuberculosis, and Malaria Act (Leadership Act) amendments, 63–64 budget allocations, 67, 71–73 evaluation of PEPFAR and, 4, 7, 26–27, 66–67 origins and purpose, 3, 6, 24, 62–63, 64, 246 palliative care provisions, 173 performance targets, 67 research goals, 261 restrictions on funding, 63, 64, 88 services for orphans and other vulnerable children, 67, 208, 210 significant HIV/AIDS provisions, 24, 64 See also President’s Emergency Plan for AIDS Relief (PEPFAR) Urban populations, 51 U.S. Agency for International Development, 84–85, 104, 263 U.S. Leadership against HIV/AIDS, TB and Malaria Act of 2002, 62–63 V Voluntary counseling and testing. See Counseling and testing W Women and girls access to care, 52, 249–250 burden of HIV/AIDS, 53–54 caregiving role, 193, 196, 217, 218 HIV/AIDS manifestations, 53 infection patterns, 52, 53 infection risk, 52–53 Leadership Act provisions, 63 PEPFAR programs and services, 8, 249 prevention program considerations, 130–131 recommendations for services, 8, 244, 250 significance of, in PEPFAR transition to sustainability, 8, 249–252 supportive care for, 196–197 vulnerabilities of young girls, 231 See also Gender differences World Bank, 41 World Health Organization antiretroviral therapy guidelines, 144, 146–147, 148, 154 health care workforce management, 257 medication quality standards, 1–2, 9–10, 142, 158–159, 160 palliative care, 171, 172 Wrap-around services, 199, 201

OCR for page 363
PEPFAR Implementation: Progress and Promise This page intentionally left blank.