Center for Global Health Division of Global HIV/AIDS John Pitman Division of Global HIV/AIDS, Center for Global Health, CDC

Summary Funding amounts and thematic priorities in PEPFAR I ( ) and PEPFAR II ( ) Changes under PEPFAR III (2015  ) Successes Challenges for the future

The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR)

 Treatment for more than 6.7 million people as of Sept 30, 2013  Male circumcision procedures for ~ 4.7 million men as of December 2013  HIV counseling and testing for more than 57.7 million people * Fiscal year 2013 unless otherwise noted Source: PEPFAR, 2013 PEPFAR Progress

2001 $1.8 billion 2001 $1.8 billion 2014 $8.9 billion 2014 $8.9 billion The Trade Off Changes in USG Global Health funding priorities, The Trade Off Changes in USG Global Health funding priorities, Source: U.S. Government data compiled by the Kaiser Family Foundation. A complete table is available at: historical-funding-table-fy14-request pdf. historical-funding-table-fy14-request pdf

PEPFAR funding for blood safety over time PEPFAR data:

PEPFAR funding for blood safety over time (2) PEPFAR data:

Who else funds blood safety?  Global Fund: $92 million for blood safety in 56 countries ( )  20% of total was awarded to China  Other bi-lateral grants from OECD member states  Projects with “blood safety” in the description ($358 million since 2002)  Canada: $5.5 million (Malawi & Mozambique, )  Italy ($61,200, DR Congo, Uganda, 2005, 2008, 2010)  Japan ($109,063, Senegal, 2010)  Norway ($668,605, Tanzania, 2006, 2007, 2009)  Spain (DR Congo, $326,369, 2010)  United States (Benin, DRC, Guinea, Lesotho, Liberia, Mali, Mozambique, Nigeria, Senegal, Uganda, $15 million, )

PEPFAR’s impact: Safety (11 countries) Source: WHO Global Database on Blood Safety

PEPFAR’s impact: Adequacy 9 PEPFAR-supported countries in Africa Source: WHO Global Database on Blood Safety

PEPFAR’s impact: Sustainability 10 of 19 PEPFAR-supported countries remain >50% dependent on external donor support to conduct routine operations GDBS, of 19 PEPFAR-supported countries remain >50% dependent on external donor support to conduct routine operations GDBS, 2012

Epidemic Control – PEPFAR’s priority Focus on the Right Thing, Right Place, Right Time  The right thing  Core interventions: highest impact on AIDS-Free Generation, goals  The right place  Geographically focused  Effectively reaching the most vulnerable  The right time – an expanding HIV epidemic is not financially sustainable

What does PEPFAR’s new focus mean for blood safety?  Clear implications for funding  Need to demonstrate impact on priority indicators  Incidence  Referral to confirmatory testing and the rest of the cascade  Accreditation (“foundational” for PEPFAR-supported laboratories)  Quality  Data systems

Reframing PEPFAR’s blood safety contributions …from comprehensive to targeted

Remaining relevant within PEPFAR A need for creative thinking Sources: DHS, AIS reports, GDBS, PEPFAR indicators CountryDemographics New adult infections % of newly diagnosed infections did not know their HIV status Estimated number of new adult infections among people who did not know their HIV status ¹ Number of new HIV infections detected/year among blood donors who reported no or low behavioral risks for HIV infection (2012) Potential proportion of new adult infections among people who do not know their status that could be attributed to blood bank screening Kenya * All adults88, %47,0581,0002.1% Male adults38, %23, % Female adults50, %24, % Uganda** All adults131, %126,6131,2091.0% Male adults59, %57, % Female adults‡72, %69, % Botswana*** All adults9, % §5, % Male adults3, %2, % Female adults5,685†50.0%2, %

Conclusion  PEPFAR can no longer support a comprehensive blood systems strengthening approach  PEPFAR can and will continue to support countries to build quality management systems, collect and use better data, and achieve accreditation  A new research agenda is needed to better understand countries’ needs, especially for adequacy and access  Resource mobilization must be a priority for countries and others interested in sustaining the achievements of the last 10 years

Thank You Center for Global Health Division of Global HIV/AIDS For more information please contact Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA Telephone: CDC-INFO ( )/TTY: Web: The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention.