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Charles Holmes, 2009-2013 From an Emergency Response to Local Ownership and Systems Strengthening

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Charles Holmes, 2009-2013 From an Emergency Response to Local Ownership and Systems Strengthening

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October 7, 2019

On October 7, 2019, the Harvard Global Health Institute will host a one-day symposium to explore what enabled this visionary program, and to showcase how it has transformed not just the worldwide HIV/AIDS response but global health delivery more broadly.
There are many lessons learned in PEPFAR’s story - from what it took to build a supply chain where there was none, to establishing the use of generic antiretroviral therapies (ARTs) and leveraging human capacity. This event convened the early architects of PEPFAR as well as experts and implementers currently leading the charge. We took a historically informed look at what it will take to stop global transmission, and shared tools useful for others hoping to move the needle on vexing problems in global health.

For more information, visit our website at https://petrieflom.law.harvard.edu/events/details/15-years-of-pepfar

October 7, 2019

On October 7, 2019, the Harvard Global Health Institute will host a one-day symposium to explore what enabled this visionary program, and to showcase how it has transformed not just the worldwide HIV/AIDS response but global health delivery more broadly.
There are many lessons learned in PEPFAR’s story - from what it took to build a supply chain where there was none, to establishing the use of generic antiretroviral therapies (ARTs) and leveraging human capacity. This event convened the early architects of PEPFAR as well as experts and implementers currently leading the charge. We took a historically informed look at what it will take to stop global transmission, and shared tools useful for others hoping to move the needle on vexing problems in global health.

For more information, visit our website at https://petrieflom.law.harvard.edu/events/details/15-years-of-pepfar

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Charles Holmes, 2009-2013 From an Emergency Response to Local Ownership and Systems Strengthening

  1. 1. 2009 – 2013 From an Emergency Response to Local Ownership and Systems Strengthening Charles Holmes MD, MPH
  2. 2. • Background on PEPFAR legislation and economic environment 2009-2013 • Consolidation of gains and improving quality and efficiency for greater impact • Enhancing country ownership • Accelerating scale-up and effectiveness of programs • Global Plan for PMTCT and maternal health • Accelerating science and data to policy • Rapid expansion of combination prevention/treatment
  3. 3. GDP growth, 2000-2015 IMF, World Economic Outlook, 2016
  4. 4. Hyde-Lantos Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act July 24, 2008
  5. 5. PEPFAR-Supported Scale-up of Treatment 67,100 249,000 541,300 1,091,700 1,743,600 2,485,300 0 500,000 1,000,000 1,500,000 2,000,000 2,500,000 3,000,000 2004 2005 2006 2007 2008 2009 Number of people directly supported on treatment by PEPFAR
  6. 6. U.S.G. Funding for the President’s Emergency Plan for AIDS Relief Kaiser Family Foundation
  7. 7. Consolidation of gains, and improving quality and efficiency for greater impact
  8. 8. Distribution of USG expenditure per person receiving HIV testing and counseling, by partner and province – Mozambique
  9. 9. Greater efficiency = More lives saved Expanded procurement via a pooled supply chain management system. Expanded use of generic antiretroviral drugs (ARVs) – by 2011 over 98% of the ARV packs purchased by PEPFAR were generic, up from 15% in 2005 Switching from air to land and sea freight Maximizing investment impact through better coordination with the Global Fund and the elimination of parallel systems
  10. 10. U.S.G. Funding for the President’s Emergency Plan for AIDS Relief Kaiser Family Foundation
  11. 11. Country ownership through strengthened transparency, accountability and partnership: Partnership Frameworks Hanoi, Vietnam July 22, 2010
  12. 12. Country ownership through strengthened transparency and partnership
  13. 13. Accelerating scale-up, effectiveness and impact of programs • Global Plan for elimination of mother of child HIV transmission and keeping mothers alive • Accelerating science and data to policy • Combination prevention/ART scale-up
  14. 14. A crisis in 2009: new infant infections and pregnant women dying of HIV In 2009, 370 000 children became newly infected with HIV globally and an estimated 50 000 pregnant women died because of HIV
  15. 15. UNAIDS, 2014
  16. 16. 2014 Global Plan Progress Report Groundbreaking progress in preventing infant HIV infections and saving the lives of pregnant women through HIV treatment
  17. 17. Accelerating science and data to policy
  18. 18. Increasing effectiveness through science in PEPFAR policymaking and programs • Established the PEPFAR Office of Research and Science • Collaborated with CDC, USAID and NIH on a series of funding opportunities centered around implementation science • Carefully targeted to areas in which we had the greatest investments and questions about how to optimize delivery, the application of emerging diagnostic/therapeutic technologies, and under-reached key populations • Established the Federally chartered PEPFAR scientific advisory board • Distinguished scientists from academia, USG agencies, and experts in program implementation and policy • To help us to ground our programs and policies in the best science
  19. 19. Emerging science to policy
  20. 20. December 1, 2011
  21. 21. Robust PEPFAR-supported scale-up, 2009-2013 PEPFAR Annual VMMC 0 1 2 3 4 5 6 7 8 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Millions Patients Currently Receiving ART (2004-2013) 0 2 4 6 8 10 12 14 2005 2006 2007 2008 2009 2010 2011 2012 2013 Millions ANC Clients who know HIV Status
  22. 22. PEPFAR 2009 – 2013 takeaways • Pivotal era for starting the process of viewing countries more as partners than recipients, and looking for every opportunity to support their leadership • This did not slow us down, but was rather a constituent part of the successes we had continuing to scale within the bounds of resource constraints • We were able to build systems that have now been adapted by others in global health to closely track the value for money for each dollar spent, and to enhance coordination and decision-making • We were able to both generate more relevant science and make better use of science discoveries as a tool to save more lives and prevent new infections • And ultimately brought effective interventions to millions of people during this era, in a way that could serve as a model for other global health efforts
  23. 23. Moving forward together!

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