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What GAO Found

The President's Emergency Plan for AIDS Relief (PEPFAR) has expanded treatment programs and increased their efficiency and effectiveness.

  • According to the Department of State's (State) Office of the U.S. Global AIDS Coordinator (OGAC), from 2005 to 2011, PEPFAR's per-patient treatment costs declined from about $1,053 to about $339. PEPFAR's increasing use of generic products and declining antiretroviral (ARV) drug prices have been a key source of savings. Programs also benefited from economies of scale and program maturity.
  • PEPFAR and partner countries have achieved substantial increases in the number of people on ARV drug treatment and have increased the percentage of eligible people receiving treatment. According to OGAC, treatment retention rates are at or above 80 percent at PEPFAR-supported treatment facilities in 10 partner countries.
  • PEPFAR has also worked with U.S. implementing agencies, international donors, and partner countries to increase the efficiency and reliability of ARV drug supply chains.
  • PEPFAR implementing agencies have evaluated a wide variety of PEPFAR program activities, demonstrating a clear commitment to program improvements.

Better information management is crucial to helping countries improve and expand treatment programs to meet the needs of the estimated 23 million people eligible for ARV treatment under 2012 international guidelines. GAO's reviews of PEPFAR treatment costs, results, and ARV drug supply chains have revealed limitations in the completeness, timeliness, and consistency of key program information. GAO also found important information lacking in PEPFAR program evaluations, plans, and results reporting. GAO has made a series of recommendations to improve the quality of this information in order to make PEPFAR programs more efficient and effective. The potential benefits that could be realized if GAO's recommendations are implemented include the following:

  • More complete and timely cost data could help countries manage costs and plan treatment expansion more effectively.
  • More consistent, complete, and timely information on treatment results could enhance the quality of treatment programs, including patient, clinic, and program management.
  • Plans to help countries improve inventory management and record keeping and tracking their progress could help supply chains operate more efficiently.
  • A more systematic and rigorous approach to planning and conducting program evaluations could result in evaluations that better inform PEPFAR stakeholders about how to improve programs.
  • OGAC could provide better context for understanding PEPFAR's achievements and challenges by comparing program results with targets and discussing efforts to ensure the quality of reported information.

Why GAO Did This Study

PEPFAR, first authorized in 2003, has supported significant advances in HIV/AIDS prevention, treatment, and care in over 30 countries, including directly supporting treatment for about 5.1 million people; however, millions more people still need treatment. Congress reauthorized PEPFAR in 2008—authorizing up to $48 billion over 5 years—directing OGAC to continue expanding the number of people receiving care and treatment through PEPFAR while also making it a major policy goal to help partner countries develop independent, sustainable HIV programs. As a result, PEPFAR began shifting efforts from directly providing treatment services toward support for treatment programs managed by partner countries. GAO completed a series of reports between 2011 and 2013 covering PEPFAR treatment program costs, results, and supply chains for ARV drugs, and PEPFAR program evaluations and planning and reporting. GAO was asked to summarize the key themes of these reports relating to (1) PEPFAR’s successes in expanding and improving treatment programs and (2) information management challenges to further improving and expanding treatment programs.

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GAO previously made 13 recommendations to State to improve PEPFAR treatment programs, program evaluations, and reporting of program results. State generally agreed with these recommendations and has begun implementing some of them.

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