The Presidents Emergency Plan For AIDS Relief PEPFAR

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The Presidents Emergency Plan For AIDS Relief
(PEPFAR)

• AMSA PREMED GHLI 2008 (G2)
• Nkemka EsiobuLydia HartsellCarissa Chu

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OUTLINE

• Background The Global AIDS Epidemic
• PEPFAR 2008 Reauthorization Mission Guiding
  Principles
• PEPFAR Structure Focus Countries
• Progress Since 2003
• Strengths and Weaknesses
• Accountability Sustainability
• Opportunities for Advocacy AMSA

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The Global AIDS Epidemic

• 2.7 million infected in 2007
• 6,800 every day
• 1 person every 20 seconds!
• 33 million people living with HIV worldwide
• 2007 33.2 million
• 2006 40.0 million
• Note Decreasing numbers

(2008 UNAIDS Report on Global AIDS)
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The Global Burden of HIV/AIDS
The Global AIDS Epidemic
Based on 2003 Figures. http//www.worldmapper.org/
display.php?selected227
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PEPFAR
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15 Focus Countries
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Structure Guiding Principles

• PEPFAR authorizes money for bilateral and
  multilateral efforts
• Largest international health initiative in
  history dedicated to a single disease
• Managed by the Department of State. Focus on
  integrated prevention, treatment, AND care
• Recipients must provide Country Operational Plans
  (a plan with measurable outcomes)
• Principle of Three Ones One National Strategy,
  One Coordinating Authority, One Monitoring and
  Evaluation System

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PEPFAR 2003 15b over 5 years

• Successes
• 5 years ago, only 50,000 PLWHA in all of
  sub-Saharan Africa were receiving ART
• In 2008, ART was provided to 1.7 million PLWHA
• There are currently 22m PLWHA in sub-Saharan
  Africa
• 2.7 million HIV/AIDS Orphans and Vulnerable
  Children have received care

Source UNAIDS 2008 Global Report
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PEPFAR 2003 15b over 5 years

• Criticism
• Restrictions/limitations on use of generic drugs
  (lack of access to second line treatment)
• Greater priority and assistance given to
  abstinence-only programs
• Overly vertical, causing brain drain
• Needed much more money for scale up

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PEPFAR Reauthorization 2008 48b

• Aims to strengthen health systems
• Broaden the scope of programs (diagonalization)
• 37b for PEPFAR Bilateral Programs
• 4b for TB (bilateral programs)
• 5b for Malaria (bilateral, President's Malaria
  Initiative)
• 2b for the Global Fund to Fight AIDS, TB, and
  Malaria
• 2-7-10" Goals for 2008
• 2 million receiving treatment
• 7 million infections averted
• 10 million receiving care

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All Funding for HIV/AIDS
Source Global Health Council
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SUSTAINABILITY THE FUTURE

• Sustainability capability of being maintained at
  a certain rate or level
• EXPANSION PEPFAR will further expand efforts to
  strengthen health systems and to collaborate with
  programs that address malaria, tuberculosis,
  child and maternal health, clean water, food and
  nutrition, education, and other needs

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3 Important Factors for Health Systems
Sustainability

• Reciprocity or bidirectional relation between a
  populations health and the health program.
• Relationship between health programs and their
  sponsors to ensure proper flow of resources
• Identification and prioritization of health
  concerns

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Healthcare Worker Shortage

• Africa has 25 of the worlds disease burden but
  only 3 of the worlds health workers.
• 4.3 million more health care workers required to
  meet Millennium Development Goals particularly in
  Africa
• The Brain Drain - Developing countries face
  exodus of skilled workers from healthcare system

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The Global Burden of Disease
Based on 2003 Figures. http//www.worldmapper.org/
display.php?selected227
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Healthcare Workforce Shortages
Based on 2003 Figures. http//www.worldmapper.org/
display.php?selected219
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How is PEPFARcontributing to the problem?

• Internal Brain Drain
• Movement of healthcare workers from public sector
  to donor sector, particularly international NGOs
  
• Sustainability of HIV programs and primary health
  care is threatened by this phenomenon
• PEPFAR provided limited support for pre-service
  training
• 1 million per focus country (FY 07)
• 3 million per focus country (FY 08)

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World Health Organization

• It will not be possible to fully address the HIV
  and AIDS crisis without a significant increase in
  the number of health care workers in the global
  South.
• As initiatives to increase treatment, prevention,
  and care expand (including PEPFAR and the Global
  Fund), they will require more and more health
  professionals to fulfill their programmatic
  goals.
• If there is not a significant increase in health
  care workers (which there hasnt been to date),
  these programs will pull health professionals
  from other parts of the public health community
  (reproductive, child survival, etc.) and leave
  those sectors with an even more severe shortage
  of health care workers.

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PEPFAR 2008 Progress Future Change

• Reauthorization increased commitment to train and
  retain at least 140,000 health care professionals
  and paraprofessionals.
• WHO Guidelines 2.3 Healthcare Workers/1000
  population

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Importance of forming partnerships

• One voice in advocacy
• GAR (Global AIDS Roundtable), Malaria and TB
  Roundtable
• Federal AIDS Policy Partnership (FAPP)
  Presidents Advisory Council on HIV/AIDS (PACHA)
• Wellness Center for Health Care Workers
• Provision of health support for healthcare
  workers and their families funded and initiated
  by PEPFAR, BD (Bector, Dickinson and Company),
  and ICN (International Council of Nurses).
  (Uganda, Lesotho, Swaziland, and Zambia)
• Supply Chain Management System
• 3-year funding of 500 M 77 M (technical
  assistance) to increase drug and commodity
  distribution networks in the 15 PEPFAR focus
  countries

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Programs for HIV/TB Co-infection

• TB is responsible for most deaths among HIV
  individuals
• 85 of the burden of HIV/AIDS-TB coinfection is
  in Africa
• ARVs spare 8 out of 10 people from contracting TB
• 2008 Study ARVs are helping to protect against
  TB
• Screening Services
• lt 10 of TB patients are tested for HIV in Africa
• HIV/AIDS patients suspected of TB receive
  screening for TB because diagnosis based on
  symptoms of TB is increasingly inaccurate
• TB patients receive free HIV testing
• Concerns Drug interaction, confidentiality in
  testing

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Integration of Health Interventions

• Counseling Services
• Family planning (contraceptives, sex education)
  integrated with HIV/AIDS counseling services
• Reproductive Health
• Contraceptive use also reduces many other STIs
  (Sexually Transmitted Infections)
• Malaria Prevention
• Provision of ITNs (Insecticide-treated nets)
  with prenatal and antenatal programs to protect
  against malaria and a host of other neglected
  diseases
• Maternal Health
• PMTCT (Preventing Mother-to-Child Transmission)
  services for HIV-infected mothers in conjunction
  with antenatal care

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Community Building with PEPFAR

• Food and Nutrition
• Psychosocial Counseling
• Care for Orphans and Vulnerable Children
• Access to primary education
• Vocational training, microfinancing ventures
• Community networks strengthening
• The bottom line Individual Empowerment

The HIV/AIDS pandemic strikes at the heart of
family and community support structures
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Provision of Food and Nutrition

• In 2008, PEPFAR updated its guidance to allow
  country teams to provide food support to patients
  in ARV treatment programs with a BMI lower than
  18.5
• Used to be 16
• In accordance with updated WHO guidance
• United States 25 (average for boys)
• Countries reported that activities planned in
  their FY 2008 Country Operational Plans include
  more than 93 million of food and
  nutrition-related activities

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Food and Nutrition Extent of Aid

• PEPFAR FUNDS ARE NOT AUTHORIZED TO
• Directly support the agriculture sector
• School feeding programs for all school children
• Broad-based food-assistance and food-security
• But, these services can be linked in partnership
  with other entities, such as the United Nations
  World Food Programme (WFP) and with host country
  governments

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Food and Nutrition I-LIFE Consortium, Malawi

• USAID-funded program involving 7 NGOs
• Villagers pick up monthly ration of cornmeal
  (55lb) (5lb) beans
• Vulnerable (eligible) Families with HIV
  guardians
• Required to take part in Hope Kit program,
  which uses drama and humor to teach hygiene,
  nutrition, and safe behavior
• Support nutritional needs, local farming
  industry, and provide valuable health services

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Goal A Global Health Strategy

• Create a holistic, strategic framework that
  incorporates all activities and actors
  contributing to global health outcomes for the
  individual patient and the local health system

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GET INVOLVED

• http//08stopaids.org/
• http//www.pepfar.gov/documents/organization/81097
  .pdf
• World AIDS Day Dec. 1, 2008
• Participate in local rallies to raise awareness
  about global AIDS
• Local testing events
• Contact local health department

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Bibilography

• 2008 UNAIDS Report on Global AIDS
• World Mapper http//www.worldmapper.org/display.ph
  p?selected227
• The Global Health Council
• http//www.globalhealth.org
• The World Health Organization
• http//www.who.int/en
• USAID
• http//www.usaid.gov