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

Abstract

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.

FIGURE 1

Number of generic versus branded drugs procured (monthly packs, 2005–2010). PEP-FAR increased its use of generic drugs from 16% in 2005 to 97% in 2010.

FIGURE 2

Total SCMS orders for 2- and 3-drug ARVs. Between 2008 and 2011, PEPFAR increased its purchases of 2- and 3-drug FDCs, as recommended by WHO.

FIGURE 3

SCMS order quantity for zidovudine (AZT), stavudine (d4T), and tenofovir (TDF) in fiscal year (FY) 2008–2011. Since 2008, SCMS orders for stavudine have declined by more than 70%, whereas orders for zidovudine and tenofovir have increased 20-fold.

FIGURE 4

Number of adults and children with HIV infection receiving ART with direct PEPFAR support in fiscal year 2004–2011. PEPFAR support increased the number of individuals who initiated ART from 66,700 to 3,905,500.

FIGURE 5

Track 1.0 ART Program. Over the 8 years of the program, Track 1.0 ART partners were instrumental in initiating ART for 1.4 million HIV-infected adults and children.

FIGURE 6

During 2011, CDC transitioned the oversight and management of the Track 1.0 ART Program from US-based partners to MOHs and other indigenous organizations for more than half of 1300 medical facilities in 13 countries that were providing ART for more than 925,000 patients.