113TH CONGRESS 

1ST SESSION S. 1545 

AN ACT 

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, 
2 

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1 SECTION 1. SHORT TITLE. 

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

3 and Oversight Act of 2013’’. 

4 SEC. 2. INSPECTOR GENERAL OVERSIGHT. 

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

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

7 2003 (22 U.S.C. 7611(f)(1)) is amended— 

8 (1) in subparagraph (A), by striking ‘‘5 coordi9 nated annual plans for oversight activity in each of 

10 the fiscal years 2009 through 2013’’ and inserting 

11 ‘‘coordinated annual plans for oversight activity in 

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

13 (2) in subparagraph (C)— 

14 (A) in clause (ii)— 

15 (i) in the heading, by striking ‘‘SUB16 SEQUENT’’ and inserting ‘‘2010 THROUGH

17 2013’’; and 

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

19 and inserting ‘‘the plans for fiscal years 

20 2010 through 2013’’; and 

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

22 clause: 

23 ‘‘(iii) 2014 PLAN.—The plan devel24 oped under subparagraph (A) for fiscal 

25 year 2014 shall be completed not later 

26 than 60 days after the date of the enact-
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1 ment of the PEPFAR Stewardship and 

2 Oversight Act of 2013. 

3 ‘‘(iv) SUBSEQUENT PLANS.—Each of 

4 the last four plans developed under sub5 paragraph (A) shall be completed not later 

6 than 30 days before each of the fiscal 

7 years 2015 through 2018, respectively.’’. 

8 SEC. 3. ANNUAL TREATMENT STUDY. 

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

10 the United States Leadership Against HIV/AIDS, Tuber11 culosis, and Malaria Act of 2003 (22 U.S.C. 7611(g)) is 

12 amended— 

13 (1) in paragraph (1), by striking ‘‘through Sep14 tember 30, 2013’’ and inserting ‘‘through September 

15 30, 2019’’; 

16 (2) by redesignating paragraph (2) as para17 graph (3); 

18 (3) by inserting after paragraph (1) the fol19 lowing new paragraph: 

20 ‘‘(2) 2013 THROUGH 2018 STUDIES.—The stud21 ies required to be submitted by September 30, 2014, 

22 and annually thereafter through September 30, 

23 2018, shall include, in addition to the elements set 

24 forth under paragraph (1), the following elements: 
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1 ‘‘(A) A plan for conducting cost studies of 

2 United States assistance under section 104A of 

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

4 2151b–2) in partner countries, taking into ac5 count the goal for more systematic collection of 

6 data, as well as the demands of such analysis 

7 on available human and fiscal resources. 

8 ‘‘(B) A comprehensive and harmonized ex9 penditure analysis by partner country, includ10 ing— 

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

12 national partner spending and comparable 

13 data across United States, Global Fund, 

14 and national partner spending; or 

15 ‘‘(ii) where providing such comparable 

16 data is not currently practicable, an expla17 nation of why it is not currently prac18 ticable, and when it will be practicable.’’; 

19 and 

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

21 paragraph: 

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

23 subsection, the term ‘partner country’ means a coun24 try with a minimum United States Government in-
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1 vestment of HIV/AIDS assistance of at least 

2 $5,000,000 in the prior fiscal year.’’. 

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

4 AIDS, TUBERCULOSIS, AND MALARIA. 

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

6 States Leadership Against HIV/AIDS, Tuberculosis, and 

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

8 (1) in subparagraph (A)— 

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

10 inserting ‘‘2018’’; 

11 (B) in clause (ii)— 

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

13 ‘‘2018’’; and 

14 (ii) by striking the last two sentences; 

15 and 

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

17 inserting ‘‘2018’’; and 

18 (2) in subparagraph (B)— 

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

20 each place it appears; 

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

22 the authorization of appropriations under sec23 tion 401’’ and inserting ‘‘to carry out section 

24 104A of the Foreign Assistance Act of 1961’’; 

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

2 inserting ‘‘2018’’. 

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

4 United States Leadership Against HIV/AIDS, Tuber5 culosis, and Malaria Act of 2003 (22 U.S.C. 7622(d)) is 

6 amended by— 

7 (1) in paragraph (5)— 

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

9 ‘‘2018’’; 

10 (B) in subparagraph (C)— 

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

12 readable format’’ after ‘‘site’’; 

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

14 follows: 

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

16 reporting of performance data and funding 

17 of grants of the Global Fund, which covers 

18 all principal recipients and all subrecipi19 ents on the fiscal cycle of each grant, and 

20 includes the distribution of resources, by 

21 grant and principal recipient and sub22 recipient, for prevention, care, treatment, 

23 drugs, and commodities purchase, and 

24 other purposes as practicable;’’; 
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1 (C) in subparagraph (D)(ii), by inserting 

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

3 ‘‘audits’’; 

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

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

6 ‘‘publicly’’; 

7 (E) in subparagraph (F)— 

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

9 and inserting a semicolon; and 

10 (ii) by striking clause (ii) and insert11 ing the following new clauses: 

12 ‘‘(ii) all principal recipients and sub13 recipients and the amount of funds dis14 bursed to each principal recipient and sub15 recipient on the fiscal cycle of the grant; 

16 ‘‘(iii) expenditure data— 

17 ‘‘(I) tracked by principal recipi18 ents and subrecipients by program 

19 area, where practicable, prevention, 

20 care, and treatment and reported in a 

21 format that allows comparison with 

22 other funding streams in each coun23 try; or 

24 ‘‘(II) if such expenditure data is 

25 not available, outlay or disbursement 
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1 data, and an explanation of progress 

2 made toward providing such expendi3 ture data; and 

4 ‘‘(iv) high-quality grant performance 

5 evaluations measuring inputs, outputs, and 

6 outcomes, as appropriate, with the goal of 

7 achieving outcome reporting;’’; and 

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

9 as follows: 

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

11 publicly available Web site in an open, machine 

12 readable format, that includes— 

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

14 import duties and internal taxes on any 

15 goods or services financed by the Global 

16 Fund; 

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

18 goods or services on which the import du19 ties and internal taxes are levied; 

20 ‘‘(iii) the total cost of the import du21 ties and internal taxes; 

22 ‘‘(iv) recovered import duties or inter23 nal taxes; and 

24 ‘‘(v) the status of country status25 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 ‘‘(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 ‘‘(H) A description of partner country and 

22 United States-funded HIV/AIDS prevention 

23 programs and policies, including— 

24 ‘‘(i) an assessment by country of 

25 progress towards targets set forth in sub-
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1 paragraph (B), with a detailed description 

2 of the metrics used to assess— 

3 ‘‘(I) programs to prevent mother 

4 to child transmission of HIV/AIDS, 

5 including coverage rates; 

6 ‘‘(II) programs to provide or pro7 mote voluntary medical male circumci8 sion, including coverage rates; 

9 ‘‘(III) programs for behavior10 change; and 

11 ‘‘(IV) other programmatic activi12 ties to prevent the transmission of 

13 HIV; 

14 ‘‘(ii) antiretroviral treatment as pre15 vention; and 

16 ‘‘(iii) a description of any new pre17 ventative interventions or methodologies. 

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

19 measurement of program efforts aimed at 

20 women and girls. 

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

22 measurement of program efforts aimed at or23 phans, vulnerable children, and youth. 

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

25 milestones used to assess effective, strategic, 
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1 and appropriately timed country ownership, in2 cluding— 

3 ‘‘(i) an explanation of the metrics 

4 used to determine whether the pace of any 

5 transition to such ownership is appropriate 

6 for that country, given that country’s level 

7 of readiness for such transition; 

8 ‘‘(ii) an analysis of governmental and 

9 local nongovernmental capacity to sustain 

10 positive outcomes; 

11 ‘‘(iii) a description of measures taken 

12 to improve partner country capacity to sus13 tain positive outcomes where needed; and 

14 ‘‘(iv) for countries undergoing a tran15 sition to greater country ownership, a de16 scription of strategies to assess and miti17 gate programmatic and financial risk and 

18 to ensure continued quality of care for es19 sential services. 

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

21 country, of specific efforts to achieve and 

22 incentivize greater programmatic and cost effec23 tiveness, including— 

24 ‘‘(i) progress toward establishing com25 mon economic metrics across prevention, 
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1 care and treatment with partner countries 

2 and the Global Fund; 

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

4 core intervention; 

5 ‘‘(iii) expenditure reporting in all pro6 gram areas, supplemented with targeted 

7 analyses of the cost-effectiveness of specific 

8 interventions; and 

9 ‘‘(iv) import duties and internal taxes 

10 imposed on program commodities and serv11 ices, by country. 

12 ‘‘(M) A description of partnership frame13 work agreements with countries, and regions 

14 where applicable, including— 

15 ‘‘(i) the objectives and structure of 

16 partnership framework agreements with 

17 countries, including— 

18 ‘‘(I) how these agreements are 

19 aligned with national HIV/AIDS plans 

20 and public health strategies and com21 mitments of such countries; and 

22 ‘‘(II) how these agreements in23 corporate a role for civil society; and 

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

25 learned in advancing partnership frame-
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1 work agreements with countries, and re2 gions as applicable, in terms of improved 

3 coordination and collaboration, definition 

4 of clear roles and responsibilities of partici5 pants and signers, and implications for 

6 how to further strengthen these agree7 ments with mutually accountable measures 

8 of progress. 

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

10 to engage new partners, including faith-based, 

11 locally-based, and United States minority-serv12 ing institutions. 

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

14 differentiation between directly and otherwise 

15 supported activities, including specific efforts to 

16 clarify programmatic attribution and contribu17 tion, as well as timelines for dissemination and 

18 implementation. 

19 ‘‘(P) A description, globally and by coun20 try, of specific efforts to address co-infections 

21 and co-morbidities of HIV/AIDS, including— 

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

23 in HIV care or treatment who started tu24 berculosis treatment; and 
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1 ‘‘(ii) the number and percentage of el2 igible HIV positive patients starting iso3 niazid preventative therapy. 

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

5 countries to train, employ, and retain health 

6 care workers, including efforts to address work7 force shortages. 

8 ‘‘(R) A description of program evaluations 

9 completed during the reporting period, includ10 ing whether all completed evaluations have been 

11 published on a publically available Internet 

12 website and whether any completed evaluations 

13 did not adhere to the common evaluation stand14 ards of practice published under paragraph (4). 

15 ‘‘(4) COMMON EVALUATION STANDARDS.—Not 

16 later than February 1, 2014, the Global AIDS Coor17 dinator shall publish on a publically available Inter18 net website the common evaluation standards of 

19 practice referred to in paragraph (3)(R). 

20 ‘‘(5) PARTNER COUNTRY DEFINED.—In this 

21 subsection, the term ‘partner country’ means a coun22 try with a minimum United States Government in23 vestment of HIV/AIDS assistance of at least 

24 $5,000,000 in the prior fiscal year.’’. 
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1 SEC. 6. ALLOCATION OF FUNDING. 

2 (a) ORPHANS AND VULNERABLE CHILDREN.—Sec3 tion 403(b) of the United States Leadership Against HIV/ 

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

5 7673(b)) is amended— 

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

7 and 

8 (2) by striking ‘‘amounts appropriated pursuant 

9 to the authorization of appropriations under section 

10 401’’ and inserting ‘‘amounts appropriated or other11 wise made available to carry out the provisions of 

12 section 104A of the Foreign Assistance Act of 1961 

13 (22 U.S.C. 2151b–2)’’. 

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

15 United States Leadership Against HIV/AIDS, Tuber16 culosis, and Malaria Act of 2003 (22 U.S.C. 7673(c)) is 

17 amended— 

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

19 and 

20 (2) by striking ‘‘amounts appropriated for bilat21 eral global HIV/AIDS assistance pursuant to section 

22 401’’ and inserting ‘‘amounts appropriated or other23 wise made available to carry out the provisions of 
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1 section 104A of the Foreign Assistance Act of 1961 

2 (22 U.S.C. 2151b–2)’’. 

Passed the Senate November 18, 2013. 

Attest: 

Secretary. 

113TH CONGRESS 

1ST SESSION S. 1545 

AN ACT 

To extend authorities related to global HIV/AIDS 

grams. and to promote oversight of United States pro-