‘‘(i) address the frequent coinfection of 
HIV and tuberculosis, in accordance with 
World Health Organization guidelines; 
‘‘(ii) promote provider-initiated or 
‘opt-out’ HIV/AIDS counseling and testing 
and appropriate referral for treatment and 
care to individuals with tuberculosis or its 
symptoms, particularly in areas with sig-
nificant HIV prevalence; and 
‘‘(iii) strengthen programs to ensure 
that individuals testing positive for HIV re-
ceive tuberculosis screening and to improve 
laboratory capacities, infection control, and 
adherence; and 
‘‘(G) activities to— 
‘‘(i) improve the effectiveness of na-
tional responses to HIV/AIDS; 
‘‘(ii) strengthen overall health systems 
in high-prevalence countries, including sup-
port for workforce training, retention, and 
effective deployment, capacity building, lab-
oratory development, equipment mainte-
nance and repair, and public health and re-
lated public financial management systems 
and operations; and
‘‘(iii) encourage fair and transparent 
procurement practices among partner coun-
tries; and 
‘‘(iv) promote in-country or intra-re-
gional pediatric training for physicians 
and other health professionals, preferably 
through public-private partnerships involv-
ing colleges and universities, with the goal 
of increasing pediatric HIV workforce ca-
pacity.’’; and 
(6) by adding at the end the following: 
‘‘(8) 
COMPACTS
AND
FRAMEWORK
AGREE-
MENTS.—The development of compacts or framework 
agreements, tailored to local circumstances, with na-
tional governments or regional partnerships in coun-
tries with significant HIV/AIDS burdens to promote 
host government commitment to deeper integration of 
HIV/AIDS services into health systems, contribute to 
health systems overall, and enhance sustainability, in-
cluding— 
‘‘(A) cost sharing assurances that meet the 
requirements under section 110; and 
‘‘(B) transition strategies to ensure sustain-
ability of such programs and activities, includ-
ing health care systems, under other inter-
national donor support, or budget support by re-
spective foreign governments.’’. 
(d) COMPACTS AND FRAMEWORK AGREEMENTS.—Sec-
tion 104A of such Act is amended— 
(1) by redesignating subsections (e) through (g) 
as subsections (f) through (h); and 
(2) by inserting after subsection (d) the fol-
lowing: 
‘‘(e) COMPACTS AND FRAMEWORK AGREEMENTS.— 
‘‘(1) FINDINGS.—Congress makes the following 
findings: 
‘‘(A) The congressionally mandated Insti-
tute of Medicine report entitled ‘PEPFAR Imple-
mentation: Progress and Promise’ states: ‘The 
next strategy [of the U.S. Global AIDS Initia-
tive] should squarely address the needs and chal-
lenges involved in supporting sustainable coun-
try HIV/AIDS programs, thereby transitioning 
from a focus on emergency relief.’. 
‘‘(B) One mechanism to promote the transi-
tion 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 au-
thorized under subsection (d)(8) shall include the fol-
lowing 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 Inter-
national Development or Department of 
Health and Human Services presence or re-
gional platform; or 
‘‘(II) countries or regions— 
‘‘(aa) experiencing significantly 
high HIV prevalence or risk of signifi-
cantly increasing incidence within the 
general population; 
‘‘(bb) served by an existing United 
States Agency for International Devel-
opment or Department of Health and 
Human Services presence or regional 
platform; and
‘‘(cc) that have inadequate finan-
cial means within such country or re-
gion. 
‘‘(B) Compacts whose primary purpose is to 
provide limited technical assistance to a country 
or region connected 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 De-
velopment or Department of Health and 
Human Services presence or regional plat-
form; 
‘‘(ii) shall require significant invest-
ments in HIV prevention, care, and treat-
ment services by the host country; 
‘‘(iii) shall be time-limited in terms of 
United States contributions; and 
‘‘(iv) shall be made only upon prior 
notification to Congress— 
‘‘(I) justifying the need for such 
compacts; 
‘‘(II) describing the expected in-
vestment by the country or regional en-
tity; and
‘‘(III) describing the scope, na-
ture, expected total United States in-
vestment, and time frame of the lim-
ited technical assistance under the 
compact 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 na-
tional HIV/AIDS and public health strategies of 
each country. 
‘‘(E) Compacts shall contain— 
‘‘(i) consideration of the specific objec-
tives that the country and the United States 
expect to achieve during the term of a com-
pact; 
‘‘(ii) consideration of the respective re-
sponsibilities of the country and the United 
States in the achievement of such objectives;
‘‘(iii) consideration of regular bench-
marks 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 economic, 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 ca-
pacity, including factors such as the 
training, retention, deployment, re-
cruitment, and utilization of health 
care workers;
‘‘(II) improve supply chain man-
agement; and 
‘‘(III) improve the health systems 
and infrastructure of the partner coun-
try, including the ability of compact 
participants to maintain and operate 
equipment transferred or purchased as 
part of the compact; 
‘‘(vii) consideration of proposed mecha-
nisms to provide oversight; 
‘‘(viii) consideration of the role of civil 
society in the development of a compact and 
the achievement of its objectives; 
‘‘(ix) a description of the current and 
potential participation of other donors in 
the achievement of such objectives, as appro-
priate; 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 re-
gional 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 
Reauthorization Act of 2008. 
‘‘(G) Amounts made available for compacts 
described in subparagraphs (A) and (B) shall be 
subject to the inclusion of— 
‘‘(i) cost sharing assurances that meet 
the requirements under section 110; and 
‘‘(ii) transition strategies to ensure 
sustainability of such programs and activi-
ties, including health care systems, under 
other international donor support, and 
budget support by respective foreign govern-
ments. 
‘‘(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 perspec-
tives of the rural and urban poor, including 
women, in each country; and 
‘‘(B) consults with private and voluntary 
organizations, including faith-based organiza-
tions, the business community, 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 Rela-
tions of the Senate; 
‘‘(ii) the Committee on Appropriations 
of the Senate; 
‘‘(iii) the Committee on Foreign Af-
fairs of the House of Representatives; and 
‘‘(iv) the Committee on Appropriations 
of the House of Representatives; and 
‘‘(B) publish such information in the Fed-
eral Register and on the Internet website of the 
Office of the Global AIDS Coordinator.’’. 
(e) ANNUAL REPORT.—Section 104A(f) of such Act, as 
redesignated, is amended— 
(1) in paragraph (1), by striking ‘‘Committee on 
International Relations’’ and inserting ‘‘Committee 
on Foreign Affairs’’; and 
(2) in paragraph (2)—
(A) in subparagraph (B), by striking ‘‘and’’ 
at the end; 
(B) by striking subparagraph (C) and in-
serting the following: 
‘‘(C) a detailed breakdown of funding allo-
cations, by program and by country, for preven-
tion activities; and 
‘‘(D) a detailed assessment of the impact of 
programs established pursuant to such sections, 
including— 
‘‘(i)(I) the effectiveness of such pro-
grams in reducing— 
‘‘(aa) the transmission of HIV, 
particularly in women and girls; 
‘‘(bb) mother-to-child transmission 
of HIV, including through drug treat-
ment 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 re-
ceives assistance under this Act; 
‘‘(III) an assessment of progress to-
wards 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 assist-
ance, including mortality and loss to follow- 
up rates, organized overall and by country; 
‘‘(ii) the progress made toward— 
‘‘(I) improving health care deliv-
ery systems (including the training of 
health care workers, including doctors, 
nurses, midwives, pharmacists, labora-
tory technicians, and compensated 
community health workers, and the use 
of codes of conduct for ethical recruit-
ing practices for health care workers); 
‘‘(II) advancing safe working con-
ditions for health care workers; and 
‘‘(III) improving infrastructure to 
promote progress toward universal ac-
cess to HIV/AIDS prevention, treat-
ment, and care by 2013;
‘‘(iii) a description of coordination ef-
forts with relevant executive branch agencies 
to link HIV/AIDS clinical and social serv-
ices with non-HIV/AIDS services as part of 
the United States health and development 
agenda; 
‘‘(iv) a detailed description of inte-
grated HIV/AIDS and food and nutrition 
programs and services, including— 
‘‘(I) the amount spent on food and 
nutrition support; 
‘‘(II) the types of activities sup-
ported; and 
‘‘(III) an assessment of the effec-
tiveness of interventions carried out to 
improve the health status of persons 
with HIV/AIDS receiving food or nu-
tritional support; 
‘‘(v) a description of efforts to improve 
harmonization, in terms of relevant execu-
tive branch agencies, coordination with 
other public and private entities, and co-
ordination with partner countries’ national 
strategic plans as called for in the ‘Three 
Ones’;
100 
‘‘(vi) a description of— 
‘‘(I) the efforts of partner coun-
tries that were signatories to the Abuja 
Declaration on HIV/AIDS, Tuber-
culosis and Other Related Infectious 
Diseases 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 investments of partner countries 
that were not signatories to such Dec-
laration; 
‘‘(vii) a detailed description of any 
compacts or framework agreements reached 
or negotiated between the United States and 
any partner countries, including a descrip-
tion of the elements of compacts described in 
subsection (e); 
‘‘(viii) a description of programs serv-
ing women and girls, including— 
‘‘(I) HIV/AIDS prevention pro-
grams that address the vulnerabilities 
of girls and women to HIV/AIDS;
101 
‘‘(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 dura-
tion of programs to address these 
issues; 
‘‘(III) information on programs to 
address the particular needs of adoles-
cent 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 pro-
grams; 
‘‘(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
102 
‘‘(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 infec-
tion 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; 
‘‘(xi) a detailed description of program 
monitoring, operations research, and im-
pact evaluation research, including— 
‘‘(I) the amount of funding pro-
vided for each research type; 
‘‘(II) an analysis of cost-effective-
ness models; and 
‘‘(III) conclusions regarding the 
efficiency, effectiveness, and quality of 
services as derived from previous or
103 
ongoing research and monitoring ef-
forts; 
‘‘(xii) building capacity to identify, 
investigate, and stop nosocomial trans-
mission 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 EN-
HANCE NUTRITION.—Section 301(c) of such Act is amended 
to read as follows:
104 
‘‘(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 individ-
uals 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, agricultural, and livelihood 
sectors and establish additional services in cir-
cumstances 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 in-
105 
fected with, and affected by, HIV/AIDS who meet 
established criteria for nutritional support (in-
cluding clinically malnourished children and 
adults, and pregnant and lactating women in 
programs in need of supplemental support), in-
cluding— 
‘‘(i) anthropometric and dietary assess-
ment; 
‘‘(ii) counseling; and 
‘‘(iii) therapeutic and supplementary 
feeding; 
‘‘(D) provide food and nutritional support 
for children affected by HIV/AIDS and to com-
munities and households caring for children af-
fected by HIV/AIDS; and 
‘‘(E) in communities where HIV/AIDS and 
food insecurity are highly prevalent, support 
programs to address these often intersecting 
health problems through community-based assist-
ance programs, with an emphasis on sustainable 
approaches. 
‘‘(2) AUTHORIZATION OF APPROPRIATIONS.—Of 
the amounts authorized to be appropriated under sec-
tion 401, there are authorized to be appropriated to 
the President such sums as may be necessary for each
106 
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 eligi-
ble 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 Reauthorization Act 
of 2008, for HIV/AIDS prevention, treatment, or care— 
‘‘(1) shall not be required, as a condition of re-
ceiving such assistance— 
‘‘(A) to endorse or utilize a multisectoral or 
comprehensive 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 organi-
zation has a religious or moral objection; and 
‘‘(2) shall not be discriminated against in the so-
licitation or issuance of grants, contracts, or coopera-
tive agreements under such provisions of law for re-
107 
fusing to meet any requirement described in para-
graph (1).’’. 
SEC. 302. ASSISTANCE TO COMBAT TUBERCULOSIS. 
(a) POLICY.—Section 104B(b) of the Foreign Assist-
ance 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 as-
sistance program of the United States to control tuber-
culosis. In all countries in which the Government of the 
United States has established development programs, par-
ticularly in countries with the highest burden of tuber-
culosis and other countries with high rates of tuberculosis, 
the United States should support the objectives of the Global 
Plan to Stop TB, including through achievement of the fol-
lowing 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 tuber-
culosis and the successful treatment of at least 85 per-
cent of the cases detected in countries with established 
United States Agency for International Development 
tuberculosis programs. 
‘‘(3) In support of the Global Plan to Stop TB, 
the President shall establish a comprehensive, 5-year
108 
United States strategy to expand and improve United 
States efforts to combat tuberculosis globally, includ-
ing a plan to support— 
‘‘(A) the successful treatment of 4,500,000 
new sputum smear tuberculosis patients under 
DOTS programs by 2013, primarily through di-
rect support for needed services, commodities, 
health workers, and training, and additional 
treatment through coordinated multilateral ef-
forts; and 
‘‘(B) the diagnosis and treatment of 90,000 
new multiple drug resistant tuberculosis cases by 
2013, and additional treatment through coordi-
nated 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 fur-
nishing 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, treatment for individuals in-
fected with both tuberculosis and HIV, and treatment 
for individuals with multi-drug resistant tuberculosis
109 
(MDR–TB), strengthening of health systems, use of 
the International Standards for Tuberculosis Care by 
all providers, empowering individuals with tuber-
culosis, and enabling and promoting research to de-
velop new diagnostics, drugs, and vaccines, and pro-
gram-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 ORGANIZA-
TION AND THE STOP TUBERCULOSIS PARTNERSHIP.—Sec-
tion 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 ORGANI-
ZATION AND THE STOP TUBERCULOSIS PARTNERSHIP.—In 
carrying out this section, the President, acting through the 
Administrator of the United States Agency for Inter-
national Development, is authorized to provide 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 coun-
tries to implement the Stop TB Strategy and specific strate-
110 
gies related to addressing multiple drug resistant tuber-
culosis (MDR–TB) and extensively drug resistant tuber-
culosis (XDR–TB).’’. 
(d) ANNUAL REPORT.—Section 104B of such Act is 
amended by inserting after subsection (f), as added by sub-
section (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 tuber-
culosis, including— 
‘‘(1) the number of tuberculosis cases diagnosed 
and the number of cases cured in countries receiving 
United States bilateral foreign assistance for tuber-
culosis control purposes; 
‘‘(2) a description of activities supported with 
United States tuberculosis resources in each country, 
including a description of how those activities specifi-
cally contribute to increasing the number of people di-
agnosed and treated for tuberculosis; 
‘‘(3) in each country receiving bilateral United 
States foreign assistance for tuberculosis control pur-
poses, the percentage provided for direct tuberculosis 
services in countries receiving United States bilateral 
foreign assistance for tuberculosis control purposes;
111 
‘‘(4) a description of research efforts and clinical 
trials to develop new tools to combat tuberculosis, in-
cluding diagnostics, drugs, and vaccines supported by 
United States bilateral assistance; 
‘‘(5) the number of persons who have been diag-
nosed and started treatment for multidrug-resistant 
tuberculosis in countries receiving United States bi-
lateral foreign assistance for tuberculosis control pro-
grams; 
‘‘(6) a description of the collaboration and co-
ordination 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 pro-
grams posed by health workforce shortages and capac-
ities; 
‘‘(8) the number of people trained in tuberculosis 
control; and 
‘‘(9) a breakdown of expenditures for direct pa-
tient tuberculosis services, drugs and other commod-
ities, drug management, training in diagnosis and 
treatment, health systems strengthening, research, and 
support costs.’’.
112 
(e) DEFINITIONS.—Section 104B(h) of such Act, as re-
designated 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, treat-
ment, 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 Inter-
national Standards 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 sys-
tems.’’; and 
(2) by redesignating paragraph (5) as para-
graph (6); and 
(3) by inserting after paragraph (4) the fol-
lowing: 
‘‘(5) STOP TB STRATEGY.—The term ‘Stop TB 
Strategy’ means the 6-point strategy to reduce tuber-
culosis developed by the World Health Organization,
113 
which is described in the Global Plan to Stop TB 
2006–2015: Actions for Life, a comprehensive plan 
developed by the Stop TB Partnership that sets out 
the actions necessary to achieve the millennium devel-
opment 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 beginning on Oc-
tober 1, 2008.’’; and 
(2) in paragraph (3), by striking ‘‘fiscal years 
2004 through 2008’’ and inserting ‘‘fiscal years 2009 
through 2013.’’. 
SEC. 303. ASSISTANCE TO COMBAT MALARIA. 
(a) AMENDMENT TO THE FOREIGN ASSISTANCE ACT 
OF 1961.—Section 104C(b) of the Foreign Assistance Act 
of 1961 (22 U.S.C. 2151–4(b)) is amended by inserting 
‘‘treatment,’’ after ‘‘control,’’. 
(b) AUTHORIZATION
OF APPROPRIATIONS.—Section 
303 of the United States Leadership Against HIV/AIDS,
114 
Tuberculosis, and Malaria Act of 2003, and Malaria Act 
of 2003 (22 U.S.C. 7633) is amended— 
(1) in subsection (b)— 
(A) in paragraph (1), by striking ‘‘such 
sums as may be necessary for fiscal years 2004 
through 2008’’ and inserting ‘‘$5,000,000,000 
during the 5-year period beginning on October 1, 
2008’’; and 
(B) in paragraph (3), by striking ‘‘fiscal 
years 2004 through 2008’’ and inserting ‘‘fiscal 
years 2009 through 2013’’; and 
(2) by adding at the end the following: 
‘‘(c) STATEMENT OF POLICY.—Providing assistance 
for the prevention, control, treatment, and the ultimate 
eradication of malaria is— 
‘‘(1) a major objective of the foreign assistance 
program of the United States; and 
‘‘(2) 1 component of a comprehensive United 
States global health strategy to reduce disease burdens 
and strengthen communities around the world. 
‘‘(d) DEVELOPMENT OF A COMPREHENSIVE 5-YEAR 
STRATEGY.—The President shall establish a comprehensive, 
5-year strategy to combat global malaria that—
115 
‘‘(1) strengthens the capacity of the United 
States to be an effective leader of international efforts 
to reduce malaria burden; 
‘‘(2) maintains sufficient flexibility and remains 
responsive to the ever-changing nature of the global 
malaria challenge; 
‘‘(3) includes specific objectives and multisectoral 
approaches and strategies to reduce the prevalence, 
mortality, incidence, and spread of malaria; 
‘‘(4) describes how this strategy would contribute 
to the United States’ overall global health and devel-
opment goals; 
‘‘(5) clearly explains how outlined activities will 
interact with other United States Government global 
health activities, including the 5-year global AIDS 
strategy required under this Act; 
‘‘(6) expands public-private partnerships and le-
verage of resources; 
‘‘(7) coordinates among relevant Federal agencies 
to maximize human and financial resources and to 
reduce duplication among these agencies, foreign gov-
ernments, and international organizations; 
‘‘(8) coordinates with other international enti-
ties, including the Global Fund;
116 
‘‘(9) maximizes United States capabilities in the 
areas of technical assistance and training and re-
search, including vaccine research; and 
‘‘(10) establishes priorities and selection criteria 
for the distribution of resources based on factors such 
as— 
‘‘(A) the size and demographics of the popu-
lation with malaria; 
‘‘(B) the needs of that population; 
‘‘(C) the country’s existing infrastructure; 
and 
‘‘(D) the ability to closely coordinate United 
States Government efforts with national malaria 
control plans of partner countries.’’. 
SEC. 304. MALARIA RESPONSE COORDINATOR. 
Section 304 of the United States Leadership Against 
HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22 
U.S.C. 7634) is amended to read as follows: 
‘‘SEC. 304. MALARIA RESPONSE COORDINATOR. 
‘‘(a) IN GENERAL.—There is established within the 
United States Agency for International Development a Co-
ordinator of United States Government Activities to Com-
bat Malaria Globally (referred to in this section as the ‘Ma-
laria Coordinator’), who shall be appointed by the Presi-
dent.
117 
‘‘(b) AUTHORITIES.—The Malaria Coordinator, acting 
through nongovernmental organizations (including faith- 
based and community-based organizations), partner coun-
try finance, health, and other relevant ministries, and rel-
evant executive branch agencies as may be necessary and 
appropriate to carry out this section, is authorized to— 
‘‘(1) operate internationally to carry out preven-
tion, care, treatment, support, capacity development, 
and other activities to reduce the prevalence, mor-
tality, and incidence of malaria; 
‘‘(2) provide grants to, and enter into contracts 
and cooperative agreements with, nongovernmental 
organizations (including faith-based organizations) to 
carry out this section; and 
‘‘(3) transfer and allocate executive branch agen-
cy funds that have been appropriated for the purposes 
described in paragraphs (1) and (2). 
‘‘(c) DUTIES.— 
‘‘(1) IN
GENERAL.—The Malaria Coordinator 
has primary responsibility for the oversight and co-
ordination of all resources and international activi-
ties of the United States Government relating to ef-
forts to combat malaria. 
‘‘(2) SPECIFIC
DUTIES.—The Malaria Coordi-
nator shall—
118 
‘‘(A) facilitate program and policy coordi-
nation of antimalarial efforts among relevant ex-
ecutive branch agencies and nongovernmental or-
ganizations by auditing, monitoring, and evalu-
ating such programs; 
‘‘(B) ensure that each relevant executive 
branch agency undertakes antimalarial pro-
grams primarily in those areas in which the 
agency has the greatest expertise, technical capa-
bility, and potential for success; 
‘‘(C) coordinate relevant executive branch 
agency activities in the field of malaria preven-
tion and treatment; 
‘‘(D) coordinate planning, implementation, 
and evaluation with the Global AIDS Coordi-
nator in countries in which both programs have 
a significant presence; 
‘‘(E) coordinate with national governments, 
international agencies, civil society, and the pri-
vate sector; and 
‘‘(F) establish due diligence criteria for all 
recipients of funds appropriated by the Federal 
Government for malaria assistance. 
‘‘(d) ASSISTANCE FOR THE WORLD HEALTH ORGANI-
ZATION.—In carrying out this section, the President may
119 
provide financial assistance to the Roll Back Malaria Part-
nership of the World Health Organization to improve the 
capacity of countries with high rates of malaria and other 
affected countries to implement comprehensive malaria con-
trol programs. 
‘‘(e) COORDINATION
OF ASSISTANCE EFFORTS.—In 
carrying out this section and in accordance with section 
104C of the Foreign Assistance Act of 1961 (22 U.S.C. 
2151b–4), the Malaria Coordinator shall coordinate the pro-
vision of assistance by working with— 
‘‘(1) relevant executive branch agencies, includ-
ing— 
‘‘(A) the Department of State (including the 
Office of the Global AIDS Coordinator); 
‘‘(B) the Department of Health and Human 
Services; 
‘‘(C) the Department of Defense; and 
‘‘(D) the Office of the United States Trade 
Representative; 
‘‘(2) relevant multilateral institutions, includ-
ing— 
‘‘(A) the World Health Organization; 
‘‘(B) the United Nations Children’s Fund; 
‘‘(C) the United Nations Development Pro-
gramme;
120 
‘‘(D) the Global Fund; 
‘‘(E) the World Bank; and 
‘‘(F) the Roll Back Malaria Partnership; 
‘‘(3) program delivery and efforts to lift barriers 
that would impede effective and comprehensive ma-
laria control programs; and 
‘‘(4) partner or recipient country governments 
and national entities including universities and civil 
society organizations (including faith- and commu-
nity-based organizations). 
‘‘(f) RESEARCH.—To carry out this section, the Ma-
laria Coordinator, in accordance with section 104C of the 
Foreign Assistance Act of 1961 (22 U.S.C. 1151d–4), shall 
ensure that operations and implementation research con-
ducted under this Act will closely complement the clinical 
and program research being undertaken by the National In-
stitutes of Health. The Centers for Disease Control and Pre-
vention should advise the Malaria Coordinator on priorities 
for operations and implementation research and should be 
a key implementer of this research. 
‘‘(g) MONITORING.—To ensure that adequate malaria 
controls are established and implemented, the Centers for 
Disease Control and Prevention should advise the Malaria 
Coordinator on monitoring, surveillance, and evaluation 
activities and be a key implementer of such activities under
134 
‘‘(d) TREATMENT, PREVENTION, AND CARE GOALS.— 
For each of the fiscal years 2009 through 2013— 
‘‘(1) the treatment goal under section 402(a)(3) 
shall be increased above 2,000,000 by at least the per-
centage increase in the amount appropriated for bi-
lateral global HIV/AIDS assistance for such fiscal 
year compared with fiscal year 2008; 
‘‘(2) any increase in the treatment goal under 
section 402(a)(3) above the percentage increase in the 
amount appropriated for bilateral global HIV/AIDS 
assistance for such fiscal year compared with fiscal 
year 2008 shall be based on long-term requirements, 
epidemiological evidence, the share of treatment needs 
being met by partner governments and other sources 
of treatment funding, and other appropriate factors; 
‘‘(3) the treatment goal under section 402(a)(3) 
shall be increased above the number calculated under 
paragraph (1) by the same percentage that the aver-
age United States Government cost per patient of pro-
viding treatment in countries receiving bilateral HIV/ 
AIDS assistance has decreased compared with fiscal 
year 2008; and 
‘‘(4) the prevention and care goals established in 
clauses (i) and (iv) of section 104A(b)(1)(A) of the 
Foreign Assistance Act of 1961 (22 U.S.C. 2151b–