# Presentation: 245947

## The President’s 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

## President Bush's Mother and Child HIV Prevention Initiative

- _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.

- Announced by President Bush on
- June 19, 2002

## Countries in the President’s Mother-to-Child Initiative

_**Africa**_
- Botswana
- Côte d’Ivoire
- Ethiopia
- Kenya
- Mozambique
- Namibia
- Nigeria
- Rwanda
- South Africa
- Tanzania
- Uganda
- Zambia

_**Caribbean**_
- Guyana
- Haiti
-  *and* Regional efforts through Caribbean Regional Epidemiology Centre (Trinidad)

**Notes:**
The Administration selected these 14 countries based on 
the burden of HIV/AIDS, particularly as indicated by ANC data, 
the level of infrastructure to support targeted efforts to prevent mother-to-child HIV transmission, 
the individual country governments’ commitment to preventing HIV and treating those infected.

## 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

## Objectives for the Initiative

- Reach up to	1 million women annually

*WHO/P. Virot*

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

## President’s 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)

## Public Law 108-25:United 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

## “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

## 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”

## 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

## 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

## 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