US President’s Emergency Strategy for AIDS Relief (PEPFAR)

US President’s Emergency Strategy for AIDS Relief (PEPFAR)

Ever since its start in 2003, the US President’s Emergency Strategy for AIDS Relief (PEPFAR) has been the vital driving force behind the worldwide scale-up of HIV care and treatment services, especially in the expansion of access to antiretroviral therapy.

In spite of initial apprehensions about cost and viability, PEPFAR overcame tests by swaying and harmonizing with other funders, by working in partnership with affected countries, by supporting indigenous ownership, using public health methodology, by encouraging task-shifting strategies, through paying close attention to health systems strengthening.

PEPFAR’s expansion of treatment access is unmatched for the global health insurance development ingenuity. PEPFAR’s expansion of treatment access is unparalleled for the global health insurance development initiative.

As of September 2011, PEPFAR openly supported the beginning of antiretroviral therapy for 4.0 million people and delivered care and support for basically 14 million people.

Benefits with regards to the prevention of morbidity and mortality are truly gained by those receiving the services, with clear evidence of societal benefits past the projected clinical benefits.

Moreover, much remains to be accomplished to get worldwide access, to improve the quality of programs, to guarantee retention of patients in care, also to continue to reinforce the health systems.

The PEPFAR approach will be based upon the following ideologies:

  • country ownership of indigenous programs
  • a results-based accountability method
  • engagement of all sectors
  • good governance


By moving back, a tide of disease, fear, and societal disruption, mostly in sub-Saharan Africa, where in some nations, the HIV epidemic affected over one-quarter of adults, PEPFAR’s treatment programs have experienced a stabilizing relation to health systems and communities.

Despite initial concerns regarding the cost and feasibility of delivering ART for persons infected with and affected by HIV in challenging global settings with weak health systems, PEPFAR-supported national treatment programs have become a beacon of the worldwide response to HIV within the last 15 years.

The scale-up of HIV care and treatment services has led to the dramatic expansion of access to antiretroviral therapy (ART) for those living with HIV (PLWH) globally.

As at the end of 2014, there were obviously 6.7 million people who started ART in low and middle-income countries (LMICs), in comparison with only 600,000 in 2006.

The number of children receiving ART has risen from 70,500 in 2005 to 600,000 last year, with coverage of prevention of mother-to-child transmission (PMTCT) services rising to 52% from only 11% in 2004.

Through PEPFAR quality funding through many groups like USAID/South Africa, URC sustained the National Department of Health and provincial health departments to nurture and advance the quality of HIV counseling and testing, prevention of mother-to-child transmission of HIV/AIDS (PMTCT), palliative care and antiretroviral therapy services, and community-based treatment support.

The project also dealt with home-based care organizations that help care support groups and relatives of people living with HIV/AIDS. Even though overall global budgets for HIV have leveled over the last years, PEPFAR has sustained a powerful focus on the expansion of HIV treatment services by leveraging and coordinating with other funders and through ways to gain efficiency.

For instance, in Zambia, the government has used Global Fund to Fight AIDS, Tuberculosis and Malaria resources to get first-line antiretroviral treatment, whereas PEPFAR has focused on consolidating regional and district health systems, training medical and public health management personnel and providing support for innovation and quality improvement.

PEPFAR has followed an efficiency agenda that has exploited the use generic antiretroviral drugs (ARVs), supported efforts to empower nurses as well as other allied medical researchers to deliver treatment, and expanded use of financial information by program managers to cut service delivery costs.




Enhanced efficiency in selection and transportation of ARVs, the increasing use generic drugs and fixed-dose combinations (FDCs), along with the transition to preferred ARV regimens has lowered the cost necessary for treatment considerably while improving the overall quality of HIV treatment in PEPFAR-supported focus countries. PEPFAR’s per-patient treatment costs, including drugs and service delivery, have declined to $335 per annum, from nearly $1100 just 10 years ago.

One key improvement adopted for the Supply Chain Management System (SCMS), established and sponsored by PEPFAR and supported by USAID, was the transition from air transport to land- or sea-based shipment.

It is projected that using sea freight for major shipments saved up to 86% in transportation costs, as of December 31, 2016, sea transport had saved PEPFAR $40.8 million in transportation costs.

SCMS also established regional distribution centers in Ghana, Kenya, and South Africa, increasing commodity accessibility and decreasing the lead time needed for delivery. PEPFAR has increased its use of generic drugs and FDCs.

In 2010, only 17% of PEPFAR-procured drugs were generic. This amount increased to 97% by 2016, leading to considerable savings compared with branded drugs.

Between 2013 and 2016 PEPFAR increased purchases of 2- and 3-drug FDCs, as recommended by the WHO. These regimens are less complex, quicker to administer, and may even improve patient adherence. Similarly, in the last 5 years since WHO HIV treatment rules suggested that countries phase out stavudine in favor of less toxic zidovudine- or tenofovir-based regimens,

SCMS orders for stavudine have declined by a lot more than 70%, whereas orders for zidovudine and tenofovir have risen twenty-fold.

From its beginning, PEPFAR has constantly supported in-country organizations and promoted their capability to increase HIV care and treatment programs. Such local PEPFAR partners comprehend the specific contexts of their communities, health systems, and HIV epidemic. Their wish to take ownership of a concrete local HIV response, as well as substantial PEPFAR support, created some of the leading treatment programs within their countries.

Examples include these:


  • Right to Care in South Africa started as a small but innovative local nongovernmental organization in South Africa in 2001 and it has rapidly expanded, providing ART services to a lot more than 130,000 individuals through USAID/PEPFAR support.


  • Right to Care, along with other partners, have become instrumental in giving expert treatment services and technical assistance to help South Africa achieve the ambitious HIV treatment targets in the National Strategic Plan.


  • The AIDS Support Organization (TASO), a Ugandan nongovernmental organization established in 1987, has extended treatment services to more than 30,000 people.

CDC/PEPFAR has given major scale-up support for The AIDS Support Organization treatment programs.


  • The Joint Clinical Research Centre started in 1990 in Uganda, initiated over 30,000 patients as it scaled up HIV treatment at 8 regional centers of excellence, 53 satellite clinics, and 26 primary outreach sites from the “The Regional Antiretroviral Therapy” program funded by USAID/PEPFAR.



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