Officials Call For Changes To Legislation That Would Reauthorize PEPFAR, Including Targets For Mother-To-Child HIV Transmission Prevention

Main Category: HIV / AIDS
Also Included In: Women's Health / Gynecology;  Pediatrics / Children's Health;  Pregnancy / Obstetrics
Article Date: 16 Nov 2007 - 11:00 PST

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Africa program directors with the Elizabeth Glaser Pediatric AIDS Foundation on Wednesday suggested various provisions for legislation that would reauthorize the President's Emergency Plan for AIDS Relief, including the creation of a five-year target for preventing mother-to-child transmissions of HIV, CQ HealthBeat reports (Bartolf, CQ HealthBeat, 11/14). PEPFAR directs an authorized $15 billion over five years for HIV/AIDS and tuberculosis, primarily to 15 focus countries, and provides funding to the Global Fund To Fight AIDS, Tuberculosis and Malaria. PEPFAR's original mandate is scheduled to expire in September 2008. President Bush in May called on Congress to double current funding levels to $30 billion over five years (Kaiser Daily HIV/AIDS Report, 9/27).

Glaser officials said that children should account for 15% of those who receive care and treatment through PEPFAR. Children make up nearly 14% of all new HIV cases, but only 9% of those receiving treatment through the program are children.

Currently, 55% of PEPFAR's budget is required to go toward treatment, 20% for prevention, 15% for palliative care, and 10% for orphans and vulnerable children. Glaser officials also called for eliminating certain budget allocations that limit how money is directed in the current program structure. They said that removing budget restrictions and the implementation of program goals would enable local groups to invest in the services and projects most needed to achieve national HIV/AIDS prevention targets.

Pamela Barnes, president and CEO of the foundation, said that because "each country faces its own unique epidemic with unique program needs," each country should have a localized, evidence-based approach carried out in partnership with the host government. Glaser officials also cited an April 2007 report by the Institute of Medicine that recommended PEPFAR spending levels be directly linked to specified targets created by countries based on their individual needs and goals.

Anja Giphart, country director of Tanzania for the foundation, said, "We hope that funding is less earmarked (in the reauthorized PEPFAR) so that we have a greater mix of options and can decide, along with our country's ministry of health, how we can best use this funding." Willie Salmond, Ugandan country director, said that PEPFAR needs to increase coordination among U.S. health agencies and clinicians in smaller districts within the countries. In addition, country leaders stressed the importance of giving more autonomy to a country's ministry of health, which could work with PEPFAR health care workers in different regions to determine what prevention programs would work best for specific areas of its country.

Joseph Esscombo, country director of Cote D'Ivoire, said that he sees how "American taxpayer money that goes to PEPFAR is saving lives." Tshiwela Neluheni, country director for South Africa, called for the legislation to strengthen community HIV/AIDS services (CQ HealthBeat, 11/14).

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