Scale-up of HIV treatment through PEPFAR: A historic public health achievement

ICAP, Columbia University, Mailman School of Public Health, New York, NY 10032, USA.
JAIDS Journal of Acquired Immune Deficiency Syndromes (Impact Factor: 4.56). 08/2012; 60 Suppl 3(Suppl 3):S96-104. DOI: 10.1097/QAI.0b013e31825eb27b
Source: PubMed


Since its inception in 2003, the US President's Emergency Plan for AIDS Relief (PEPFAR) has been an important driving force behind the global scale-up of HIV care and treatment services, particularly in expansion of access to antiretroviral therapy. Despite initial concerns about cost and feasibility, PEPFAR overcame challenges by leveraging and coordinating with other funders, by working in partnership with the most affected countries, by supporting local ownership, by using a public health approach, by supporting task-shifting strategies, and by paying attention to health systems strengthening. As of September 2011, PEPFAR directly supported initiation of antiretroviral therapy for 3.9 million people and provided care and support for nearly 13 million people. Benefits in terms of prevention of morbidity and mortality have been reaped by those receiving the services, with evidence of societal benefits beyond the anticipated clinical benefits. However, much remains to be accomplished to achieve universal access, to enhance the quality of programs, to ensure retention of patients in care, and to continue to strengthen health systems.

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    • "In much of sub-Saharan Africa, a severe shortage of health care workers and a disproportionately high burden of disease make it difficult to provide basic health services, much less meet ambitious new targets for combating HIV/AIDS [1–4]. Efforts by countries to respond to the HIV epidemic have highlighted the importance of the health workforce and have focused attention on the practice and education of health care workers [5–7]. Many global health initiatives, such as the President's Emergency Plan for AIDS Relief (PEPFAR), involve strategies to expand the capacity of the health workforce, such as strengthening health professional pre-service education and shifting the responsibility for delivering HIV services from physicians to mid-level health professionals (task shifting) [8–11]. "
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