1. PEPFAR Guidance Blueprint: Creating an AIDS Free Generation
Supplement to presentation by Ambassador Deborah Birx for ClASS Consultants
November, 2014

2. Session Topics
Main foundational points from PEPFAR Durban Meeting (outlined in Townhall Forum with Ambassador Birx presentation ClASS website)
PEPFAR Quality Strategy (PQS)
Monitoring, Evaluation and Reporting (MER) guidance
Site Improvement through Monitoring System (SIMS)
Expenditure Analysis (EA)
Care and Treatment Earmark guidance
Integrated PEPFAR Site List (iPSL)
Data for Accountability, Transparency and Impact (DATIM)
Durban conference for USG personnel; Town Hall Forum discusses similar themes.

3. PEPFAR Durban Meeting
“Delivering Sustainable Results with Accountability, Transparency, and Impact”
Five Key Agendas supporting the Blueprint
Impact
Efficiency
Sustainability
Partnership: Working Together towards an AIDS-Free Generation
Human Rights: Securing, Protecting, & Promoting Human Rights
Each agenda item has metrics for success as well as timelines/deliverables.

4. PEPFAR Durban Meeting – 3 Guiding Pillars
Accountability
Demonstrate cost-effective programming that maximizes the impact of every dollar invested
Transparency
Demonstrate increased transparency with validation and sharing of all levels of program data
Impact
Demonstrate sustained control of the epidemic – save lives and avert new infections

5. Blueprint: Creating an AIDS Free Generation
Four Road Maps supporting the Blueprint
Saving Lives: Impact
Smart Investments: Efficiency
Shared Responsibility: Sustainability
Driving Results with Science

6. Road Map for Saving Lives: Impact
Work toward the elimination of new HIV infections among children by 2015 and keeping their mothers alive.
Increase coverage of HIV treatment both to reduce AIDS-related mortality and to enhance HIV prevention.
Increase the number of males who are circumcised for HIV prevention.
Increase access to, and uptake of, HIV testing and counseling, condoms and other evidence-based, appropriately-targeted prevention interventions.

7. Road Map for Smart Investments: Efficiency
Target HIV-associated tuberculosis (TB) and reduce co-morbidity and mortality.
Increase access to, and uptake of, HIV services by key populations.
Partner with people living with HIV to design, manage and implement HIV programs to ensure that they are responsive to, and respectful of, their needs.
Strengthen PEPFAR’s continued focus on women, girls and gender equality.
Reach orphans and vulnerable children (OVC) affected by AIDS, and support programs that help them develop to their full potential.
Strengthen programmatic commitment to and emphasis on reaching and supporting young people with HIV services.
Strengthen PEPFAR supply chains and business processes to increase the efficiency of our investments.
Increase efficiencies through innovation and greater integration of services with other U.S., bilateral and multilateral global health investments

8. Road Map for Shared Responsibilities: Sustainability
Partner with countries in a joint move toward country-led, managed, and implemented responses.
Increase support for civil society as a partner in the global AIDS response.
Expand collaboration with multilateral and bilateral partners.
Increase private sector mobilization toward an AIDS-free generation.

9. Road Map for Driving Results with Science
Leverage greatest impact by continuing to invest in implementation science.
Support implementation research.
Evaluate the efficacy of optimized combination prevention.
Support innovative research to develop new technologies for prevention (e.g., microbicides, vaccines) and care e.g., new treatments or treatment regimens).
Develop evidence-based approaches to reaching people early enough in their disease progression to help maintain a strong immune system, stave off opportunistic infections, particularly TB, and reduce new HIV infections.
Support the deployment of suitable technology for measurement of viral load, both through tiered laboratory networks and ‘point-of-care’ tests as they become available.
Assist countries in adopting breakthrough new technologies with proven impact, such as new, molecular-based TB tests that have dramatically reduced diagnosis and treatment time for people living with TB and HIV.

10. New Directions
Restructuring of State/Office of Global AIDS Coordinator
A substantially revised COP
More USG oversight in the field
Secretary Kerry: Call for Interagency Collaborative for Program Improvement
“…share data and share best practices in order to deliver better quality services at a better cost.”
“Triangulate impact, expenditure, and quality analyses to significantly increase the impact per dollar of PEPFAR programs”

11. Interagency Collaborative for Program Improvement
Goal: Support PEPFAR teams to conduct site & above site level monitoring and real-time reporting, aggregation and analysis
Use the data to improve quality
Triangulate impact, expenditure, and quality analyses to significantly increase the impact per dollar of PEPFAR programs
Allocate resources based on performance and validated data

12. Budget Realities  Focus on Critical Activities
Combination Prevention (PMTCT, ART, Condoms, VMMC)
Prevention (effective/targeted)
OVC – holistic services for families
Neglected & Hard to Reach Populations
Pediatrics
Adolescent girls
Key populations – MSM & Transgender, Female Sex Worker, People who inject drugs
Health Systems, especially human resources for health, supply chain, lab, and strategic information that will specifically required to support above activities

13. Hot Topic Areas Accelerating PMTCT
Close Gaps in ART Coverage for TB/HIV Patients
Laboratory
Quality assurance for rapid HIV testing
Develop country-specific strategies for scale-up of viral load testing and development of viral load networks
Prevention
High impact interventions
VMMC, Condoms, HTC and demand creation for clinical services
High need populations
Key Populations, fishing communities, adolescent girls
High impact locations

14. Care and Treatment Earmark Guidance
In PEPFAR’s original authorization, Congress recommended 55% of funds spent on treatment, 15% on palliative care, 20% on prevention, of which at least 33% be spent on abstinence-until- marriage programs, and 10% on OVCs.
For FY , 55% to be spent on treatment, 10% on OVCs, and 33% of prevention funding on abstinence-until-marriage.
FY guidance relaxed some requirements: 10% to be spent on OVCs and at least half on treatment and care, the 33% abstinence-until-marriage directive was removed and replaced by a requirement of “balanced funding” for prevention.  
The PEPFAR Stewardship and Oversight Act ( ) continues spending directives for OVCs and requires at least 50% of bilateral HIV assistance to be spent on treatment and care.
Source:

15. Expenditure Analysis (EA) Initiative
EA data show what PEFPAR funds were used for in each country/region according to major and detailed cost categories.
Began in 9 PEFPAR countries in 2012 and will expand to all PEFPAR operating units in 2014.
EA Dashboard uses interactive graphs and maps to share the results from PEPFAR’s growing expenditure analysis data collection program.
Graphs and maps can be downloaded and viewed by country/region, program area, major cost category, detailed cost category.
Link to EA Guidance FY 2014 on class website

16. PQS will support high-impact efforts that are country-owned-that is, owned by government, civil society, the private sector, and other stakeholders in the partner country.
“…striving to help achieve high-impact national HIV responses that are country-owned—that is, owned by government, civil society, the private sector, and other stakeholders in the partner country.”

17. PQS Priorities 1
1. Compliance for HIV clinical services with guidelines, protocols, and standards in support of optimal patient outcomes
2. Costs and efficiencies gained through institutionalizing countries’ ability to improve HIV programs
3. Sustainability of improvement methods

18. PQS Priorities 2
4. Rapid scaling of lessons from successful quality improvement initiatives
5. Institutionalization of the ability of the host country to improve HIV programs
6. National capacity in collecting and using high quality improvement related data
7. Learning agendas to support activities specifically designed to expand knowledge about a wide range of improvement issues

19. Supporting PEPFAR III pillars with Data
Accountability
Transparency
Impact
Demonstrate
cost-effective programming that maximizes the impact of each dollar invested
Demonstrate transparency with validation and sharing of all levels of program data
Demonstrate
sustained control of the epidemic – save lives and avert new infections
AIDS-free Generation

20. PEPFAR’s Evolving Data Needs
Setting site-level targets and results
Epi and geospatial data overlays for volume, yield, performance analysis
New and emerging data streams addressing accountability, transparency, impact, quality
Tighter feedback loops for course correction, continuous analysis

21. Monitoring, Evaluation and Reporting (MER)
Goal: Improve and strengthen collection and use of data
Articulates evaluation standards that should improve the quality of evaluations and their contribution to decision-making
Provides consistency for evaluation implementation standards across PEPFAR
Represents interagency consensus of standards deemed most relevant to conducting quality evaluations within PEPFAR
As part of the broader PEPFAR Monitoring, Evaluation, and Reporting (MER) initiative to improve and strengthen the collection and use of data, the purpose of this document is to articulate evaluation standards that should improve the quality of evaluations and their contribution to decision-making. Simultaneously, this document responds to recommendations by the Government Accountability Office (GAO) and the Institute of Medicine (IOM), and stipulations within congressional reauthorization to expand the utility of evaluation processes and data across PEPFAR programming for greater accountability and transparency.
Source:

22. Site Improvement through Monitoring System (SIMS) 1
Goal: Standardize site monitoring of key program area elements and quality of care to increase the impact of PEPFAR programs on the epidemic
Primary Objectives:
Monitor capacity at sites, community and above- site to provide high-quality HIV/AIDS services in all program areas
Facilitate use of these data and quality outcomes to improve services
Provide foundational data for regional, national, and global programmatic decision making
Source: Joseph Amann SIMS Presentation for QI Course Cape Town November 2014

23. Site Improvement through Monitoring System (SIMS) 2
Secondary Objectives
Demonstrate PEPFAR and its implementing agencies’ accountability for funded activities
Emphasize in-country technical staff role in accountability, monitoring, and improvement
Improve capacity building by:
Providing guidance to assess the content of services through standards-based monitoring
Recognizing successes to improve morale and accountability of staff

24. PEPFAR’s New Information System
Data for Accountability, Transparency & Impact (DATIM): PEPFAR’s new information system
Starting October 2014, used to enter all PEPFAR Evaluation Standards of Practice adherence data
Integrates data entry for all PEPFAR sites: integrated PEPFAR Site List (iPSL)
iPSL is the critical backbone for any data entry in DATIM (including SIMS)

25. PEPFAR Dashboards
Goal: Enable all stakeholders, including US citizens, civil society organizations, USG agencies, donors, and host-country governments, to view and utilize PEPFAR planned budgets, program results, and expenditure analysis data in an accessible and easy- to-use format.
Supporting PEPFAR’s priority of Transparency
3 Dashboards:
Planned Funding Dashboard
Program Impact Dashboard
Expenditure Analysis Dashboard

26. It always seems impossible until it’s done.
- Nelson Mandela