II 

Calendar No. 202 

113TH CONGRESS 

1ST SESSION S. 1545 

[Report No. 113–112] 

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

of United States programs. 

IN THE SENATE OF THE UNITED STATES 

SEPTEMBER 24, 2013 

Mr. MENENDEZ (for himself and Mr. CORKER) introduced the following bill; 

which was read twice and referred to the Committee on Foreign Relations 

OCTOBER 2, 2013 

Reported by Mr. MENENDEZ, with amendments 

[Omit the part struck through and insert the part printed in italic] 

A BILL 

To extend authorities related to global HIV/AIDS and to 

promote oversight of United States programs. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘PEPFAR Stewardship 

5 and Oversight Act of 2013’’. 


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1 SEC. 2. INSPECTOR GENERAL OVERSIGHT. 

2 Section 101(f)(1) of the United States Leadership 

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

4 2003 (22 U.S.C. 7611(f)(1)) is amended— 

5 (1) in subparagraph (A), by striking ‘‘5 coordi6 nated annual plans for oversight activity in each of 

7 the fiscal years 2009 through 2013’’ and inserting 

8 ‘‘coordinated annual plans for oversight activity in 

9 each of the fiscal years 2009 through 2018’’; and 

10 (2) in subparagraph (C)— 

11 (A) in clause (ii)— 

12 (i) in the heading, by striking ‘‘SUB13 SEQUENT’’ and inserting ‘‘2010 THROUGH

14 2013’’; and 

15 (ii) by striking ‘‘the last four plans’’ 

16 and inserting ‘‘the plans for fiscal years 

17 2010 through 2013’’; and 

18 (B) by adding at the end the following new 

19 clause: 

20 ‘‘(iii) 2014 PLAN.—The plan devel21 oped under subparagraph (A) for fiscal 

22 year 2014 shall be completed not later 

23 than 60 days after the date of the enact24 ment of the PEPFAR Stewardship and 

25 Oversight Act of 2013. 


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1 ‘‘(iv) SUBSEQUENT PLANS.—Each of 

2 the last four plans developed under sub3 paragraph (A) shall be completed not later 

4 than 30 days before each of the fiscal 

5 years 2015 through 2018, respectively.’’. 

6 SEC. 3. ANNUAL TREATMENT STUDY. 

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

8 the United States Leadership Against HIV/AIDS, Tuber9 culosis, and Malaria Act of 2003 (22 U.S.C. 7611(g)) is 

10 amended— 

11 (1) in paragraph (1), by striking ‘‘through Sep12 tember 30, 2013’’ and inserting ‘‘through September 

13 30, 2019’’; 

14 (2) by redesignating paragraph (2) as para15 graph (3); 

16 (3) by inserting after paragraph (1) the fol17 lowing new paragraph: 

18 ‘‘(2) 2013 THROUGH 2018 STUDIES.—The stud19 ies required to be submitted by September 30, 2014, 

20 and annually thereafter through September 30, 

21 2018, shall include, in addition to the elements set 

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

23 ‘‘(A) A plan for conducting cost studies of 

24 United States assistance under section 104A of 

25 the Foreign Assistance Act of 1961 (22 U.S.C. 


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1 2151b–2) in partner countries, taking into ac2 count the goal for more systematic collection of 

3 data, as well as the demands of such analysis 

4 on available human and fiscal resources. 

5 ‘‘(B) A comprehensive and harmonized ex6 penditure analysis by partner country, includ7 ing— 

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

9 national partner spending and comparable 

10 data across United States, Global Fund, 

11 and national partner spending; or 

12 ‘‘(ii) where providing such comparable 

13 data is not currently practicable, an expla14 nation of why it is not currently prac15 ticable, and when it will be practicable.’’; 

16 and 

17 (4) by adding at the end the following new 

18 paragraph: 

19 ‘‘(4) PARTNER COUNTRY DEFINED.—In this 

20 subsection, the term ‘partner country’ means a coun21 try with a minimum United States Government in22 vestment of HIV/AIDS assistance of at least 

23 $5,000,000 annually in the prior fiscal year.’’. 


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1 SEC. 4. PARTICIPATION IN THE GLOBAL FUND TO FIGHT 

2 AIDS, TUBERCULOSIS, AND MALARIA. 

3 (a) LIMITATION.—Section 202(d)(4) of the United 

4 States Leadership Against HIV/AIDS, Tuberculosis, and 

5 Malaria Act of 2003 (22 U.S.C. 7622(d)(4)) is amended— 

6 (1) in subparagraph (A)— 

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

8 inserting ‘‘2018’’; 

9 (B) in clause (ii)— 

10 (i) by striking ‘‘2013’’ and inserting 

11 ‘‘2018’’; and 

12 (ii) by striking the last two sentences; 

13 and 

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

15 inserting ‘‘2018’’; and 

16 (2) in subparagraph (B)— 

17 (A) by striking ‘‘under this subsection’’ 

18 each place it appears; 

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

20 the authorization of appropriations under sec21 tion 401’’ and inserting ‘‘to carry out section 

22 104A of the Foreign Assistance Act of 1961’’; 

23 and 

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

25 inserting ‘‘2018’’. 


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

2 United States Leadership Against HIV/AIDS, Tuber3 culosis, and Malaria Act of 2003 (22 U.S.C. 7622(d)) is 

4 amended by— 

5 (1) in paragraph (5)— 

6 (A) by striking ‘‘2013’’ and inserting 

7 ‘‘2018’’; 

8 (B) in subparagraph (C)— 

9 (i) by inserting ‘‘in an open, machine 

10 readable format’’ after ‘‘site’’; 

11 (ii) by amending clause (v) to read as 

12 follows: 

13 ‘‘(v) a regular collection, analysis, and 

14 reporting of performance data and funding 

15 of grants of the Global Fund, which covers 

16 all principal recipients and all subrecipi17 ents on the fiscal cycle of each grant, and 

18 includes the distribution of resources, by 

19 grant and principal recipient and sub20 recipient, for prevention, care, treatment, 

21 drugs, and commodities purchase, and 

22 other purposes as practicable;’’; 

23 (C) in subparagraph (D)(ii), by inserting 

24 ‘‘, in an open, machine readable format,’’ after 

25 ‘‘audits’’; 


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1 (D) in subparagraph (E), by inserting ‘‘, 

2 in an open, machine readable format,’’ after 

3 ‘‘publicly’’; 

4 (E) in subparagraph (F)— 

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

6 and inserting a semicolon; and 

7 (ii) by striking clause (ii) and insert8 ing the following new clauses: 

9 ‘‘(ii) all principal recipients and sub10 recipients and the amount of funds dis11 bursed to each principal recipient and sub12 recipient on the fiscal cycle of the grant; 

13 ‘‘(iii) expenditure data— 

14 ‘‘(I) tracked by principal recipi15 ents and subrecipients by prevention, 

16 care, and treatment as practicable by 

17 program area, where practicable, pre18 vention, care, and treatment and re19 ported in a format that allows com20 parison with other funding streams in 

21 each country; or 

22 ‘‘(II) if such expenditure data is 

23 not available, outlay or disbursement 

24 data, and an explanation of progress 


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1 made toward providing such expendi2 ture data; and 

3 ‘‘(iv) high-quality grant performance 

4 evaluations measuring inputs, outputs, and 

5 outcomes, as appropriate, with the goal of 

6 achieving outcome reporting;’’; and 

7 (F) by amending subparagraph (G) to read 

8 as follows: 

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

10 publicly available Web site in an open, machine 

11 readable format, that includes— 

12 ‘‘(i) a list of all countries imposing 

13 import duties and internal taxes on any 

14 goods or services financed by the Global 

15 Fund; 

16 ‘‘(ii) a description of the types of 

17 goods or services on which the import du18 ties and internal taxes are levied; 

19 ‘‘(iii) the total cost of the import du20 ties and internal taxes; 

21 ‘‘(iv) recovered import duties or inter22 nal taxes; and 

23 ‘‘(v) the status of country status24 agreements;’’. 


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1 SEC. 5. ANNUAL REPORT. 

2 Section 104A(f) of the Foreign Assistance Act of 

3 1961 (22 U.S.C. 2151b–2(f)) is amended to read as fol4 lows: 

5 ‘‘(f) ANNUAL REPORT.— 

6 ‘‘(1) IN GENERAL.—Not later than February 

7 15, 2014, and annually thereafter, the President 

8 shall submit to the Committee on Foreign Relations 

9 of the Senate and the Committee on Foreign Affairs 

10 of the House of Representatives a report in an open, 

11 machine readable format, on the implementation of 

12 this section for the prior fiscal year. 

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

14 later than February 15, 2014, shall include the ele15 ments required by law prior to the enactment of the 

16 PEPFAR Stewardship and Oversight Act of 2013. 

17 ‘‘(2)(3) REPORT ELEMENTS.—Each report sub18 mitted after February 15, 2014, shall include the 

19 following: 

20 ‘‘(A) A description based on internationally 

21 available data, and where practicable high-qual22 ity country-based data, of the total global bur23 den and need for HIV/AIDS prevention, treat24 ment, and care, including— 

25 ‘‘(i) estimates by partner country of 

26 the global burden and need; and 


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1 ‘‘(ii) HIV incidence, prevalence, and 

2 AIDS deaths for the reporting period. 

3 ‘‘(B) Reporting on annual targets across 

4 prevention, treatment, and care interventions in 

5 partner countries, including— 

6 ‘‘(i) a description of how those targets 

7 are designed to— 

8 ‘‘(I) ensure that the annual in9 crease in new patients on 

10 antiretroviral treatment exceeds the 

11 number of annual new HIV infections; 

12 ‘‘(II) reduce the number of new 

13 HIV infections below the number of 

14 deaths among persons infected with 

15 HIV; and 

16 ‘‘(III) achieve an AIDS-free gen17 eration; 

18 ‘‘(ii) national targets across preven19 tion, treatment, and care that are— 

20 ‘‘(I) established by partner coun21 tries; or 

22 ‘‘(II) where such national partner 

23 country-developed targets are unavail24 able, a description of progress towards 


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1 developing national partner country 

2 targets; and 

3 ‘‘(iii) bilateral programmatic targets 

4 across prevention, treatment, and care, in5 cluding— 

6 ‘‘(I) the number of adults and 

7 children to be directly supported on 

8 HIV treatment under United States9 funded programs; 

10 ‘‘(II) the number of adults and 

11 children to be otherwise supported on 

12 HIV treatment under United States13 funded programs; and 

14 ‘‘(III) other programmatic tar15 gets for activities directly and other16 wise supported by United States-fund17 ed programs. 

18 ‘‘(C) A description, by partner country, of 

19 HIV/AIDS funding from all sources, including 

20 funding levels from partner countries, other do21 nors, and the private sector, as practicable. 

22 ‘‘(D) A description of how United States23 funded programs, in conjunction with the Glob24 al Fund, other donors, and partner countries, 


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1 together set targets, measure progress, and 

2 achieve positive outcomes in partner countries. 

3 ‘‘(E) An annual assessment of outcome in4 dicator development, dissemination, and per5 formance for programs supported under this 

6 section, including ongoing corrective actions to 

7 improve reporting. 

8 ‘‘(F) A description and explanation of 

9 changes in related guidance or policies related 

10 to implementation of programs supported under 

11 this section. 

12 ‘‘(G) An assessment and quantification of 

13 progress over the reporting period toward 

14 achieving the targets set forth in subparagraph 

15 (B), including— 

16 ‘‘(i) the number, by partner country, 

17 of persons on HIV treatment, including 

18 specifically— 

19 ‘‘(I) the number of adults and 

20 children on HIV treatment directly 

21 supported by United States-funded 

22 programs; and 

23 ‘‘(II) the number of adults and 

24 children on HIV treatment otherwise 


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1 supported by United States-funded 

2 programs; 

3 ‘‘(ii) HIV treatment coverage rates by 

4 partner country; 

5 ‘‘(iii) the net increase in persons on 

6 HIV treatment by partner country; 

7 ‘‘(iv) new infections of HIV by part8 ner country; 

9 ‘‘(v) the number of HIV infections 

10 averted; 

11 ‘‘(vi) antiretroviral treatment program 

12 retention rates by partner country, includ13 ing— 

14 ‘‘(I) performance against annual 

15 targets for program retention; and 

16 ‘‘(II) the retention rate of per17 sons on HIV treatment directly sup18 ported by United States-funded pro19 grams; and 

20 ‘‘(vii) a description of supportive care, 

21 including management of co-morbidities. 

22 ‘‘(H) A description of national partner 

23 country and United States-funded HIV/AIDS 

24 prevention programs and policies, including— 


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1 ‘‘(i) an assessment by country of 

2 progress towards targets set forth in sub3 paragraph (B), with a detailed description 

4 of the metrics used to assess— 

5 ‘‘(I) programs to prevent mother 

6 to child transmission of HIV/AIDS, 

7 including coverage rates; 

8 ‘‘(II) programs to provide or pro9 mote voluntary medical male circumci10 sion, including coverage rates; 

11 ‘‘(III) programs for behavior12 change; and 

13 ‘‘(IV) other programmatic activi14 ties to prevent the transmission of 

15 HIV; 

16 ‘‘(ii) antiretroviral treatment as pre17 vention; and 

18 ‘‘(iii) a description of any new pre19 ventative interventions or methodologies. 

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

21 measurement of program efforts aimed at 

22 women and girls. 

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

24 measurement of program efforts aimed at or25 phans, vulnerable children, and youth. 


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

2 milestones used to assess effective, strategic, 

3 and appropriately timed country ownership, in4 cluding— 

5 ‘‘(i) an explanation of the metrics 

6 used to determine whether the pace of any 

7 transition to such ownership is appropriate 

8 for that country, given that country’s level 

9 of readiness for such transition; 

10 ‘‘(ii) an analysis of governmental and 

11 local nongovernmental capacity to sustain 

12 positive outcomes; 

13 ‘‘(iii) a description of measures taken 

14 to improve partner country capacity to sus15 tain positive outcomes where needed; and 

16 ‘‘(iv) for countries undergoing a tran17 sition to greater country ownership, a de18 scription of strategies to assess and miti19 gate programmatic and financial risk and 

20 to ensure continued quality of care for es21 sential services. 

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

23 country, of specific efforts to achieve and 

24 incentivize greater programmatic and cost effec25 tiveness, including— 


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1 ‘‘(i) progress toward establishing com2 mon economic metrics across prevention, 

3 care and treatment with partner counties 

4 and the Global Fund; 

5 ‘‘(ii) average costs, by country and by 

6 core intervention; 

7 ‘‘(iii) expenditure reporting in all pro8 gram areas, supplemented with targeted 

9 analyses of the cost-effectiveness of specific 

10 interventions; and 

11 ‘‘(iv) import duties and internal taxes 

12 imposed on program commodities and serv13 ices, by country. 

14 ‘‘(M) A description of partnership frame15 work agreements with countries, and regions 

16 where applicable, including— 

17 ‘‘(i) the objectives and structure of 

18 partnership framework agreements with 

19 countries, including— 

20 ‘‘(I) how these agreements are 

21 aligned with national HIV/AIDS plans 

22 and public health strategies and com23 mitments of such countries; and 

24 ‘‘(II) how these agreements in25 corporate a role for civil society; and 


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1 ‘‘(ii) a description of what has been 

2 learned in advancing partnership frame3 work agreements with countries, and re4 gions as applicable, in terms of improved 

5 coordination and collaboration, definition 

6 of clear roles and responsibilities of partici7 pants and signers, and implications for 

8 how to further strengthen these agree9 ments with mutually accountable measures 

10 of progress. 

11 ‘‘(N) A description of efforts and activities 

12 to engage new partners, including faith-based, 

13 community-based locally-based, and United 

14 States minority-serving institutions. 

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

16 differentiation between directly and otherwise 

17 supported activities, including specific efforts to 

18 clarify programmatic attribution and contribu19 tion, as well as timelines for dissemination and 

20 implementation. 

21 ‘‘(P) A description, globally and by country, 

22 of specific efforts to address co-infections and co23 morbidities of HIV/AIDS, including— 


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1 ‘‘ ‘‘(i) the number and percent of people 

2 in HIV care or treatment who started tuber3 culosis treatment; and 

4 ‘‘ ‘‘(ii) the number and percentage of 

5 eligible HIV positive patients starting iso6 niazid preventative therapy. 

7 ‘‘(Q) A description of efforts by partner 

8 countries to train, employ, and retain health 

9 care workers, including efforts to address work10 force shortages. 

11 ‘‘(3)(4) PARTNER COUNTRY DEFINED.—In this 

12 subsection, the term ‘partner country’ means a coun13 try with a minimum United States Government in14 vestment of HIV/AIDS assistance of at least 

15 $5,000,000 annually in the prior fiscal year.’’. 

16 SEC. 6. ALLOCATION OF FUNDING. 

17 (a) ORPHANS AND VULNERABLE CHILDREN.—Sec18 tion 403(b) of the United States Leadership Against HIV/ 

19 AIDS, Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 

20 7673(b)) is amended— 

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

22 and 

23 (2) by striking ‘‘amounts appropriated pursuant 

24 to the authorization of appropriations under section 

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1 wise made available to carry out the provisions of 

2 section 104A of the Foreign Assistance Act of 1961 

3 (22 U.S.C. 2151b–2)’’. 

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

5 United States Leadership Against HIV/AIDS, Tuber6 culosis, and Malaria Act of 2003 (22 U.S.C. 7673(c)) is 

7 amended— 

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

9 and 

10 (2) by striking ‘‘amounts appropriated for bilat11 eral global HIV/AIDS assistance pursuant to section 

12 401’’ and inserting ‘‘amounts appropriated or other13 wise made available to carry out the provisions of 

14 section 104A of the Foreign Assistance Act of 1961 

15 (22 U.S.C. 2151b–2)’’. 


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Calendar No. 202 

113TH CONGRESS 

1ST SESSION S. 1545 

[Report No. 113–112] 

A BILL 

To extend authorities related to global HIV/AIDS 

grams. and to promote oversight of United States proOCTOBER 2, 2013 

Reported with amendments 


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