A decade ago the world faced the devastating consequences of an HIV pandemic that to many seemed unstoppable. But when the US Government committed support to the response to HIV in 2003 by creating the largest bilateral global health programme in history, it set bold goals. Thanks to its investments in HIV programmes and its health diplomacy efforts in partner countries around the globe, especially in those most affected by HIV, the US initiative known as the President’s Emergency Plan for AIDS Relief (PEPFAR) met or even surpassed most of those goals: saving the lives of millions of people; supporting the scale-up of HIV prevention, care, and treatment; and strengthening systems and policies for the HIV response.1 For example, according to the most recent results reported by PEPFAR, as of September, 2012, the US Government has supported life-saving antiretroviral treatment for nearly 5·1 million men, women, and children worldwide.2 In fiscal year 2012, PEPFAR supported antiretroviral drugs for the prevention of mother-to-child transmission for nearly 750 000 pregnant women who were HIV positive.2 With this success, PEPFAR restored hope to many and changed people’s ideas for what can be accomplished in global health with ambitious aims and ample funding.
PEPFAR’s Congressional reauthorisation in 2008 asked the US Institute of Medicine to assess the effectiveness of the US Government’s response to global HIV/AIDS.3 The assessment, done over 4 years, examines PEPFAR since its inception. It drew on a variety of data sources, including financial data, programme monitoring indicators and clinical data, extensive document review, and primary data collection through more than 400 semi-structured interviews with a range of stakeholders in 13 PEPFAR partner countries, at PEPFAR headquarters, and from other institutions and multilateral agencies involved in the global HIV response. This assessment’s painstaking analysis through rigorous mixed quantitative and qualitative methods provided the assessment committee at the Institute of Medicine with an unprecedented depth of knowledge to speak in a strong voice about how to improve the federal government’s support for the global response to HIV/AIDS. The resulting report, Evaluation of PEPFAR, was released on Feb 20, 2013.
Robert E Black
The Lancet
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