S. 1545 

One Hundred Thirteenth Congress 

of the 

United States of America 

AT THE FIRST SESSION 

Begun and held at the City of Washington on Thursday, 

the third day of January, two thousand and thirteen 

An Act 

To extend authorities related to global HIV/AIDS and to promote oversight of 

United States programs. 

Be it enacted by the Senate and House of Representatives of 

the United States of America in Congress assembled, 

SECTION 1. SHORT TITLE. 

This Act may be cited as the ‘‘PEPFAR Stewardship and Oversight Act of 2013’’. 

SEC. 2. INSPECTOR GENERAL OVERSIGHT. 

Section 101(f)(1) of the United States Leadership Against HIV/ 

AIDS, Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7611(f)(1)) 

is amended— 

(1) in subparagraph (A), by striking ‘‘5 coordinated annual 

plans for oversight activity in each of the fiscal years 2009 

through 2013’’ and inserting ‘‘coordinated annual plans for oversight activity in each of the fiscal years 2009 through 2018’’; 

and 

(2) in subparagraph (C)— 

(A) in clause (ii)— 

(i) in the heading, by striking ‘‘SUBSEQUENT’’ and 

inserting ‘‘2010 THROUGH 2013’’; and 

(ii) by striking ‘‘the last four plans’’ and inserting 

‘‘the plans for fiscal years 2010 through 2013’’; and 

(B) by adding at the end the following new clause: 

‘‘(iii) 2014 PLAN.—The plan developed under 

subparagraph (A) for fiscal year 2014 shall be completed not later than 60 days after the date of the 

enactment of the PEPFAR Stewardship and Oversight 

Act of 2013. 

‘‘(iv) SUBSEQUENT PLANS.—Each of the last four 

plans developed under subparagraph (A) shall be completed not later than 30 days before each of the fiscal 

years 2015 through 2018, respectively.’’. 

SEC. 3. ANNUAL TREATMENT STUDY. 

(a) ANNUAL STUDY; MESSAGE.—Section 101(g) of the United 

States Leadership Against HIV/AIDS, Tuberculosis, and Malaria 

Act of 2003 (22 U.S.C. 7611(g)) is amended— 

(1) in paragraph (1), by striking ‘‘through September 30, 

2013’’ and inserting ‘‘through September 30, 2019’’; 

(2) by redesignating paragraph (2) as paragraph (3); 

(3) by inserting after paragraph (1) the following new paragraph: 
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‘‘(2) 2013 THROUGH 2018 STUDIES.—The studies required 

to be submitted by September 30, 2014, and annually thereafter 

through September 30, 2018, shall include, in addition to the 

elements set forth under paragraph (1), the following elements: 

‘‘(A) A plan for conducting cost studies of United States 

assistance under section 104A of the Foreign Assistance 

Act of 1961 (22 U.S.C. 2151b–2) in partner countries, taking 

into account the goal for more systematic collection of data, 

as well as the demands of such analysis on available human 

and fiscal resources. 

‘‘(B) A comprehensive and harmonized expenditure 

analysis by partner country, including— 

‘‘(i) an analysis of Global Fund and national 

partner spending and comparable data across United 

States, Global Fund, and national partner spending; 

or 

‘‘(ii) where providing such comparable data is not 

currently practicable, an explanation of why it is not 

currently practicable, and when it will be practicable.’’; 

and 

(4) by adding at the end the following new paragraph: 

‘‘(4) PARTNER COUNTRY DEFINED.—In this subsection, the 

term ‘partner country’ means a country with a minimum United 

States Government investment of HIV/AIDS assistance of at 

least $5,000,000 in the prior fiscal year.’’. 

SEC. 4. PARTICIPATION IN THE GLOBAL FUND TO FIGHT AIDS, TUBERCULOSIS, AND MALARIA. 

(a) LIMITATION.—Section 202(d)(4) of the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 

(22 U.S.C. 7622(d)(4)) is amended— 

(1) in subparagraph (A)— 

(A) in clause (i), by striking ‘‘2013’’ and inserting 

‘‘2018’’; 

(B) in clause (ii)— 

(i) by striking ‘‘2013’’ and inserting ‘‘2018’’; and 

(ii) by striking the last two sentences; and 

(C) in clause (vi), by striking ‘‘2013’’ and inserting 

‘‘2018’’; and 

(2) in subparagraph (B)— 

(A) by striking ‘‘under this subsection’’ each place it 

appears; 

(B) in clause (ii), by striking ‘‘pursuant to the 

authorization of appropriations under section 401’’ and 

inserting ‘‘to carry out section 104A of the Foreign Assistance Act of 1961’’; and 

(C) in clause (iv), by striking ‘‘2013’’ and inserting 

‘‘2018’’. 

(b) WITHHOLDING FUNDS.—Section 202(d)(5) of the United 

States Leadership Against HIV/AIDS, Tuberculosis, and Malaria 

Act of 2003 (22 U.S.C. 7622(d)) is amended by— 

(1) in paragraph (5)— 

(A) by striking ‘‘2013’’ and inserting ‘‘2018’’; 

(B) in subparagraph (C)— 

(i) by inserting ‘‘in an open, machine readable format’’ after ‘‘site’’; 

(ii) by amending clause (v) to read as follows: 
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‘‘(v) a regular collection, analysis, and reporting 

of performance data and funding of grants of the Global 

Fund, which covers all principal recipients and all 

subrecipients on the fiscal cycle of each grant, and 

includes the distribution of resources, by grant and 

principal recipient and subrecipient, for prevention, 

care, treatment, drugs, and commodities purchase, and 

other purposes as practicable;’’; 

(C) in subparagraph (D)(ii), by inserting ‘‘, in an open, 

machine readable format,’’ after ‘‘audits’’; 

(D) in subparagraph (E), by inserting ‘‘, in an open, 

machine readable format,’’ after ‘‘publicly’’; 

(E) in subparagraph (F)— 

(i) in clause (i), by striking ‘‘; and’’ and inserting 

a semicolon; and 

(ii) by striking clause (ii) and inserting the following new clauses: 

‘‘(ii) all principal recipients and subrecipients and 

the amount of funds disbursed to each principal 

recipient and subrecipient on the fiscal cycle of the 

grant; 

‘‘(iii) expenditure data— 

‘‘(I) tracked by principal recipients and subrecipients by program area, where practicable, 

prevention, care, and treatment and reported in 

a format that allows comparison with other 

funding streams in each country; or 

‘‘(II) if such expenditure data is not available, 

outlay or disbursement data, and an explanation 

of progress made toward providing such expenditure data; and 

‘‘(iv) high-quality grant performance evaluations 

measuring inputs, outputs, and outcomes, as appropriate, with the goal of achieving outcome reporting;’’; 

and 

(F) by amending subparagraph (G) to read as follows: 

‘‘(G) has published an annual report on a publicly 

available Web site in an open, machine readable format, 

that includes— 

‘‘(i) a list of all countries imposing import duties 

and internal taxes on any goods or services financed 

by the Global Fund; 

‘‘(ii) a description of the types of goods or services 

on which the import duties and internal taxes are 

levied; 

‘‘(iii) the total cost of the import duties and internal 

taxes; 

‘‘(iv) recovered import duties or internal taxes; and 

‘‘(v) the status of country status-agreements;’’. 

SEC. 5. ANNUAL REPORT. 

Section 104A(f) of the Foreign Assistance Act of 1961 (22 U.S.C. 

2151b–2(f)) is amended to read as follows: 

‘‘(f) ANNUAL REPORT.— ‘‘(1) IN GENERAL.—Not later than February 15, 2014, and 

annually thereafter, the President shall submit to the Committee on Foreign Relations of the Senate and the Committee 
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on Foreign Affairs of the House of Representatives a report 

in an open, machine readable format, on the implementation 

of this section for the prior fiscal year. 

‘‘(2) REPORT DUE IN 2014.—The report due not later than 

February 15, 2014, shall include the elements required by 

law prior to the enactment of the PEPFAR Stewardship and 

Oversight Act of 2013. 

‘‘(3) REPORT ELEMENTS.—Each report submitted after February 15, 2014, shall include the following: 

‘‘(A) A description based on internationally available 

data, and where practicable high-quality country-based 

data, of the total global burden and need for HIV/AIDS 

prevention, treatment, and care, including— 

‘‘(i) estimates by partner country of the global burden and need; and 

‘‘(ii) HIV incidence, prevalence, and AIDS deaths 

for the reporting period. 

‘‘(B) Reporting on annual targets across prevention, 

treatment, and care interventions in partner countries, 

including— 

‘‘(i) a description of how those targets are designed 

to— 

‘‘(I) ensure that the annual increase in new 

patients on antiretroviral treatment exceeds the 

number of annual new HIV infections; 

‘‘(II) reduce the number of new HIV infections 

below the number of deaths among persons 

infected with HIV; and 

‘‘(III) achieve an AIDS-free generation; 

‘‘(ii) national targets across prevention, treatment, 

and care that are— 

‘‘(I) established by partner countries; or 

‘‘(II) where such national partner countrydeveloped targets are unavailable, a description 

of progress towards developing national partner 

country targets; and 

‘‘(iii) bilateral programmatic targets across prevention, treatment, and care, including— 

‘‘(I) the number of adults and children to be 

directly supported on HIV treatment under United 

States-funded programs; 

‘‘(II) the number of adults and children to 

be otherwise supported on HIV treatment under 

United States-funded programs; and 

‘‘(III) other programmatic targets for activities 

directly and otherwise supported by United Statesfunded programs. 

‘‘(C) A description, by partner country, of HIV/AIDS 

funding from all sources, including funding levels from 

partner countries, other donors, and the private sector, 

as practicable. 

‘‘(D) A description of how United States-funded programs, in conjunction with the Global Fund, other donors, 

and partner countries, together set targets, measure 

progress, and achieve positive outcomes in partner countries. 
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‘‘(E) An annual assessment of outcome indicator 

development, dissemination, and performance for programs 

supported under this section, including ongoing corrective 

actions to improve reporting. 

‘‘(F) A description and explanation of changes in related 

guidance or policies related to implementation of programs 

supported under this section. 

‘‘(G) An assessment and quantification of progress over 

the reporting period toward achieving the targets set forth 

in subparagraph (B), including— 

‘‘(i) the number, by partner country, of persons 

on HIV treatment, including specifically— 

‘‘(I) the number of adults and children on HIV 

treatment directly supported by United Statesfunded programs; and 

‘‘(II) the number of adults and children on 

HIV treatment otherwise supported by United 

States-funded programs; 

‘‘(ii) HIV treatment coverage rates by partner 

country; 

‘‘(iii) the net increase in persons on HIV treatment 

by partner country; 

‘‘(iv) new infections of HIV by partner country; 

‘‘(v) the number of HIV infections averted; 

‘‘(vi) antiretroviral treatment program retention 

rates by partner country, including— 

‘‘(I) performance against annual targets for 

program retention; and 

‘‘(II) the retention rate of persons on HIV treatment directly supported by United States-funded 

programs; and 

‘‘(vii) a description of supportive care. 

‘‘(H) A description of partner country and United 

States-funded HIV/AIDS prevention programs and policies, 

including— 

‘‘(i) an assessment by country of progress towards 

targets set forth in subparagraph (B), with a detailed 

description of the metrics used to assess— 

‘‘(I) programs to prevent mother to child transmission of HIV/AIDS, including coverage rates; 

‘‘(II) programs to provide or promote voluntary 

medical male circumcision, including coverage 

rates; 

‘‘(III) programs for behavior-change; and 

‘‘(IV) other programmatic activities to prevent 

the transmission of HIV; 

‘‘(ii) antiretroviral treatment as prevention; and 

‘‘(iii) a description of any new preventative interventions or methodologies. 

‘‘(I) A description of the goals, scope, and measurement 

of program efforts aimed at women and girls. 

‘‘(J) A description of the goals, scope, and measurement 

of program efforts aimed at orphans, vulnerable children, 

and youth. 

‘‘(K) A description of the indicators and milestones 

used to assess effective, strategic, and appropriately timed 

country ownership, including— 
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‘‘(i) an explanation of the metrics used to determine 

whether the pace of any transition to such ownership 

is appropriate for that country, given that country’s 

level of readiness for such transition; 

‘‘(ii) an analysis of governmental and local nongovernmental capacity to sustain positive outcomes; 

‘‘(iii) a description of measures taken to improve 

partner country capacity to sustain positive outcomes 

where needed; and 

‘‘(iv) for countries undergoing a transition to 

greater country ownership, a description of strategies 

to assess and mitigate programmatic and financial risk 

and to ensure continued quality of care for essential 

services. 

‘‘(L) A description, globally and by partner country, 

of specific efforts to achieve and incentivize greater programmatic and cost effectiveness, including— 

‘‘(i) progress toward establishing common economic 

metrics across prevention, care and treatment with 

partner countries and the Global Fund; 

‘‘(ii) average costs, by country and by core intervention; 

‘‘(iii) expenditure reporting in all program areas, 

supplemented with targeted analyses of the costeffectiveness of specific interventions; and 

‘‘(iv) import duties and internal taxes imposed on 

program commodities and services, by country. 

‘‘(M) A description of partnership framework agreements with countries, and regions where applicable, 

including— 

‘‘(i) the objectives and structure of partnership 

framework agreements with countries, including— 

‘‘(I) how these agreements are aligned with 

national HIV/AIDS plans and public health strategies and commitments of such countries; and 

‘‘(II) how these agreements incorporate a role 

for civil society; and 

‘‘(ii) a description of what has been learned in 

advancing partnership framework agreements with 

countries, and regions as applicable, in terms of 

improved coordination and collaboration, definition of 

clear roles and responsibilities of participants and 

signers, and implications for how to further strengthen 

these agreements with mutually accountable measures 

of progress. 

‘‘(N) A description of efforts and activities to engage 

new partners, including faith-based, locally-based, and 

United States minority-serving institutions. 

‘‘(O) A definition and description of the differentiation 

between directly and otherwise supported activities, 

including specific efforts to clarify programmatic attribution 

and contribution, as well as timelines for dissemination 

and implementation. 

‘‘(P) A description, globally and by country, of specific 

efforts to address co-infections and co-morbidities of HIV/ 

AIDS, including— 
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‘‘(i) the number and percent of people in HIV care 

or treatment who started tuberculosis treatment; and 

‘‘(ii) the number and percentage of eligible HIV 

positive patients starting isoniazid preventative 

therapy. 

‘‘(Q) A description of efforts by partner countries to 

train, employ, and retain health care workers, including 

efforts to address workforce shortages. 

‘‘(R) A description of program evaluations completed 

during the reporting period, including whether all completed evaluations have been published on a publically 

available Internet website and whether any completed 

evaluations did not adhere to the common evaluation standards of practice published under paragraph (4). 

‘‘(4) COMMON EVALUATION STANDARDS.—Not later than February 1, 2014, the Global AIDS Coordinator shall publish on 

a publically available Internet website the common evaluation 

standards of practice referred to in paragraph (3)(R). 

‘‘(5) PARTNER COUNTRY DEFINED.—In this subsection, the 

term ‘partner country’ means a country with a minimum United 

States Government investment of HIV/AIDS assistance of at 

least $5,000,000 in the prior fiscal year.’’. 

SEC. 6. ALLOCATION OF FUNDING. 

(a) ORPHANS AND VULNERABLE CHILDREN.—Section 403(b) of 

the United States Leadership Against HIV/AIDS, Tuberculosis, and 

Malaria Act of 2003 (22 U.S.C. 7673(b)) is amended— 

(1) by striking ‘‘2013’’ and inserting ‘‘2018’’; and 

(2) by striking ‘‘amounts appropriated pursuant to the 

authorization of appropriations under section 401’’ and 

inserting ‘‘amounts appropriated or otherwise made available 

to carry out the provisions of section 104A of the Foreign 

Assistance Act of 1961 (22 U.S.C. 2151b–2)’’. 

(b) FUNDING ALLOCATION.—Section 403(c) of the United States 

Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 

2003 (22 U.S.C. 7673(c)) is amended— 

(1) by striking ‘‘2013’’ and inserting ‘‘2018’’; and 

(2) by striking ‘‘amounts appropriated for bilateral global 

HIV/AIDS assistance pursuant to section 401’’ and inserting 

‘‘amounts appropriated or otherwise made available to carry 
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out the provisions of section 104A of the Foreign Assistance 

Act of 1961 (22 U.S.C. 2151b–2)’’. 

Speaker of the House of Representatives. 

Vice President of the United States and

President of the Senate.