H. R. 5501—34 
‘‘(B) transition strategies to ensure sustainability of 
such programs and activities, including health care sys-
tems, under other international donor support, or budget 
support by respective foreign governments.’’. 
(d) COMPACTS AND FRAMEWORK AGREEMENTS.—Section 104A 
of such Act is amended— 
(1) by redesignating subsections (e) through (g) as sub-
sections (f) through (h); and 
(2) by inserting after subsection (d) the following: 
‘‘(e) COMPACTS AND FRAMEWORK AGREEMENTS.— 
‘‘(1) FINDINGS.—Congress makes the following findings: 
‘‘(A) The congressionally mandated Institute of Medi-
cine report entitled ‘PEPFAR Implementation: Progress 
and Promise’ states: ‘The next strategy [of the U.S. Global 
AIDS Initiative] should squarely address the needs and 
challenges involved in supporting sustainable country HIV/ 
AIDS programs, thereby transitioning from a focus on 
emergency relief.’. 
‘‘(B) One mechanism to promote the transition from 
an emergency to a public health and development approach 
to HIV/AIDS is through compacts or framework agreements 
between the United States Government and each partici-
pating nation. 
‘‘(2) ELEMENTS.—Compacts on HIV/AIDS authorized under 
subsection (d)(8) shall include the following elements: 
‘‘(A) Compacts whose primary purpose is to provide 
direct services to combat HIV/AIDS are to be made 
between— 
‘‘(i) the United States Government; and 
‘‘(ii)(I) national or regional entities representing 
low-income countries served by an existing United 
States Agency for International Development or 
Department of Health and Human Services presence 
or regional platform; or 
‘‘(II) countries or regions— 
‘‘(aa) experiencing significantly high HIV 
prevalence or risk of significantly increasing 
incidence within the general population; 
‘‘(bb) served by an existing United States 
Agency for International Development or Depart-
ment of Health and Human Services presence or 
regional platform; and 
‘‘(cc) that have inadequate financial means 
within such country or region. 
‘‘(B) Compacts whose primary purpose is to provide 
limited technical assistance to a country or region con-
nected to services provided within the country or region— 
‘‘(i) may be made with other countries or regional 
entities served by an existing United States Agency 
for International Development or Department of 
Health and Human Services presence or regional plat-
form; 
‘‘(ii) shall require significant investments in HIV 
prevention, care, and treatment services by the host 
country; 
‘‘(iii) shall be time-limited in terms of United 
States contributions; and
H. R. 5501—35 
‘‘(iv) shall be made only upon prior notification 
to Congress— 
‘‘(I) justifying the need for such compacts; 
‘‘(II) describing the expected investment by the 
country or regional entity; and 
‘‘(III) describing the scope, nature, expected 
total United States investment, and time frame 
of the limited technical assistance under the com-
pact and its intended impact. 
‘‘(C) Compacts shall include provisions to— 
‘‘(i) promote local and national efforts to reduce 
stigma associated with HIV/AIDS; and 
‘‘(ii) work with and promote the role of civil society 
in combating HIV/AIDS. 
‘‘(D) Compacts shall take into account the overall 
national health and development and national HIV/AIDS 
and public health strategies of each country. 
‘‘(E) Compacts shall contain— 
‘‘(i) consideration of the specific objectives that the 
country and the United States expect to achieve during 
the term of a compact; 
‘‘(ii) consideration of the respective responsibilities 
of the country and the United States in the achieve-
ment of such objectives; 
‘‘(iii) consideration of regular benchmarks to 
measure progress toward achieving such objectives; 
‘‘(iv) an identification of the intended beneficiaries, 
disaggregated by gender and age, and including 
information on orphans and vulnerable children, to 
the maximum extent practicable; 
‘‘(v) consideration of the methods by which the 
compact is intended to— 
‘‘(I) address the factors that put women and 
girls at greater risk of HIV/AIDS; and 
‘‘(II) strengthen elements such as the eco-
nomic, educational, and social status of women, 
girls, orphans, and vulnerable children and the 
inheritance rights and safety of such individuals; 
‘‘(vi) consideration of the methods by which the 
compact will— 
‘‘(I) strengthen the health care capacity, 
including factors such as the training, retention, 
deployment, recruitment, and utilization of health 
care workers; 
‘‘(II) improve supply chain management; and 
‘‘(III) improve the health systems and infra-
structure of the partner country, including the 
ability of compact participants to maintain and 
operate equipment transferred or purchased as 
part of the compact; 
‘‘(vii) consideration of proposed mechanisms to pro-
vide oversight; 
‘‘(viii) consideration of the role of civil society in 
the development of a compact and the achievement 
of its objectives;
H. R. 5501—36 
‘‘(ix) a description of the current and potential 
participation of other donors in the achievement of 
such objectives, as appropriate; and 
‘‘(x) consideration of a plan to ensure appropriate 
fiscal accountability for the use of assistance. 
‘‘(F) For regional compacts, priority shall be given to 
countries that are included in regional funds and programs 
in existence as of the date of the enactment of the Tom 
Lantos and Henry J. Hyde United States Global Leadership 
Against HIV/AIDS, Tuberculosis, and Malaria Reauthoriza-
tion Act of 2008. 
‘‘(G) Amounts made available for compacts described 
in subparagraphs (A) and (B) shall be subject to the inclu-
sion of— 
‘‘(i) cost sharing assurances that meet the require-
ments under section 110; and 
‘‘(ii) transition strategies to ensure sustainability 
of such programs and activities, including health care 
systems, under other international donor support, and 
budget support by respective foreign governments. 
‘‘(3) LOCAL INPUT.—In entering into a compact on HIV/ 
AIDS authorized under subsection (d)(8), the Coordinator of 
United States Government Activities to Combat HIV/AIDS 
Globally shall seek to ensure that the government of a 
country— 
‘‘(A) takes into account the local perspectives of the 
rural and urban poor, including women, in each country; 
and 
‘‘(B) consults with private and voluntary organizations, 
including faith-based organizations, the business commu-
nity, and other donors in the country. 
‘‘(4) CONGRESSIONAL
AND
PUBLIC
NOTIFICATION
AFTER 
ENTERING
INTO
A
COMPACT.—Not later than 10 days after 
entering into a compact authorized under subsection (d)(8), 
the Global AIDS Coordinator shall— 
‘‘(A) submit a report containing a detailed summary 
of the compact and a copy of the text of the compact 
to— 
‘‘(i) the Committee on Foreign Relations of the 
Senate; 
‘‘(ii) the Committee on Appropriations of the 
Senate; 
‘‘(iii) the Committee on Foreign Affairs of the 
House of Representatives; and 
‘‘(iv) the Committee on Appropriations of the House 
of Representatives; and 
‘‘(B) publish such information in the Federal Register 
and on the Internet website of the Office of the Global 
AIDS Coordinator.’’. 
(e) ANNUAL REPORT.—Section 104A(f) of such Act, as redesig-
nated, is amended— 
(1) in paragraph (1), by striking ‘‘Committee on Inter-
national Relations’’ and inserting ‘‘Committee on Foreign 
Affairs’’; and 
(2) in paragraph (2)— 
(A) in subparagraph (B), by striking ‘‘and’’ at the end;
H. R. 5501—37 
(B) by striking subparagraph (C) and inserting the 
following: 
‘‘(C) a detailed breakdown of funding allocations, by 
program and by country, for prevention activities; and 
‘‘(D) a detailed assessment of the impact of programs 
established pursuant to such sections, including— 
‘‘(i)(I) the effectiveness of such programs in 
reducing— 
‘‘(aa) the transmission of HIV, particularly in 
women and girls; 
‘‘(bb) mother-to-child transmission of HIV, 
including through drug treatment and therapies, 
either directly or by referral; and 
‘‘(cc) mortality rates from HIV/AIDS; 
‘‘(II) the number of patients receiving treatment 
for AIDS in each country that receives assistance under 
this Act; 
‘‘(III) an assessment of progress towards the 
achievement of annual goals set forth in the timetable 
required under the 5-year strategy established under 
section 101 of the United States Leadership Against 
HIV/AIDS, Tuberculosis, and Malaria Act of 2003 and, 
if annual goals are not being met, the reasons for 
such failure; and 
‘‘(IV) retention and attrition data for programs 
receiving United States assistance, including mortality 
and loss to follow-up rates, organized overall and by 
country; 
‘‘(ii) the progress made toward— 
‘‘(I) improving health care delivery systems 
(including the training of health care workers, 
including doctors, nurses, midwives, pharmacists, 
laboratory technicians, and compensated commu-
nity health workers, and the use of codes of con-
duct for ethical recruiting practices for health care 
workers); 
‘‘(II) advancing safe working conditions for 
health care workers; and 
‘‘(III) improving infrastructure to promote 
progress toward universal access to HIV/AIDS 
prevention, treatment, and care by 2013; 
‘‘(iii) a description of coordination efforts with rel-
evant executive branch agencies to link HIV/AIDS clin-
ical and social services with non-HIV/AIDS services 
as part of the United States health and development 
agenda; 
‘‘(iv) a detailed description of integrated HIV/AIDS 
and food and nutrition programs and services, 
including— 
‘‘(I) the amount spent on food and nutrition 
support; 
‘‘(II) the types of activities supported; and 
‘‘(III) an assessment of the effectiveness of 
interventions carried out to improve the health 
status of persons with HIV/AIDS receiving food 
or nutritional support;
H. R. 5501—38 
‘‘(v) a description of efforts to improve harmoni-
zation, in terms of relevant executive branch agencies, 
coordination with other public and private entities, 
and coordination with partner countries’ national stra-
tegic plans as called for in the ‘Three Ones’; 
‘‘(vi) a description of— 
‘‘(I) the efforts of partner countries that were 
signatories to the Abuja Declaration on HIV/AIDS, 
Tuberculosis and Other Related Infectious Dis-
eases to adhere to the goals of such Declaration 
in terms of investments in public health, including 
HIV/AIDS; and 
‘‘(II) a description of the HIV/AIDS invest-
ments of partner countries that were not signato-
ries to such Declaration; 
‘‘(vii) a detailed description of any compacts or 
framework agreements reached or negotiated between 
the United States and any partner countries, including 
a description of the elements of compacts described 
in subsection (e); 
‘‘(viii) a description of programs serving women 
and girls, including— 
‘‘(I) HIV/AIDS prevention programs that 
address the vulnerabilities of girls and women to 
HIV/AIDS; 
‘‘(II) information on the number of individuals 
served by programs aimed at reducing the 
vulnerabilities of women and girls to HIV/AIDS 
and data on the types, objectives, and duration 
of programs to address these issues; 
‘‘(III) information on programs to address the 
particular needs of adolescent girls and young 
women; and 
‘‘(IV) 
programs 
to 
prevent 
gender-based 
violence or to assist victims of gender based 
violence as part of, or in coordination with, HIV/ 
AIDS programs; 
‘‘(ix) a description of strategies, goals, programs, 
and interventions to— 
‘‘(I) address the needs and vulnerabilities of 
youth populations; 
‘‘(II) expand access among young men and 
women to evidence-based HIV/AIDS health care 
services and HIV prevention programs, including 
abstinence education programs; and 
‘‘(III) expand community-based services to 
meet the needs of orphans and of children and 
adolescents affected by or vulnerable to HIV/AIDS 
without increasing stigmatization; 
‘‘(x) a description of— 
‘‘(I) the specific strategies funded to ensure 
the reduction of HIV infection among injection 
drug users; 
‘‘(II) the number of injection drug users, by 
country, reached by such strategies; and 
‘‘(III) medication-assisted drug treatment for 
individuals with HIV or at risk of HIV;
H. R. 5501—39 
‘‘(xi) a detailed description of program monitoring, 
operations research, and impact evaluation research, 
including— 
‘‘(I) the amount of funding provided for each 
research type; 
‘‘(II) an analysis of cost-effectiveness models; 
and 
‘‘(III) conclusions regarding the efficiency, 
effectiveness, and quality of services as derived 
from previous or ongoing research and monitoring 
efforts; 
‘‘(xii) building capacity to identify, investigate, and 
stop nosocomial transmission of infectious diseases, 
including HIV and tuberculosis; and 
‘‘(xiii) a description of staffing levels of United 
States government HIV/AIDS teams in countries with 
significant HIV/AIDS programs, including whether or 
not a full-time coordinator was on staff for the year.’’. 
(f) AUTHORIZATION OF APPROPRIATIONS.—Section 301(b) of the 
United States Leadership Against HIV/AIDS, Tuberculosis, and 
Malaria Act of 2003 (22 U.S.C. 7631(b)) is amended— 
(1) in paragraph (1), by striking ‘‘fiscal years 2004 through 
2008’’ and inserting ‘‘fiscal years 2009 through 2013’’; and 
(2) in paragraph (3), by striking ‘‘fiscal years 2004 through 
2008’’ and inserting ‘‘fiscal years 2009 through 2013’’. 
(g) RELATIONSHIP TO ASSISTANCE PROGRAMS TO ENHANCE 
NUTRITION.—Section 301(c) of such Act is amended to read as 
follows: 
‘‘(c) FOOD AND NUTRITIONAL SUPPORT.— 
‘‘(1) IN GENERAL.—As indicated in the report produced by 
the Institute of Medicine, entitled ‘PEPFAR Implementation: 
Progress and Promise’, inadequate caloric intake has been 
clearly identified as a principal reason for failure of clinical 
response to antiretroviral therapy. In recognition of the impact 
of malnutrition as a clinical health issue for many persons 
living with HIV/AIDS that is often associated with health and 
economic impacts on these individuals and their families, the 
Global AIDS Coordinator and the Administrator of the United 
States Agency for International Development shall— 
‘‘(A) follow World Health Organization guidelines for 
HIV/AIDS food and nutrition services; 
‘‘(B) integrate nutrition programs with HIV/AIDS 
activities through effective linkages among the health, agri-
cultural, and livelihood sectors and establish additional 
services in circumstances in which referrals are inadequate 
or impossible; 
‘‘(C) provide, as a component of care and treatment 
programs for persons with HIV/AIDS, food and nutritional 
support to individuals infected with, and affected by, HIV/ 
AIDS who meet established criteria for nutritional support 
(including clinically malnourished children and adults, and 
pregnant and lactating women in programs in need of 
supplemental support), including— 
‘‘(i) anthropometric and dietary assessment; 
‘‘(ii) counseling; and 
‘‘(iii) therapeutic and supplementary feeding;
H. R. 5501—40 
‘‘(D) provide food and nutritional support for children 
affected by HIV/AIDS and to communities and households 
caring for children affected by HIV/AIDS; and 
‘‘(E) in communities where HIV/AIDS and food insecu-
rity are highly prevalent, support programs to address 
these often intersecting health problems through commu-
nity-based assistance programs, with an emphasis on 
sustainable approaches. 
‘‘(2) AUTHORIZATION OF APPROPRIATIONS.—Of the amounts 
authorized to be appropriated under section 401, there are 
authorized to be appropriated to the President such sums as 
may be necessary for each of the fiscal years 2009 through 
2013 to carry out this subsection.’’. 
(h) ELIGIBILITY FOR ASSISTANCE.—Section 301(d) of such Act 
is amended to read as follows: 
‘‘(d) ELIGIBILITY FOR ASSISTANCE.—An organization, including 
a faith-based organization, that is otherwise eligible to receive 
assistance under section 104A of the Foreign Assistance Act of 
1961, under this Act, or under any amendment made by this Act 
or by the Tom Lantos and Henry J. Hyde United States Global 
Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthor-
ization Act of 2008, for HIV/AIDS prevention, treatment, or care— 
‘‘(1) shall not be required, as a condition of receiving such 
assistance— 
‘‘(A) to endorse or utilize a multisectoral or comprehen-
sive approach to combating HIV/AIDS; or 
‘‘(B) to endorse, utilize, make a referral to, become 
integrated with, or otherwise participate in any program 
or activity to which the organization has a religious or 
moral objection; and 
‘‘(2) shall not be discriminated against in the solicitation 
or issuance of grants, contracts, or cooperative agreements 
under such provisions of law for refusing to meet any require-
ment described in paragraph (1).’’. 
SEC. 302. ASSISTANCE TO COMBAT TUBERCULOSIS. 
(a) POLICY.—Section 104B(b) of the Foreign Assistance Act of 
1961 (22 U.S.C. 2151b–3(b)) is amended to read as follows: 
‘‘(b) POLICY.—It is a major objective of the foreign assistance 
program of the United States to control tuberculosis. In all countries 
in which the Government of the United States has established 
development programs, particularly in countries with the highest 
burden of tuberculosis and other countries with high rates of tuber-
culosis, the United States should support the objectives of the 
Global Plan to Stop TB, including through achievement of the 
following goals: 
‘‘(1) Reduce by half the tuberculosis death and disease 
burden from the 1990 baseline. 
‘‘(2) Sustain or exceed the detection of at least 70 percent 
of sputum smear-positive cases of tuberculosis and the success-
ful treatment of at least 85 percent of the cases detected in 
countries with established United States Agency for Inter-
national Development tuberculosis programs. 
‘‘(3) In support of the Global Plan to Stop TB, the President 
shall establish a comprehensive, 5-year United States strategy 
to expand and improve United States efforts to combat tuber-
culosis globally, including a plan to support—
H. R. 5501—41 
‘‘(A) the successful treatment of 4,500,000 new sputum 
smear tuberculosis patients under DOTS programs by 2013, 
primarily through direct support for needed services, 
commodities, health workers, and training, and additional 
treatment through coordinated multilateral efforts; and 
‘‘(B) the diagnosis and treatment of 90,000 new mul-
tiple drug resistant tuberculosis cases by 2013, and addi-
tional treatment through coordinated multilateral efforts.’’. 
(b) PRIORITY TO STOP TB STRATEGY.—Section 104B(e) of such 
Act is amended to read as follows: 
‘‘(e) PRIORITY TO STOP TB STRATEGY.—In furnishing assistance 
under subsection (c), the President shall give priority to— 
‘‘(1) direct services described in the Stop TB Strategy, 
including expansion and enhancement of Directly Observed 
Treatment Short-course (DOTS) coverage, rapid testing, treat-
ment for individuals infected with both tuberculosis and HIV, 
and treatment for individuals with multi-drug resistant tuber-
culosis (MDR–TB), strengthening of health systems, use of the 
International Standards for Tuberculosis Care by all providers, 
empowering individuals with tuberculosis, and enabling and 
promoting research to develop new diagnostics, drugs, and vac-
cines, and program-based operational research relating to tuber-
culosis; and 
‘‘(2) funding for the Global Tuberculosis Drug Facility, the 
Stop Tuberculosis Partnership, and the Global Alliance for TB 
Drug Development.’’. 
(c) ASSISTANCE FOR THE WORLD HEALTH ORGANIZATION AND 
THE STOP TUBERCULOSIS PARTNERSHIP.—Section 104B of such Act 
is amended— 
(1) by redesignating subsection (f) as subsection (h); and 
(2) by inserting after subsection (e) the following: 
‘‘(f) ASSISTANCE FOR THE WORLD HEALTH ORGANIZATION AND 
THE STOP TUBERCULOSIS PARTNERSHIP.—In carrying out this sec-
tion, the President, acting through the Administrator of the United 
States Agency for International Development, is authorized to pro-
vide increased resources to the World Health Organization and 
the Stop Tuberculosis Partnership to improve the capacity of coun-
tries with high rates of tuberculosis and other affected countries 
to implement the Stop TB Strategy and specific strategies related 
to addressing multiple drug resistant tuberculosis (MDR–TB) and 
extensively drug resistant tuberculosis (XDR–TB).’’. 
(d) ANNUAL REPORT.—Section 104B of such Act is amended 
by inserting after subsection (f), as added by subsection (c) of 
this section, the following: 
‘‘(g) ANNUAL REPORT.—The President shall submit an annual 
report to Congress that describes the impact of United States foreign 
assistance on efforts to control tuberculosis, including— 
‘‘(1) the number of tuberculosis cases diagnosed and the 
number of cases cured in countries receiving United States 
bilateral foreign assistance for tuberculosis control purposes; 
‘‘(2) a description of activities supported with United States 
tuberculosis resources in each country, including a description 
of how those activities specifically contribute to increasing the 
number of people diagnosed and treated for tuberculosis; 
‘‘(3) in each country receiving bilateral United States for-
eign assistance for tuberculosis control purposes, the percentage 
provided for direct tuberculosis services in countries receiving
H. R. 5501—42 
United States bilateral foreign assistance for tuberculosis con-
trol purposes; 
‘‘(4) a description of research efforts and clinical trials 
to develop new tools to combat tuberculosis, including 
diagnostics, drugs, and vaccines supported by United States 
bilateral assistance; 
‘‘(5) the number of persons who have been diagnosed and 
started treatment for multidrug-resistant tuberculosis in coun-
tries receiving United States bilateral foreign assistance for 
tuberculosis control programs; 
‘‘(6) a description of the collaboration and coordination of 
United States anti-tuberculosis efforts with the World Health 
Organization, the Global Fund, and other major public and 
private entities within the Stop TB Strategy; 
‘‘(7) the constraints on implementation of programs posed 
by health workforce shortages and capacities; 
‘‘(8) the number of people trained in tuberculosis control; 
and 
‘‘(9) a breakdown of expenditures for direct patient tuber-
culosis services, drugs and other commodities, drug manage-
ment, training in diagnosis and treatment, health systems 
strengthening, research, and support costs.’’. 
(e) DEFINITIONS.—Section 104B(h) of such Act, as redesignated 
by subsection (c), is amended— 
(1) in paragraph (1), by striking the period at the end 
and inserting the following: ‘‘including— 
‘‘(A) low-cost and effective diagnosis, treatment, and 
monitoring of tuberculosis; 
‘‘(B) a reliable drug supply; 
‘‘(C) a management strategy for public health systems; 
‘‘(D) health system strengthening; 
‘‘(E) promotion of the use of the International Stand-
ards for Tuberculosis Care by all care providers; 
‘‘(F) bacteriology under an external quality assessment 
framework; 
‘‘(G) short-course chemotherapy; and 
‘‘(H) sound reporting and recording systems.’’; and 
(2) by redesignating paragraph (5) as paragraph (6); and 
(3) by inserting after paragraph (4) the following: 
‘‘(5) STOP
TB
STRATEGY.—The term ‘Stop TB Strategy’ 
means the 6-point strategy to reduce tuberculosis developed 
by the World Health Organization, which is described in the 
Global Plan to Stop TB 2006–2015: Actions for Life, a com-
prehensive plan developed by the Stop TB Partnership that 
sets out the actions necessary to achieve the millennium 
development goal of cutting tuberculosis deaths and disease 
burden in half by 2015.’’. 
(f) AUTHORIZATION OF APPROPRIATIONS.—Section 302 (b) of the 
United States Leadership Against HIV/AIDS, Tuberculosis, and 
Malaria Act of 2003 (22 U.S.C. 7632(b)) is amended— 
(1) in paragraph (1), by striking ‘‘such sums as may be 
necessary for each of the fiscal years 2004 through 2008’’ and 
inserting ‘‘a total of $4,000,000,000 for the 5-year period begin-
ning on October 1, 2008.’’; and 
(2) in paragraph (3), by striking ‘‘fiscal years 2004 through 
2008’’ and inserting ‘‘fiscal years 2009 through 2013.’’.