New Partnerrs Initiative (NPI) ( ) SOTA PEPFAR II John Crrowley (USAID/Washington) July 27, 2009 Cape p Town,, South Africa

The New Law: “Hyde Hyde-Lantos Lantos” •

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PL 110-293: 110 293: “Tom Tom Lantos and Henry JJ. Hyde United States Global Leadership Against A HIV/AIDS, Tuberculosis,, and Malaria Reauthorization R Act of 2008” Enacted July 30, 2008 A th i Authorizes funding f di for f the th period p i d from f October O t b 1, 1 2009 to September 30, 2013 – $48 billi billion ttotal t l over fiv five years, including i l di $39 billi billion for HIV/AIDS, $4 billion n for TB, $5 billion for Malaria Replaces the “U.S. Leadersship Act of 2003” that originally authorized PEPFA AR

Key Th hemes • • • • • • • • •

Continuity and Expansion – Building on Success Sustainability Data Analysis – Evidence-B Based Best Practices Capacity p y Building g – Infrasttructure,, Systems, y , Workforce Harmonization with Partnerr Governments P blic Private Public Pri ate Partnerships Coordination with other Heealth/Development Programs Attention to Vulnerabilitiess of Girls and Women Implementation of 2007 IO OM study recommendations

Overalll Goals • •

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Prevent 12 million new infeections Care for 12 million individu uals infected with or affected byy HIV/AIDS,, including g 5 million OVC Increase number of individu uals with HIV/AIDS on treatment – No specific number is sttated in the legislation – T t Treatment t goall to t be b callculated l l t d based b d on appropriation i ti level, cost of treatment, and epidemiological evidence H l ttrain Help i 140,000 140 000 new hea h alth lth care workers k All goals are cumulative, bu uilding on results from PEPFAR A I

PMT TCT

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OGAC will establish an a expert PMTCT Panel Panel will prepare a rep port assessing effectiveness of curren nt activities Panel will provide reco ommendations on how to help countries reach taarget of 80% of pregnant women with access to counseling, testing, and treatment

Preveention • •

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No earmark for ABY progrrams or prevention in general Funding for activities relateed to sexual transmission should be “balanced,” takin ng into account “objective epidemiological evidence as a to the source of infections.” Countries spending less thaan half of sexual transmission funds on ABY must report to Congress on the objective epidemiological id i l i l evidence id th h led hat l d to their h i decision. d ii Activities addressing mediccal male circumcision, multiple concurrent sexuall partnerin ing, microbicides, i bi id andd female f l and male condoms are expllicitly supported.

Orphans and Vullnerable Children

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10% funding earmark rem mains intact from PEPFAR I Goal of 5 million OVC reeceiving care, with emphasis on comprehensive, p coordiinated system y of services integrated throughout the continuum of care Care and treatment services to be p provided to children with HIV in proportion to o their percentage within the HIV-infected population of o the country

Gender/Wom men and Girls

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Specifically requires that prrevention strategies address vulnerabilities l bili i off women an ndd girls i l to HIV infection i f i Strategies should address faactors that lead to gender di disparities i i in i HIV infection i f i n, including i l di male l norms andd gender-based violence Calls for accountability meaasures related to reaching women and girls and addresssing gender disparities Sense of Congress that expaanding the range of femalecontrolled HIV prevention tools t is necessary and urgent

Care and Treatment T •

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More than half of appropriaated amount should be spent for care and treatment (chan nge from 55% earmark for treatment in PEPFAR I) Includes nutrition and food support for people living with HIV/AIDS For TB/HIV coinfection, coinfection prromotes opt-out opt out HIV/AIDS counseling and testing and appropriate referral for care and treatment No palliative care earmark

Food and Nutrition

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Strengthened emphasis on food f and nutrition programs as components off HIV/AIDS /A S programs p Requires q nutritional assessm ments in all HIV programs, p g , following WHO guidelines for HIV/AIDS food and nutrition services Encourages integration of F&N F and HIV/AIDS programs through g multisectoral linkag gges

Health Systems and d Capacity Building

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Emphasis p throughout g the leegislation g on strengthening g g health systems, infrastructu ure, policies, and HR. Goal to help p train at least 14 40,000 , new health care professionals, paraprofessio onals, and CHW Equip q p teachers with skills needed n for HIV/AIDS prevention and support Financial a c a Systems Sys e s –Treasur easury y Dept. ep . receives ece ves funding u d g too help improve host country financial f management

Accoun ntability Evaluations/Audits •

IOM: performance assessment and im mpact evaluation

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GAO: comprehensive assessment wiithin 3 years

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I Inspectors t General: G l $15m $15 to t HHS, HHS USAID, U USAID and d St State t IG IGs

Strategic Plans/Performance Reportss •

President: 5-year strategy to combat global HIV/AIDS

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OGAC: annual reports – performancce and best practices

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Partnership Frameworks: OGAC repport upon finalization

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Health Systems: 5-year strategic plann (OGAC/USAID)

Odds annd Ends •

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Rescinds ban on entry to tthe U.S. for foreigners with HIV Adds Vietnam as a focus country and Central Asia Asia, Eastern Europe, and Latin n America as regions of specific interest Global Fund: $2 billion in n FY09 Tuberculosis: adds speciffic TB goals and strengthens and elevates focus on TB Malaria: strengthens focu us on malaria and institutionalizes Malaria Coordinator C at USAID Indian (Native American)) Safety and Health: $2 billion