The Presidents Emergency Plan for AIDS Relief

1
The Presidents Emergency Plan for AIDS Relief

• RJ Simonds, MD
• Global AIDS Program
• Centers for Disease Control and Prevention
• Department of Health and Human Services
• December 16, 2003

2
President Bush's Mother and Child HIV Prevention
Initiative
Announced by President Bush on June 19, 2002

• Preventive Treatment and Care Interventions
• If infrastructure is adequate, provide
  combination ARV for pregnant woman and care and
  treatment for family.
• If infrastructure not yet adequate, provide
  short-course nevirapine only.
• Support safe infant feeding.
• Health Care Delivery Systems
• Initiate hospital twinning program.
• Provide Volunteer Health Care Corps assistance.
• Support NGOs, governments to sustain prevention
  efforts.

3
Countries in the Presidents Mother-to-Child
Initiative

• Africa
• Botswana
• Côte dIvoire
• Ethiopia
• Kenya
• Mozambique
• Namibia
• Nigeria
• Rwanda
• South Africa
• Tanzania
• Uganda
• Zambia

• Caribbean
• Guyana
• Haiti
• and Regional efforts through Caribbean Regional
  Epidemiology Centre (Trinidad)

4
Goals of the Mother-to-Child Initiative

• Increase preventive treatment and care for
  pregnant women and their infants
• Improve health care delivery systems in Africa
  and the Caribbean

5
Objectives for the Initiative

• Reach up to 1 million women annually

• Reduce mother-to-child HIV transmission by up
  to 40 among women treated

WHO/P. Virot
6
Presidents Emergency Plan for AIDS Relief

• Announced January 28, 2003
• Targets 14 countries
• Goals
• Prevent 7 million new HIV infections
• Treat 2 million HIV-infected people
• Provide care for 10 million HIV-infected people
  and AIDS orphans

• Overall budget for global AIDS 15 billion
  over 5 years (10 billion new money)

7
Public Law 108-25United States Leadership
Against HIV/AIDS, Tuberculosis, and Malaria Act
of 2003

• Authorizes PEPFAR
• Requires comprehensive 5-year global HIV/AIDS
  strategy by February 2004
• Authorizes Global AIDS Coordinator
• Appropriations pending
• 15th country requested

8
Sense of Congress for Distribution of PEPFAR
Funds
33 of prevention funds should be for
abstinence-until-marriage programs 75 of
treatment funds should be for purchase and
distribution of ARVs
Source Public Law 108-25
9
Global AIDS Coordinator at Department of State
(S/GAC)

• Mr. Randall Tobias was confirmed as the Global
  AIDS Coordinator by the Senate Oct 3, 2003
• Rank of Ambassador reports directly to the
  Secretary of State
• Responsible for oversight and coordination of
  all resources and international activities of the
  U.S. Government to combat the HIV/AIDS pandemic

10
Implementation of PEPFAR

• To be implemented as a single USG program
  coordinated by the Global AIDS Coordinator
• Builds on structure laid down by International
  Mother and Child HIV Prevention Initiative
• Coordinates with other donors at HQ and country
  level
• Works within national plans of countries
• To be implemented based on a "network model of
  health care delivery
• Implementation Tracks
• 1.0, 1.5, 2.0

11
Laboratory Needs for PEPFAR

• Individuals
• Diagnosis of HIV infection (adults and children)
• VCT, blood safety, PMTCT, HIV care
• Determination of eligibility for ARV (e.g., CD4)
• Monitoring for ARV toxicity
• Diagnosis of
• TB
• STI
• malaria
• Programs
• HIV resistance

12
Needs for Implementing Lab Services to Support
PEPFAR

• Space
• Equipment
• Expendable commodities (reagents, gloves,
  needles, syringes, etc.)
• Laboratory guidelines
• Training programs
• Trained or trainable people (technicians,
  administrators, managers)
• Information systems
• Quality assurance programs