1. Response to HIV in Next Decade Definitive way to measure client centered approach to prevention and treatment services
Ambassador Deborah Birx, MD
PEPFAR Principals Meeting
July 21, 2019

2. Policies
Populations
Partnerships

3. Triangulation of community survey data with program data to understand who we are missing and why and fix it

4. PHIA Results Show Achievements towards 90/90/90 Goals – differential progress

5. Treatment Leading Community Viral Load Suppression
Less progress despite
investment
Dates are when survey data collection ended.

6. Political Will Matters Policies Matter
Data Matters as it allows us to see past our perceptions and assumptions to see who we need to reach and if we are reaching clients in the manner they want to be seen and served and creates the space for an equity based response rather than an “equal response”
Resources Matter – but funding amounts did not predict outcomes and imoact

7. Using granular data We have identified the key gaps in the program execution and together we are tailoring our response to the gaps : testing well children and young adults as the gateway to prevention and treatment services and focused site level program improvements

8. Namibia HIV + Population “Pyramid”
Male
Female

9. Uganda : Who are we missing in treatment ?
Need to also focus efforts on children
Age
Sex
PLHIV
On Treatment
<10
Female
33,845
19,945
59%
>=90%
>=85%
Male
34,899
18,536
53%
80%-89%
75%-84%
10-19
55,863
37,068
66%
70%-79%
65%-75%
37,938
23,145
61%
<70%
<65%
20-29
191,563
184,565
96%
84,177
56,300
67%
30-39
244,765
246,242
101%
157,202
122,223
78%
40-49
173,370
168,392
97%
138,140
110,934
80%
50+
119,007
100,442
84%
107,315
77,770
72%
1,378,085
1,165,562
85%
Internal Use Only

10. Must focus on who we are missing : Botswana : adult males vs females

11. Must use the data to change policy immediately and measure impact of the change

12. Retention
losing clients in the first 6 months

13. Stalled progress over the past 8 years and poor expansion of treatment related to retention of clients on treatment
Source: Preliminary 2019 estimates

14. Since 2010 Haiti has added new clients to the baseline 27,000 on treatment (180,000) but currently only 93,020 clients are on treatment
Haiti has lost 82,000 clients

15. Must use granular data to define our failures and work with and fund the community to identify implement in partnership corrective actions

16. Prevention
Must be effective and targeted and continually evolve based on client needs

17. PEPFAR has now supported
over 20 Million VMMCs
Voluntary medical male circumcision (VMMC) PEPFAR supported Over 20 Million men in receiving VMMC through Q

18. Must have PrEP, Condom use along with the VMMC targets and track policies change needed to address the structural barriers

19. Condoms: There was an increase in procurement of Male and Female Condom/lubricants in CY2016 and CY2017

20. PREP_NEW Targets FY2017 – FY2019

21. WHERE for DREAMS??
Took prevalence & # cases into consideration to choose countries

22. DREAMS Core Package Talking points:
Some points about the program that have to be taken into consideration as we look at data on DREAMS…
DREAMS involves a COMPREHENSIVE package of programs and services ; these differ by:
Country (little variation across countries; PrEP is the component that some still do not have)
District (little variation across districts within a country)
Age group
Individual needs (not all AGYW need post violence care; AGYW not sexually active don’t need condoms)
DREAMS does not exist in a vacuum
Broader PEPFAR programming
Not just for AGYW, but also for men who are likely to be the sex partners of AGYW
if we decrease the risk of young adult men with our other programming, we reduce risk for AGYW

23. provides the frame to understand who we have reached and who needs to be reached with prevention and treatment services and we must constantly evolve to meet the needs of our clients