Presentation on theme: "PEPFAR Guidance Blueprint: Creating an AIDS Free Generation"— Presentation transcript:
1 PEPFAR Guidance Blueprint: Creating an AIDS Free Generation Supplement to presentation by Ambassador Deborah Birx for ClASS ConsultantsNovember, 2014
2 Session TopicsMain 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) guidanceSite Improvement through Monitoring System (SIMS)Expenditure Analysis (EA)Care and Treatment Earmark guidanceIntegrated 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 BlueprintImpactEfficiencySustainabilityPartnership: Working Together towards an AIDS-Free GenerationHuman Rights: Securing, Protecting, & Promoting Human RightsEach agenda item has metrics for success as well as timelines/deliverables.
4 PEPFAR Durban Meeting – 3 Guiding Pillars AccountabilityDemonstrate cost-effective programming that maximizes the impact of every dollar investedTransparencyDemonstrate increased transparency with validation and sharing of all levels of program dataImpactDemonstrate sustained control of the epidemic – save lives and avert new infections
5 Blueprint: Creating an AIDS Free Generation Four Road Maps supporting the BlueprintSaving Lives: ImpactSmart Investments: EfficiencyShared Responsibility: SustainabilityDriving 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 DirectionsRestructuring of State/Office of Global AIDS CoordinatorA substantially revised COPMore USG oversight in the fieldSecretary 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 analysisUse the data to improve qualityTriangulate impact, expenditure, and quality analyses to significantly increase the impact per dollar of PEPFAR programsAllocate 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 familiesNeglected & Hard to Reach PopulationsPediatricsAdolescent girlsKey populations – MSM & Transgender, Female Sex Worker, People who inject drugsHealth 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 PatientsLaboratoryQuality assurance for rapid HIV testingDevelop country-specific strategies for scale-up of viral load testing and development of viral load networksPreventionHigh impact interventionsVMMC, Condoms, HTC and demand creation for clinical servicesHigh need populationsKey Populations, fishing communities, adolescent girlsHigh 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 11. Compliance for HIV clinical services with guidelines, protocols, and standards in support of optimal patient outcomes2. Costs and efficiencies gained through institutionalizing countries’ ability to improve HIV programs3. Sustainability of improvement methods
18 PQS Priorities 24. Rapid scaling of lessons from successful quality improvement initiatives5. Institutionalization of the ability of the host country to improve HIV programs6. National capacity in collecting and using high quality improvement related data7. Learning agendas to support activities specifically designed to expand knowledge about a wide range of improvement issues
19 Supporting PEPFAR III pillars with Data AccountabilityTransparencyImpactDemonstratecost-effective programming that maximizes the impact of each dollar investedDemonstrate transparency with validation and sharing of all levels of program dataDemonstratesustained control of the epidemic – save lives and avert new infectionsAIDS-free Generation
20 PEPFAR’s Evolving Data Needs Setting site-level targets and resultsEpi and geospatial data overlays for volume, yield, performance analysisNew and emerging data streams addressing accountability, transparency, impact, qualityTighter feedback loops for course correction, continuous analysis
21 Monitoring, Evaluation and Reporting (MER) Goal: Improve and strengthen collection and use of dataArticulates evaluation standards that should improve the quality of evaluations and their contribution to decision-makingProvides consistency for evaluation implementation standards across PEPFARRepresents interagency consensus of standards deemed most relevant to conducting quality evaluations within PEPFARAs 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 epidemicPrimary Objectives:Monitor capacity at sites, community and above- site to provide high-quality HIV/AIDS services in all program areasFacilitate use of these data and quality outcomes to improve servicesProvide foundational data for regional, national, and global programmatic decision makingSource: Joseph Amann SIMS Presentation for QI Course Cape Town November 2014
23 Site Improvement through Monitoring System (SIMS) 2 Secondary ObjectivesDemonstrate PEPFAR and its implementing agencies’ accountability for funded activitiesEmphasize in-country technical staff role in accountability, monitoring, and improvementImprove capacity building by:Providing guidance to assess the content of services through standards-based monitoringRecognizing successes to improve morale and accountability of staff
24 PEPFAR’s New Information System Data for Accountability, Transparency & Impact (DATIM): PEPFAR’s new information systemStarting October 2014, used to enter all PEPFAR Evaluation Standards of Practice adherence dataIntegrates 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 DashboardsGoal: 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 Transparency3 Dashboards:Planned Funding DashboardProgram Impact DashboardExpenditure Analysis Dashboard
26 It always seems impossible until it’s done. - Nelson Mandela