The 2008 Leadership Act called on the U.S. Global AIDS Coordinator to develop a 5-year strategy to combat global HIV/AIDS, including a plan to achieve a number of prevention, treatment, and care program goals. The 5-year PEPFAR strategy, which OGAC released in December 2009, specifies multiyear program goals and outlines multiyear targets including those listed in the Leadership Act. The 2008 Leadership Act, which amends the 2003 Leadership Act, requires that OGAC submit an annual report to Congress, including an assessment of progress toward the achievement of annual goals. If annual goals are not being met, the 2008 Leadership Act states that the report should identify the reasons for such failure. GPRA and our prior work identify practices related to performance planning and reporting. GPRA calls for the use of several performance management practices intended to improve federal program effectiveness, accountability, and service delivery and to enhance congressional decision making by requiring federal agencies to provide more objective information on program performance. In addition, our prior work suggests the use of a practice to bolster program performance reporting. These practices include the following, among others:  Performance planning. GPRA calls for preparation of public annual performance plans that articulate goals for the upcoming fiscal year. These plans should link annual program goals to program activities, include indicators that will be used to measure performance, provide information on the operational processes and resources required to meet the performance goals, and identify the procedures that will be used to verify and validate performance information.  Performance reporting. GPRA calls for annual performance reports reviewing the success of achieving the performance goals of the fiscal year. The reports are to describe and review results compared with performance goals, provide explanations for any unmet goals and actions needed to address them, and include summaries of completed program evaluations. In addition, our prior work found that explaining any limitations of performance information can provide context for understanding and assessing program performance and the costs and challenges faced in gathering, processing, and analyzing data. This practice can help identify the actions needed to address any inadequacies in the completeness and reliability of performance data and thereby improve program performance reporting. In August 2009, OGAC issued its Next Generation Indicators Reference Guide, providing an updated list of indicators for establishing targets and reporting on results of PEPFAR prevention, care, treatment, and health systems strengthening programs. The guidance classifies 32 indicators as essential and reported—that is, indicators that PEPFAR country or regional teams must use in submitting data on program results to OGAC. (See app. III for a list of the 32 essential reported PEPFAR indicators.) The guidance advises PEPFAR country and regional teams to require PEPFAR implementing partners to submit data for an additional set of indicators, if applicable, but does not require country and regional teams to submit these data to OGAC. The guidance also provides a list of recommended indicators for implementing partners and PEPFAR program managers who need additional information for program management. The guidance states that PEPFAR interagency country or regional teams determine how to collect data from PEPFAR implementing partners and relevant national systems, as well as how to aggregate, store, and use the PEPFAR program monitoring indicators in country. OGAC, USAID, and CDC officials share responsibility for PEPFAR planning and reporting activities—including developing and approving PEPFAR operational plans and reports—and conduct agency-specific planning and reporting procedures. The procedures support agencies’ internal program management and provide data for external reporting on PEPFAR results. OGAC’s Strategic Information (SI) office guides and coordinates PEPFAR performance planning and reporting for countries and regions receiving U.S. HIV/AIDS assistance. SI advisors—as of July 2011, 20 CDC and USAID officials—provide technical support and assistance to country and regional teams for developing annual operational plans for PEPFAR programs. In helping to develop the country-level and regional operational plans, when requested, SI advisors work with the country and regional teams to describe partner-level PEPFAR activities during the preceding fiscal year and establish country-level and regional targets for the coming year. When OGAC receives the operational plans (typically in October), SI advisors review the performance targets. After the plans are approved by the U.S. Global AIDS Coordinator, OGAC aggregates budget, program activity, and planned performance information in the plans to create an annual PEPFAR operational plan to be submitted to Congress. When requested, OGAC’s SI office also guides and assists PEPFAR teams in preparing and submitting data on program results to the U.S. Global AIDS Coordinator. SI advisors work with PEPFAR country and regional teams to submit data on program results semi-annually (typically in May) and annually (typically in November). The semi-annual data consist of targets and results for a subset of eight PEPFAR essential indicators; the annual data consist of targets and results for all 32 essential reported PEPFAR indicators. SI advisors review the submitted data, and SI office staff further review and reconcile treatment data with data from the Global Fund, UNAIDS, and the World Health Organization. Once the data are confirmed, OGAC considers them to be PEPFAR’s final results for the year. These data, which OGAC maintains internally, are intended to support PEPFAR program monitoring, midcourse correction, and planning for subsequent fiscal years. PEPFAR program results data also supply information for public reports and other documents, including OGAC’s annual report to Congress on PEPFAR performance, typically published in February, as well as a World AIDS Day (December 1) press release on PEPFAR results. USAID’s Office of HIV/AIDS, in Washington, D.C., and USAID officials in regional and country missions share responsibility for global HIV/AIDS performance planning and reporting, including oversight of USAID implementing partners. The Office of HIV/AIDS comprises four divisions, two of which—the Implementation Support Division and the Strategic Planning, Evaluation, and Reporting Division—provide assistance to the agency and field missions in managing programs and incorporating programmatic best practices. USAID uses PEPFAR program results data for its annual performance plans and reports. USAID also conducts foreign assistance performance planning and reporting jointly with State’s Office of the Director of U.S. Foreign Assistance, using State’s and USAID’s Foreign Assistance Framework. In addition to producing multiyear country assistance strategies and mission strategic plans, USAID country or regional missions complete annual operational plans and annual performance plans and reports for monitoring, evaluating, and reporting progress in achieving the agency’s foreign assistance objectives. USAID guidance further specifies required elements of mission performance management plans, including indicators, baseline values and targets, data sources, any known data limitations, and data quality assessment procedures. State’s and USAID’s master list of standard indicators specifies 46 HIV/AIDS- related indicators for setting targets and reporting results. According to USAID officials, the HIV/AIDS-related indicator descriptions are aligned with those for PEPFAR. Through its audits of USAID’s global HIV/AIDS program activities, from fiscal year 2008 to 2011, USAID’s OIG has made recommendations related to performance planning and reporting. We identified 130 USAID OIG recommendations regarding performance monitoring of USAID- administered PEPFAR activities for fiscal years 2008 to 2011, which we categorized using 12 components of HIV/AIDS program monitoring and evaluations systems, as defined by UNAIDS. Of these recommendations, 94 recommendations, or 72 percent, are related to routine program monitoring or data quality—specifically, 39 percent are related to routine program monitoring (producing timely and high-quality program monitoring data); 11 percent are related to supportive supervision and data auditing (monitoring data quality periodically and addressing any obstacles to producing high-quality data); and 22 percent are related to both routine program monitoring and supportive supervision and data auditing. (See fig. 1.) For example, the OIG reported in 2009 that the USAID mission in one country did not sufficiently verify and validate implementing partner performance data and, as a result, recommended that the mission establish procedures, including site visits, for validating these data. (We categorized this recommendation as relating to both routine program monitoring and supportive supervision and data auditing.) In addition, we found that a number of recommendations related to human capacity for monitoring and evaluation, often in combination with recommendations for improving program monitoring. For example, a 2010 audit of another USAID country mission’s PEPFAR program found that inadequate training of implementing partner staff resulted in weak data collection methods and reporting of inaccurate performance data. The OIG recommended that the mission develop a training plan for implementing partner staff in charge of data collection and reporting. Routine program monitoring (51 recommendations) Routine program monitoring and supportive supervision and data auditing (29 recommendations) Supportive supervision and data auditing (14 recommendations) Supportive supervision and data auditing and human capacity (10 recommendations) Human capacity (5 recommendations) Human capacity and routine program monitoring (6 recommendations) Partnerships for monitoring and evaluation (3 recommendations) Routine program monitoring and partnerships for monitoring and evaluation (2 recommendations) Organizational structures and routine program monitoring (2 recommendations) According to data provided by USAID, as of June 2011, the agency had implemented about two-thirds (65 percent) of USAID OIG report recommendations related to program performance monitoring and evaluation; about a third (35 percent) of the remaining recommendations are due for final action by December 2011. (See fig. 2.) CDC’s Division of Global HIV/AIDS (DGHA), in Atlanta, Georgia, is responsible, along with CDC officials in 41 overseas offices, for global HIV/AIDS programs in more than 75 countries. DGHA comprises a regional and country management office and eight headquarters-based technical and operational branches, including epidemiology and strategic information; health economics, systems, and integration; and country operations.