October 7, 2019 On October 7, 2019, the Harvard Global Health Institute will host a one-day symposium to explore what enabled this visionary program, and to showcase how it has transformed not just the worldwide HIV/AIDS response but global health delivery more broadly. There are many lessons learned in PEPFAR’s story - from what it took to build a supply chain where there was none, to establishing the use of generic antiretroviral therapies (ARTs) and leveraging human capacity. This event convened the early architects of PEPFAR as well as experts and implementers currently leading the charge. We took a historically informed look at what it will take to stop global transmission, and shared tools useful for others hoping to move the needle on vexing problems in global health. For more information, visit our website at https://petrieflom.law.harvard.edu/events/details/15-years-of-pepfar

1. 2009 – 2013 From an Emergency
Response to Local Ownership
and Systems Strengthening
Charles Holmes
MD, MPH

2. • Background on PEPFAR legislation and economic
environment 2009-2013
• Consolidation of gains and improving quality and
efficiency for greater impact
• Enhancing country ownership
• Accelerating scale-up and effectiveness of
programs
• Global Plan for PMTCT and maternal health
• Accelerating science and data to policy
• Rapid expansion of combination
prevention/treatment

4. GDP growth, 2000-2015
IMF, World Economic Outlook, 2016

5. Hyde-Lantos Tom Lantos and Henry J. Hyde United States Global Leadership
Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act
July 24, 2008

6. PEPFAR-Supported Scale-up of Treatment
67,100
249,000
541,300
1,091,700
1,743,600
2,485,300
0
500,000
1,000,000
1,500,000
2,000,000
2,500,000
3,000,000
2004 2005 2006 2007 2008 2009
Number of people directly supported on treatment by
PEPFAR

7. U.S.G. Funding for the President’s Emergency Plan for AIDS Relief
Kaiser Family Foundation

9. Consolidation of gains, and improving quality and
efficiency for greater impact

12. Distribution of USG expenditure per person receiving HIV testing and
counseling, by partner and province – Mozambique

13. Greater efficiency = More lives saved
Expanded procurement via a pooled supply chain management
system.
Expanded use of generic antiretroviral drugs (ARVs) – by 2011 over
98% of the ARV packs purchased by PEPFAR were generic, up from
15% in 2005
Switching from air to land and sea freight
Maximizing investment impact through better coordination with the
Global Fund and the elimination of parallel systems

14. U.S.G. Funding for the President’s Emergency Plan for AIDS Relief
Kaiser Family Foundation

15. Country ownership through strengthened transparency,
accountability and partnership: Partnership Frameworks
Hanoi, Vietnam July 22, 2010

16. Country ownership through strengthened
transparency and partnership

17. Accelerating scale-up, effectiveness and impact of
programs
• Global Plan for elimination of mother of child HIV
transmission and keeping mothers alive
• Accelerating science and data to policy
• Combination prevention/ART scale-up

18. A crisis in 2009: new infant infections and
pregnant women dying of HIV
In 2009, 370 000 children became newly infected with HIV globally
and an estimated 50 000 pregnant women died because of HIV

20. UNAIDS, 2014

21. 2014 Global Plan Progress Report
Groundbreaking progress in preventing infant HIV infections and saving
the lives of pregnant women through HIV treatment

22. Accelerating science and data to policy

23. Increasing effectiveness through science in
PEPFAR policymaking and programs
• Established the PEPFAR Office of Research and Science
• Collaborated with CDC, USAID and NIH on a series of funding opportunities
centered around implementation science
• Carefully targeted to areas in which we had the greatest investments and
questions about how to optimize delivery, the application of emerging
diagnostic/therapeutic technologies, and under-reached key populations
• Established the Federally chartered PEPFAR scientific advisory board
• Distinguished scientists from academia, USG agencies, and experts in program
implementation and policy
• To help us to ground our programs and policies in the best science

24. Emerging science to policy

25. December 1, 2011

26. Robust PEPFAR-supported scale-up, 2009-2013
PEPFAR Annual VMMC
0
1
2
3
4
5
6
7
8
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Millions
Patients Currently Receiving
ART (2004-2013)
0
2
4
6
8
10
12
14
2005 2006 2007 2008 2009 2010 2011 2012 2013
Millions
ANC Clients who know HIV Status

27. PEPFAR
2009 – 2013
takeaways
• Pivotal era for starting the process of viewing countries more as partners
than recipients, and looking for every opportunity to support their leadership
• This did not slow us down, but was rather a constituent part of the successes
we had continuing to scale within the bounds of resource constraints
• We were able to build systems that have now been adapted by others in
global health to closely track the value for money for each dollar spent, and
to enhance coordination and decision-making
• We were able to both generate more relevant science and make better use
of science discoveries as a tool to save more lives and prevent new infections
• And ultimately brought effective interventions to millions of people during
this era, in a way that could serve as a model for other global health efforts

28. Moving forward together!