I 

113TH CONGRESS 

1ST SESSION H. R. 3177 

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

of United States programs. 

IN THE HOUSE OF REPRESENTATIVES 

SEPTEMBER 25, 2013 

Mr. ENGEL (for himself, Mr. ROYCE, Ms. LEE of California, and Ms. ROSLEHTINEN) introduced the following bill; which was referred to the Committee on Foreign Affairs 

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’’. 

6 SEC. 2. INSPECTOR GENERAL OVERSIGHT. 

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

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

9 2003 (22 U.S.C. 7611(f)(1)) is amended— 


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1 (1) in subparagraph (A), by striking ‘‘5 coordi2 nated annual plans for oversight activity in each of 

3 the fiscal years 2009 through 2013’’ and inserting 

4 ‘‘coordinated annual plans for oversight activity in 

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

6 (2) in subparagraph (C)— 

7 (A) in clause (ii)— 

8 (i) in the heading, by striking ‘‘SUB9 SEQUENT’’ and inserting ‘‘2010 THROUGH

10 2013’’; and 

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

12 and inserting ‘‘the plans for fiscal years 

13 2010 through 2013’’; and 

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

15 clause: 

16 ‘‘(iii) 2014 PLAN.—The plan devel17 oped under subparagraph (A) for fiscal 

18 year 2014 shall be completed not later 

19 than 60 days after the date of the enact20 ment of the PEPFAR Stewardship and 

21 Oversight Act of 2013. 

22 ‘‘(iv) SUBSEQUENT PLANS.—Each of 

23 the last four plans developed under sub24 paragraph (A) shall be completed not later 


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1 than 30 days before each of the fiscal 

2 years 2015 through 2018, respectively.’’. 

3 SEC. 3. ANNUAL TREATMENT STUDY. 

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

5 the United States Leadership Against HIV/AIDS, Tuber6 culosis, and Malaria Act of 2003 (22 U.S.C. 7611(g)) is 

7 amended— 

8 (1) in paragraph (1), by striking ‘‘through Sep9 tember 30, 2013’’ and inserting ‘‘through September 

10 30, 2019’’; 

11 (2) by redesignating paragraph (2) as para12 graph (3); 

13 (3) by inserting after paragraph (1) the fol14 lowing new paragraph: 

15 ‘‘(2) 2013 THROUGH 2018 STUDIES.—The stud16 ies required to be submitted by September 30, 2014, 

17 and annually thereafter through September 30, 

18 2018, shall include, in addition to the elements set 

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

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

21 United States assistance under section 104A of 

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

23 2151b–2) in partner countries, taking into ac24 count the goal for more systematic collection of 


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1 data, as well as the demands of such analysis 

2 on available human and fiscal resources. 

3 ‘‘(B) A comprehensive and harmonized ex4 penditure analysis by partner country, includ5 ing— 

6 ‘‘(i) an analysis of Global Fund 

7 spending and partner country spending 

8 and comparable data across United States 

9 spending, Global Fund spending, and part10 ner country spending at the national level; 

11 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) DEFINITION.—In this subsection, the term 

20 ‘partner country’ means a country that received not 

21 less than $5,000,000 in United States HIV/AIDS 

22 assistance under section 104A of the Foreign Assist23 ance Act of 1961 (22 U.S.C. 2151b–2) during the 

24 immediately preceding 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) by striking ‘‘2013’’ each place it appears 

7 and inserting ‘‘2018’’; 

8 (2) in subparagraph (A)(ii), by striking the last 

9 two sentences; 

10 (3) in subparagraph (B)— 

11 (A) in each of clauses (i) through (iv), by 

12 striking ‘‘under this subsection’’ and inserting 

13 ‘‘for a contribution to the Global Fund’’; and 

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

15 the authorization of appropriations under sec16 tion 401’’ and inserting ‘‘to carry out section 

17 104A of the Foreign Assistance Act of 1961’’. 

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

19 United States Leadership Against HIV/AIDS, Tuber20 culosis, and Malaria Act of 2003 (22 U.S.C. 7622(d)(5)) 

21 is amended— 

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

23 (2) in subparagraph (C)— 

24 (A) by inserting ‘‘in an open, machine 

25 readable format’’ after ‘‘site’’; 


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1 (B) by striking clause (v) and inserting the 

2 following: 

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

4 reporting of performance data and funding 

5 of grants of the Global Fund, which covers 

6 all principal recipients and all sub-recipi7 ents on the fiscal cycle of each grant, and 

8 includes the distribution of resources, by 

9 grant and principal recipient and sub-re10 cipient, for prevention, care, treatment, 

11 drugs, and commodities purchase, and 

12 other purposes, as practicable;’’; 

13 (3) in subparagraph (D)(ii), by inserting ‘‘, in 

14 an open machine readable format,’’ after ‘‘audits’’; 

15 (4) in subparagraph (E), by inserting ‘‘, in an 

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

17 (5) in subparagraph (F)— 

18 (A) in clause (i), by striking ‘‘and’’ at the 

19 end; and 

20 (B) by striking clause (ii) and inserting the 

21 following: 

22 ‘‘(ii) all principal recipients and sub23 recipients and the amount of funds dis24 bursed to each principal recipient and sub25 recipient on the fiscal cycle of the grant; 


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1 ‘‘(iii) expenditure data— 

2 ‘‘(I) tracked by principal recipi3 ents and sub-recipients by program 

4 area, where practicable, in prevention, 

5 care, and treatment, reported in a for6 mat that allows comparison with other 

7 funding streams in each country; or 

8 ‘‘(II) if expenditure data is not 

9 available, outlay or disbursement 

10 data, and each public report shall in11 clude an explanation of progress made 

12 toward providing expenditure data; 

13 and 

14 ‘‘(iv) high-quality grant performance 

15 evaluations measuring inputs, outputs, and 

16 outcomes, as appropriate, with the goal of 

17 achieving outcome reporting;’’; and 

18 (6) by striking subparagraph (G) and inserting 

19 the following: 

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

21 publicly available Web site in an open, machine 

22 readable format, that includes— 

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

24 import duties and internal taxes on any 


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1 goods or services financed by the Global 

2 Fund; 

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

4 goods or services on which import duties 

5 and internal taxes are levied; 

6 ‘‘(iii) the total cost of the import du7 ties and internal taxes; 

8 ‘‘(iv) recovered import duties or inter9 nal taxes; and 

10 ‘‘(v) the status of country status11 agreements;’’. 

12 SEC. 5. ANNUAL REPORT. 

13 (a) IN GENERAL.—Section 104A(f) of the Foreign 

14 Assistance Act of 1961 (22 U.S.C. 2151b–2(f)) is amend15 ed to read as follows: 

16 ‘‘(f) ANNUAL REPORT.— 

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

18 15, 2014, and annually thereafter, the President 

19 shall submit to the Committee on Foreign Relations 

20 of the Senate and the Committee on Foreign Affairs 

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

22 machine readable format, on the implementation of 

23 this section for the prior fiscal year. 


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1 ‘‘(2) REPORT ELEMENTS.—Each report sub2 mitted after February 15, 2014, shall include the 

3 following: 

4 ‘‘(A) A description based on internationally 

5 available data, using high-quality country-based 

6 data where practicable, of the total global bur7 den and need for HIV/AIDS prevention, treat8 ment, and care, including— 

9 ‘‘(i) estimates by partner country of 

10 the global burden and need; and 

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

12 AIDS deaths for the reporting period. 

13 ‘‘(B) Reporting on targets across preven14 tion, treatment, and care interventions in part15 ner countries, including— 

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

17 are designed to— 

18 ‘‘(I) ensure that the annual in19 crease in new patients on antiretrovi20 ral treatment exceeds the number of 

21 annual new HIV infections; 

22 ‘‘(II) reduce the number of new 

23 HIV infections so that it falls below 

24 number of deaths among persons in25 fected with HIV; and 


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1 ‘‘(III) achieve an AIDS-free gen2 eration; 

3 ‘‘(ii) national targets across preven4 tion, treatment, and care that are— 

5 ‘‘(I) established by partner coun6 tries; or 

7 ‘‘(II) where such national partner 

8 country-developed targets are unavail9 able, a description of progress towards 

10 developing national partner country 

11 targets; and 

12 ‘‘(iii) bilateral programmatic targets 

13 across prevention, treatment, and care, in14 cluding— 

15 ‘‘(I) the number of adults and 

16 children to be directly supported on 

17 HIV treatment under this section; 

18 ‘‘(II) the number of adults and 

19 children to be otherwise supported on 

20 HIV treatment under this section; and 

21 ‘‘(III) other programmatic tar22 gets for activities directly and other23 wise supported by United States-fund24 ed programs. 


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

2 HIV/AIDS funding from all sources, including 

3 funding levels from partner countries, other do4 nors, and the private sector, as practicable. 

5 ‘‘(D) A description of how United States 

6 bilateral programs, in conjunction with the 

7 Global Fund, other donors, and partner coun8 tries together set targets, measure progress, 

9 and achieve positive outcomes in partner coun10 tries. 

11 ‘‘(E) An annual assessment of outcome in12 dicator development, dissemination, and per13 formance for programs supported under this 

14 section, including ongoing corrective actions to 

15 improve reporting. 

16 ‘‘(F) A description and explanation of 

17 changes in related guidance or policies related 

18 to implementation of programs supported under 

19 this section. 

20 ‘‘(G) An assessment and quantification of 

21 progress over the reporting period toward 

22 achieving the targets described in subparagraph 

23 (B), including— 


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

2 of persons on HIV treatment, including 

3 specifically— 

4 ‘‘(I) the number of adults and 

5 children on HIV treatment directly 

6 supported by United States-funded 

7 programs; 

8 ‘‘(II) the number of adults and 

9 children on HIV treatment otherwise 

10 supported by United States-funded 

11 programs; 

12 ‘‘(ii) HIV treatment coverage rates by 

13 country; 

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

15 HIV treatment by partner country; 

16 ‘‘(iv) new infections of HIV by coun17 try; 

18 ‘‘(v) the number of HIV infections 

19 averted; 

20 ‘‘(vi) antiretroviral treatment program 

21 retention rates, by partner country, includ22 ing— 

23 ‘‘(I) performance against annual 

24 targets for program retention; and 


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1 ‘‘(II) the retention rate of per2 sons on HIV treatment directly sup3 ported by United States-funded pro4 grams; and 

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

6 including management of co-morbidities. 

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

8 United States-funded HIV/AIDS prevention 

9 programs and policies, including— 

10 ‘‘(i) an assessment, by partner coun11 try, of progress to achieve the targets de12 scribed in subparagraph (B), with a de13 tailed description of the metrics used to as14 sess— 

15 ‘‘(I) programs to prevent mother 

16 to child transmission of HIV/AIDS, 

17 including coverage rates; 

18 ‘‘(II) programs to provide or pro19 mote voluntary medical male circumci20 sion, including coverage rates; 

21 ‘‘(III) programs for behavior22 change; and 

23 ‘‘(IV) other programmatic activi24 ties to prevent the transmission of 

25 HIV; 


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1 ‘‘(ii) a description of antiretroviral 

2 treatment as prevention; and 

3 ‘‘(iii) a description of any new pre4 ventative interventions or methodologies. 

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

6 measurement of program efforts aimed at 

7 women and girls. 

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

9 measurement of program efforts aimed at or10 phans, vulnerable children, and youth. 

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

12 milestones used to assess effective, strategic, 

13 and appropriately timed partner country owner14 ship, including— 

15 ‘‘(i) an explanation of the metrics 

16 used to determine whether the pace of any 

17 transition to such ownership is appropriate 

18 for such partner country, given that coun19 try’s level of readiness for such transition; 

20 ‘‘(ii) an analysis of governmental and 

21 local nongovernmental capacity to sustain 

22 positive outcomes; 

23 ‘‘(iii) a description of measures taken 

24 to improve partner country capacity to sus25 tain positive outcomes where needed; and 


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1 ‘‘(iv) for partner countries undergoing 

2 a transition to greater country ownership, 

3 a description of strategies to assess and 

4 mitigate programmatic and financial risk 

5 to ensure continued quality of care for es6 sential services. 

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

8 country, of specific efforts to achieve and 

9 incentivize greater programmatic and cost effec10 tiveness, including— 

11 ‘‘(i) progress toward establishing com12 mon economic metrics across prevention, 

13 care and treatment with partner counties 

14 and the Global Fund; 

15 ‘‘(ii) average costs, by partner country 

16 and by core intervention; 

17 ‘‘(iii) expenditure reporting in all pro18 gram areas, supplemented with targeted 

19 analyses of the cost-effectiveness of specific 

20 interventions; and 

21 ‘‘(iv) import duties and internal taxes 

22 imposed on program commodities and serv23 ices, by partner country. 


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1 ‘‘(M) A description of partnership frame2 work agreements with countries and regions, 

3 where applicable, including— 

4 ‘‘(i) the objectives and structures of 

5 such agreements, including— 

6 ‘‘(I) how such agreements are 

7 aligned with national HIV/AIDS 

8 plans, public health strategies, and 

9 commitments of such countries and 

10 regions; and 

11 ‘‘(II) how such agreements incor12 porate a role for civil society; and 

13 ‘‘(ii) what has been learned in advanc14 ing partnership framework agreements 

15 with countries, and regions as applicable, 

16 in terms of improved coordination and col17 laboration, definition of clear roles and re18 sponsibilities and implications for how to 

19 further strengthen these agreements with 

20 mutually accountable measures of prog21 ress. 

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

23 to engage new partners, including faith-based, 

24 community-based, and United States minority25 serving institutions. 


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

2 differentiation between directly and otherwise 

3 supported activities, including specific efforts to 

4 clarify programmatic attribution and contribu5 tion, as well as timelines for dissemination and 

6 implementation. 

7 ‘‘(3) DEFINITION.—In this subsection, the term 

8 ‘partner country’ means a country that received not 

9 less than $5,000,000 in United States HIV/AIDS 

10 assistance under this section during the immediately 

11 preceding fiscal year.’’. 

12 (b) REPORT ELEMENTS FOR FISCAL YEAR 2013 RE13 PORT.—The annual report required to be submitted by not 

14 later than February 15, 2014, to the Committee on For15 eign Relations of the Senate and the Committee on For16 eign Affairs of the House of Representatives under section 

17 104A(f) of the Foreign Assistance Act of 1961, as amend18 ed by subsection (a) of this section, shall include the re19 port elements contained in paragraph (2) of such section 

20 104A(f) as such section was in effect on the day before 

21 the date of the enactment of this Act. 

22 SEC. 6. ALLOCATION OF FUNDING. 

23 (a) ORPHANS AND VULNERABLE CHILDREN.—Sec24 tion 403(b) of the United States Leadership Against HIV/ 


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

2 7673(b)) is amended— 

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

4 and 

5 (2) by striking ‘‘amounts appropriated pursuant 

6 to the authorization of appropriations under section 

7 401’’ and inserting ‘‘amounts appropriated or other8 wise made available to carry out the provisions of 

9 section 104A of the Foreign Assistance Act of 1961 

10 (22 U.S.C. 2151b–2)’’. 

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

12 United States Leadership Against HIV/AIDS, Tuber13 culosis, and Malaria Act of 2003 (22 U.S.C. 7673(c)) is 

14 amended— 

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

16 (2) by striking ‘‘amounts appropriated’’ and in17 serting ‘‘amounts appropriated or otherwise made 

18 available to carry out the provisions of section 104A 

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

20 2151b–2)’’; and 

21 (3) by striking ‘‘pursuant to section 401’’. 

Æ 


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