Performance Goal Statement: By September 30, 2017, U.S. health assistance for combating HIV/AIDS will support progress in creating an AIDS-free generation by increasing the number of people receiving comprehensive, evidence-based HIV/AIDS prevention, care, and treatment services.
Performance Goal Overview
The U.S. Government is committed to making strategic, scientifically sound investments to help scale up HIV prevention, treatment, and care interventions, particularly in high-burden countries. The HIV/AIDS epidemic continues to impact much of the world, and in many low- and middle-income countries, recent studies reveal that HIV disproportionately impacts key populations and demonstrates the existence of concentrated epidemics in these groups.
The U.S. Government’s HIV/AIDS assistance is coordinated through the Office of the U.S. Global AIDS Coordinator to implement the PEPFAR. It continues to expand and progress, contributing to the dramatic improvements seen in many national epidemic trends. The U.S. Government effort has been instrumental in this successful transition, but this level of effort must be increased on a global scale if the goal of an AIDS-free generation and epidemic control is to be achieved. This global response is framed in the context of the UNAIDS ambitious 90-90-90 global goals: 90 percent of all people living with HIV will know their HIV status; 90 percent of all people with diagnosed HIV infection will receive sustained antiretroviral therapy; and 90 percent of all people receiving antiretroviral therapy will have viral suppression by 2020. This goal is dependent on a dramatic pivot in how PEPFAR conducts business, focusing on a greater use of data and evidence-based interventions to target geographic areas and specific populations where disease burden is greatest. PEPFAR efforts are also dependent on linkages between U.S. efforts with those of partner countries, major bilateral and multilateral actors, civil society, people living with HIV/AIDS, faith-based organizations, foundations, and the private sector.
This collaborative relationship continues to evolve in conjunction with a focus on a more data-driven agenda that targets geographic areas and populations where impacts will be greatest.
While global results associated with this larger effort are a more complete illustration of progress, in this report the focus is on PEPFAR’s contribution to this combined work. PEPFAR is a major driver of these achievements, and as this new phase expands, this pivot in approach will continue to place more emphasis on impact, efficiency, sustainability, partnership, and human rights in the fight against this epidemic. On World AIDS Day (December 1, 2015), President Obama announced bold two-year targets for PEPFAR, reaching 12.9 million persons on ART, 13 million VMMC, and a 40 percent reduction in new infections.
Key Indicator: Number of adults and children with advanced HIV infection receiving Antiretroviral Therapy (ART)
FY 2012 FY 2013 FY 2014 FY 2015 FY 2016 FY 2017
Target N/A N/A N/A N/A 11.4 million* 12.9 million*
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Result 5.1 million 6.7 million 7.7 million 9.5 million
*Targets were set based on President Obama’s announcement for World AIDS Day in 2015.
Indicator Analysis
PEPFAR support in FY 2015 helped a total of 9.5 million persons to receive life-saving antiretroviral treatment.
This result continues the trend in growth experienced over the last several years of U.S. Government support to country programs. This increase in numbers is largely due to countries adopting the WHO guidelines of treating those with a CD4 cell count (also known as T-cells) of less than 500 versus 350, which allows more people to enroll in treatment, and an aggressive scale up of treatment.
A new reporting framework now permits a disaggregation of data according to the type of support provided, which allows PEPFAR to better describe its contribution to national and global efforts. Direct Service Delivery (DSD) support requires PEPFAR investment towards critical inputs such as health care worker salaries or
commodities at the site-level, in addition to an established or a routinized presence (e.g., quarterly visits) at the point of service delivery to ensure quality services are provided. Technical Assistance for Service Delivery Improvement (TA-DSI) support is defined by the provision of essential technical support to the site, at least on a quarterly basis. This technical support may take the form of clinical mentorship, supportive supervision, site-level quality improvement or quality assurance support, as well as routine support of monitoring, evaluation, and reporting activities, just to name a few examples. This year PEPFAR supported 5.8 million persons receiving antiretrovirals consistent with the DSD level of effort and 3.7 million persons consistent with the TA-DSI level.
Indicator Methodology
Data source: Data are submitted by country teams to headquarters on a quarterly basis. These data represent the achievements of actual performance by partners at treatment sites in countries where PEPFAR provides support. Typically data are managed by these partners and subjected to a variety of quality control and assurance measures. Once submitted to the PEPFAR team in-country, the U.S. Government team conducts additional quality assurance procedures. This information is then forwarded to headquarters, where a team of advisors performs one more quality analysis.
Data Quality: PEPFAR works continuously with partners and country teams to strengthen data quality assurance procedures and practices. Use of the DSD and TA-DSI data types was introduced this year for the first time, and some reporting issues were evident in most countries. These problems will be resolved as implementing partners, country teams, and headquarter personnel become more familiar with these new methods. PEPFAR has also initiated the PEPFAR Oversight, Accountability, and Response Team process, a joint field and
headquarters effort through which data quality is reviewed and addressed throughout the year.
Key Indicator: Number of HIV-positive pregnant women who received antiretrovirals to reduce risk of mother-to-child transmission
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FY 2012 FY 2013
Baseline FY 2014 FY 2015 FY 2016 FY 2017
Target N/A N/A N/A N/A 766,898* TBD
Result 747,300 781,800 745,369 832,000
*Targets were set based on President Obama’s announcement for World AIDS Day in 2015.
Indicator Analysis
This indicator documents the provision of antiretroviral to HIV-positive pregnant women in PEPFAR-supported programs. Focusing only on PEPFAR-supported service delivery programs provides a description of the scale of PEPFAR effort, permitting an improved understanding of PEPFAR progress in this strategic framework.
The PEPFAR 2015 results of providing 832,000 for antiretroviral therapy for pregnant women continue along the same positive trend exhibited over the last decade, and this figure reverses the drop in numbers from 2014.
This dip in values was interpreted to be associated with a decrease in HIV prevalence among pregnant women, even as the number of pregnant women tested increased. This lower prevalence is consistent with a decreasing global HIV incidence. UNAIDS’ 2014 Progress Report on the Global Plan cites program saturation in some countries as a potential explanation for the lower testing and treatment results. Alternatively, another explanation proposed was that testing was not focused in the correct geographic location within a country.
During 2015, in conjunction with the PEPFAR 3.0 pivot to locations with greater disease burden, the results grew significantly relative to the previous year. These results validate the PEPFAR 3.0 realignment and call attention to the ongoing and increasing need for services in these operating units.
As noted for the treatment indicator, a new reporting framework now permits a disaggregation of data according to the type of support provided. DSD support requires PEPFAR investment towards critical inputs such as health care worker salaries or commodities at the site-level, in addition to an established or a routinized presence (e.g., quarterly visits) at the point of service delivery to ensure quality services are provided. TA-SDI support is defined by the provision of essential technical support to the site, at least on a quarterly basis. This technical support may take the form of clinical mentorship, supportive supervision, site-level quality
improvement or quality assurance support, as well as routine support of monitoring, evaluation, and reporting activities, just to name a few examples. PEPFAR support 489,000 HIV-positive pregnant women at the DSD level of effort and 343,000 at the TA-DSI level.
Indicator Methodology
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Data source: Data are submitted by country teams to headquarters on a semi-annual basis. These data represent the achievements of actual performance by partners at PMTCT sites in countries where PEPFAR provides support. Typically data are managed by these partners and subjected to a variety of quality control and assurance measures. Once submitted to the PEPFAR team in-country, the U.S. Government team conducts additional quality assurance procedures. This information is forwarded to headquarters where a team of advisors performs one more quality analysis.
Data Quality: PEPFAR works continuously with partners and country teams to strengthen data quality assurance procedures and practices. Use of the DSD and TA-DSI data types was introduced this year for the first time, and some reporting issues were evident in most countries. These problems will be resolved as implementing partners, country teams, and headquarter personnel become more familiar with these new methods.
Key Indicator: Number of males circumcised as part of the Voluntary Medical Male Circumcisions (VMMC) for HIV prevention program
FY 2012 FY 2013 FY 2014 FY 2015 FY 2016 FY 2017
Target N/A N/A N/A N/A 11,000,000 13,000,000
Result 1,131,901 2,230,075 2,242,267 2,573,000
*Targets were set based on President Obama’s announcement for World AIDS Day in 2015.
Indicator Analysis
VMMC is a one-time, low cost intervention shown to reduce men’s risk of HIV infection by approximately 60 percent. This medical intervention has the potential to save millions of lives and billions of dollars in future HIV/AIDS treatment costs. The procedure is also drawing millions of men into health services – some for the first time in their lives. WHO recommends VMMC as part of a comprehensive package of HIV prevention services, and PEPFAR supports the implementation of VMMC in 14 East and Southern African countries, which have the highest unmet need for this intervention and where programs will have the greatest return on investment. In conjunction with ARV Treatment and PMTCT, VMMC comprises the third medically based component of the combination prevention strategy implemented globally.
At the end of FY 2015, after eight years of VMMC for HIV prevention programming, PEPFAR had supported more than nine million VMMC procedures in 14 east and southern African countries. Approximately 2.57 million of these were in FY 2015 alone, the greatest reach of the program in any single year to date. In coordination with ART scale-up, PEPFAR-supported VMMC programs in high burden areas—where HIV transmission is likely to be highest—to reduce viral acquisition among men, and in turn prevent onward transmission to women. These
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efforts will further focus on increasing VMMC coverage among age groups most immediately at risk of sexually acquiring HIV, primarily older adolescents and young adults. PEPFAR programs continue to strive to achieve 80 percent adult male circumcision prevalence (equating to 20.3 million circumcisions) among the 14 countries to maximally and efficiently reduce HIV incidence in the shortest period of time possible and contribute to
PEPFAR’s overarching strategies for epidemic control. VMMC is also promoted as a complement to the DREAMS (Determined-Resilient-Empowered-AIDS-Free-Mentored-Safe) Initiative targeting adolescent girls and young women to aggressively reduce the number of new infections within this highly vulnerable cohort.
Indicator Methodology
Data source: Data are submitted by country teams to headquarters on a semi-annual basis. These data represent the achievements of actual performance by partners at treatment sites in countries where PEPFAR provides support. Typically data are managed by these partners and subjected to a variety of quality control and assurance measures. Once submitted to the PEPFAR team in-country, the U.S. Government team conducts
additional quality assurance procedures. This information is forwarded to headquarters, where a team of advisors performs one more quality analysis.
Data quality: PEPFAR works continuously with partners and country teams to strengthen data quality assurance procedures and practices. Use of the DSD and TA-DSI data types was introduced this year for the first time, and some reporting issues were evident in most countries. These problems will be resolved as implementing partners, country teams, and headquarter personnel become more familiar with these new methods.