Key Issues and Questions for PEPFAR’s Future

Key Findings
  1. Ingram G, Making USAID a premier development agency, February 2021, Brookings, accessed: https://www.brookings.edu/research/making-usaid-a-premier-development-agency/.

     

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  2. O’Neill Institute for National and Global Health Law at Georgetown University Law Center, Reorganization and the Future of PEPFAR; Implications of State and USAID Reform, 2018.

     

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Issue Brief
  1. PEPFAR’s definition of epidemic control is when “the total number of new HIV infections fall below the total number of deaths from all causes among HIV-infected individuals.” For more information, see U.S. Department of State, PEPFAR Strategy for Accelerating HIV/AIDS Epidemic Control (2017-2020), September 2017, accessed: https://www.state.gov/wp-content/uploads/2019/08/PEPFAR-Strategy-for-Accelerating-HIVAIDS-Epidemic-Control-2017-2020.pdf and KFF, KFF Dashboard: Progress Toward Global HIV Targets in PEPFAR Countries, August 2021.

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  2. U.S. Department of State, PEPFAR Latest Global Results, July 2021, accessed: https://www.state.gov/wp-content/uploads/2021/06/PEPFAR-Latest-Global-Results_JUNE-2021-1.pdf.

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  3. Institute of Medicine, Evaluation of PEPFAR, 2013, accessed: https://www.nap.edu/catalog/18256/evaluation-of-pepfar.

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  4. Institute of Medicine, PEPFAR Implementation: Progress and Promise, 2007, accessed: https://www.nap.edu/catalog/11905/pepfar-implementation-progress-and-promise.

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  5. UNAIDS, Global AIDS Strategy 2021-2026, End Inequalities. End AIDS, July 2021, accessed: https://www.unaids.org/sites/default/files/media_asset/global-AIDS-strategy-2021-2026_en.pdf (May 16, 2021).

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  6. U.S. Department of State, Guiding Principles for the Next Phase of PEPFAR, December 2020, accessed: https://www.state.gov/wp-content/uploads/2020/12/Guiding-Principles-for-the-Next-Phase-of-PEPFAR.pdf.

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  7. U.S. Department of State, Draft Overview – PEPFAR Strategy: Vision 2025, accessed: https://www.state.gov/development-of-the-next-pepfar-strategy-vision-2025/ (September 10, 2021).

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  8. KFF, PEPFAR Reauthorization: Side-by-Side of Legislation Over Time, January 2019.

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  9. UNAIDS AIDSInfo database, accessed: https://aidsinfo.unaids.org (August 12, 2021).

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  10. UNAIDS further analysis of Global Health Estimates 2019: Deaths by Cause, Age, Sex, by Region, 2000-2019, 2020.

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  11. UNAIDS AIDSInfo database, accessed: https://aidsinfo.unaids.org (August 12, 2021).

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  12. KFF, KFF Dashboard: Progress Toward Global HIV Targets in PEPFAR Countries, August 2021.

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  13. UNAIDS, Evidence Review: Implementation of the 2016-2021 UNAIDS Strategy On the Fast Track to End AIDS, 47th meeting of the UNAIDS Program Coordinating Board, UNAIDS/PCB(47)/CRP3, accessed: https://www.unaids.org/sites/default/files/media_asset/PCB47_CRP3_Evidence_Review_EN.pdf (May 16, 2021).

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  14. UNAIDS, Seizing the Moment: Tackling Entrenched Inequalities to End Epidemics, 2020, accessed: https://www.unaids.org/sites/default/files/media_asset/2020_global-aids-report_en.pdf (accessed on May 16, 2021).

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  15. Data for figure sourced from One World in Data, U.S. Department of State, United Nations, World Bank.

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  16. WHO, “WHO Coronavirus (COVID-19) Dashboard,” accessed: https://covid19.who.int/ (September 10, 2021).

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  17. The World Bank, The World Bank in Africa, 2020, accessed: https://www.worldbank.org/en/region/afr/overview (May 9, 2021).

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  18. U.S. Department of State, PEPFAR Technical Guidance in Context of COVID-19 Pandemic (version dated February 24, 2021, accessed: https://www.state.gov/wp-content/uploads/2021/02/02.24.21-PEPFAR-Technical-Guidance-During-COVID.pdf (August 12, 2021).

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  19. U.S. Department of State, PEPFAR 2021 Country & Regional Operational Plan (COP/ROP) Guidance for All PEPFAR Countries, pages 11-13, accessed: https://www.state.gov/wp-content/uploads/2021/02/PEPFAR-COP21-Guidance-Final.pdf.

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  20. WHO, Pulse survey on continuity of essential health services during the COVID-19 pandemic, August 2020, accessed: https://apps.who.int/iris/rest/bitstreams/1297631/retrieve.

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  21. UNAIDS, Prevailing Against Pandemics by Putting People at the Center, December 2020, accessed: https://www.unaids.org/sites/default/files/media_asset/prevailing-against-pandemics_en.pdf.

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  22. The Global Fund, The Impact of COVID-19 on HIV, TB and Malaria Services and Systems for Health: A Snapshot from 502 Health Facilities Across Africa and Asia, April 2021, accessed: https://www.theglobalfund.org/media/10776/covid-19_2020-disruption-impact_report_en.pdf.

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  23. The Global Fund, Results Report 2021, September 2021, accessed: https://www.theglobalfund.org/en/news/2021-09-08-global-fund-results-report-reveals-covid-19-devastating-impact-on-hiv-tb-and-malaria-programs/ (September 8, 2021).

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  24. United Nations, “Addressing the Impact of the COVID-19 Pandemic on Violence Against Women and Girls,” November 20202, accessed: https://www.un.org/en/addressing-impact-covid-19-pandemic-violence-against-women-and-girls.

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  25. The Global Fund, The Impact of COVID-19 on HIV, TB and Malaria Services and Systems for Health: A Snapshot from 502 Health Facilities Across Africa and Asia, April 2021, accessed: https://www.theglobalfund.org/media/10776/covid-19_2020-disruption-impact_report_en.pdf.

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  26. The World Bank, “Global Economy to Expand by 4% in 2021; Vaccine Deployment and Investment Key to Sustaining the Recovery,” January 2021, accessed: https://www.worldbank.org/en/news/press-release/2021/01/05/global-economy-to-expand-by-4-percent-in-2021-vaccine-deployment-and-investment-key-to-sustaining-the-recovery.

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  27. International Monetary Fund, “Sub-Saharan Africa: Navigating a Long Pandemic,” April 2021, accessed: https://www.imf.org/en/News/Articles/2021/04/14/pr21108-sub-saharan-africa-navigating-a-long-pandemic.

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  28. The Global Fund launched an immediate response to COVID-19 to help mitigate the impact of COVID-19 on HIV, TB, and malaria programs and support national COVID-19 responses. This includes new funding and grant flexibilities, among other measures. For more information, see: “The Global Fund, Our COVID-19 Response,” accessed: https://www.theglobalfund.org/en/our-covid-19-response/ (August 12, 2021).

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  29. Golin R, et al, “PEPFAR’s response to the convergence of the HIV and COVID‐19 pandemics in Sub‐Saharan Africa,” Journal of the International AIDS Society, accessed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7405155/.

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  30. U.S. Department of State, PEPFAR Technical Guidance in the Context-19 Pandemic, accessed: https://www.state.gov/pepfar/coronavirus/ (August 12, 2021).

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  31. U.S. Department of State, PEPFAR Technical Guidance in the Context-19 Pandemic, accessed: https://www.state.gov/pepfar/coronavirus/ (August 12, 2021).

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  32. U.S. Department of State, PEPFAR 2021 Country & Regional Operational Plan (COP/ROP) Guidance for All PEPFAR Countries, accessed: https://www.state.gov/wp-content/uploads/2021/02/PEPFAR-COP21-Guidance-Final.pdf.

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  33. U.S. Department of State, PEPFAR Update – Stakeholder Townhall (presentation on August 2, 2021), provided to KFF by the Office of the Global AIDS Coordinator.

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  34. U.S. Department of State, PEPFAR Update – Stakeholder Townhall (presentation on August 2, 2021), provided to KFF by the Office of the Global AIDS Coordinator.

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  35. Mehta N et al., “Impact of COVID-19 on HIV treatment interruption in seven PEPFAR countries, April-June 2020,” 11th IAS Conference on HIV Science, 2021, Abstract ALX01LB04.

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  36. U.S. Department of State, PEPFAR Update – Stakeholder Townhall (presentation on August 2, 2021), provided to KFF by the Office of the Global AIDS Coordinator.

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  37. U.S. Congress, H.R. 1319, “American Rescue Plan Act of 2021,” January 3, 2021, accessed: https://www.congress.gov/117/bills/hr1319/BILLS-117hr1319enr.pdf.

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  38. U.S. Department of State, PEPFAR Update – Stakeholder Townhall (presentation on August 2, 2021), provided to KFF by the Office of the Global AIDS Coordinator.

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  39. White House. National Strategy for the COVID-19 Response and Pandemic Preparedness, January 21, 2020, accessed: https://www.whitehouse.gov/wp-content/uploads/2021/01/National-Strategy-for-the-COVID-19-Response-and-Pandemic-Preparedness.pdf.

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  40. KFF, Breaking Down the U.S. Global Health Budget by Program Area, May 2021.

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  41. Not including emergency funding appropriated in FY 2021 for COVID-19.

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  42. KFF, “White House Releases Full FY 2022 Budget Request,” June 2, 2021.

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  43. UNAIDS, Fact Sheet 2021, accessed: https://www.unaids.org/sites/default/files/media_asset/UNAIDS_FactSheet_en.pdf (July 27, 2021).

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  44. U.S. Office of Management and Budget, Major Savings and Reforms: Budget of the U.S. Government Fiscal Year 2018, accessed: https://www.govinfo.gov/content/pkg/BUDGET-2018-MSV/pdf/BUDGET-2018-MSV.pdf (page 70).

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  45. Igoe M, “PEPFAR to 'accelerate' implementation in 13 countries under new strategy,” September 19, 2017, Devex, accessed: https://www.devex.com/news/pepfar-to-accelerate-implementation-in-13-countries-under-new-strategy-91064#:~:text=The%20initiative%20will%20maintain%20lifesaving,treating%20HIV%2C%20the%20official%20said (August 12, 2021).

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  46. KFF/UNAIDS, Donor Government Funding for HIV in Low- and Middle-Income Countries in 2020, July 2021.

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  47. UNAIDS, UNAIDS Data 2020, 2020, accessed: https://www.unaids.org/sites/default/files/media_asset/2020_aids-data-book_en.pdf (May 15, 2021).

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  48. UNAIDS, Prevailing Against Pandemics by Putting People at the Centre, December 2020, accessed: https://www.unaids.org/sites/default/files/media_asset/prevailing-against-pandemics_en.pdf (May 10, 2021).

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  49. Kates J et al., “Domestic government spending on HIV: Three scenarios assessing decreased donor support,” International AIDS Conference 2018, Abstract 7731, accessed: https://programme.aids2018.org/Abstract/Abstract/7731.

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  50. KFF, Forthcoming analysis, 2021.

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  51. See, for example, the discussion by Members of Congress during consideration of PEPFAR’s 2018 reauthorization, accessed: https://www.govinfo.gov/content/pkg/CREC-2018-11-13/pdf/CREC-2018-11-13-pt1-PgH9488.pdf; a letter from Representative Kay Granger, accessed: https://kaygranger.house.gov/2018/12/bipartisan-achievement-s-saving-lives-0; and this Devex article, accessed: https://www.devex.com/news/opinion-we-started-pepfar-politicizing-aids-would-be-a-disaster-91659.

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  52. See, for example, the House of Representatives’ Committee Report accompanying the 2018 reauthorization of PEPFAR, that states, “While goals such as strengthening health systems, combatting non-communicable diseases, and establishing social safety nets for children in adversity are worthy objectives—and PEPFAR and the Global Fund clearly have had corollary, net-positive effects on these and other global health and development priorities—these objectives can and should be addressed through different initiatives. PEPFAR’s past and future success is contingent on remaining focused upon the three core diseases.” See: https://www.congress.gov/115/crpt/hrpt1014/CRPT-115hrpt1014.pdf.

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  53. KFF calculations on member composition of the U.S. Congress.

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  54. UNAIDS, Seizing the Moment: Global AIDS Update 2020, accessed: https://www.unaids.org/sites/default/files/media_asset/2020_global-aids-report_executive-summary_en.pdf.

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  55. PEPFAR’s initial focus countries were primarily those that were targeted by President Clinton’s 1999 “LIFE” Initiative, see: https://clintonwhitehouse4.archives.gov/media/pdf/2pager.pdf), and President George W. Bush’s 2002 “International Mother and Child HIV Prevention Initiative,” see: https://georgewbush-whitehouse.archives.gov/news/releases/2002/06/20020619-3.html.

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  56. UNAIDS, Global AIDS Strategy 2021-2026, End Inequalities. End AIDS, July 2021, accessed: https://www.unaids.org/sites/default/files/media_asset/global-AIDS-strategy-2021-2026_en.pdf (May 16, 2021).

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  57. White House, U.S. COVID-19 Global Response and Recovery Framework, July 1, 2021, accessed: https://www.whitehouse.gov/wp-content/uploads/2021/07/U.S.-COVID-19-Global-Response-and-Recovery-Framework.pdf.

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  58. USAID, “Equity in Health,” accessed: https://www.usaid.gov/global-health/global-health-newsletter/equity-in-health (accessed August 12, 2021).

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  59. KFF analysis of data from the U.S. Department of State’s U.S. Foreign Assistance Dashboard, accessed: www.foreignassistance.gov; U.S. Department of State, “Where We Work – PEPFAR” webpage, accessed: https://www.state.gov/where-we-work-pepfar (July 2021); U.S. Department of State, PEPFAR 2021 Country & Regional Operational Plan (COP/ROP) Guidance for All PEPFAR Countries, accessed: https://www.state.gov/wp-content/uploads/2021/02/PEPFAR-COP21-Guidance-Final.pdf; CDC’s Global HIV & Tuberculosis “Where We Work” webpage, accessed: https://www.cdc.gov/globalhivtb/index.html (July 2021).

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  60. 14 countries were specified in PEPFAR’s 2003 authorizing legislation: Botswana, Côte d’Ivoire, Ethiopia, Guyana, Haiti, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda, and Zambia. Viet Nam was added in 2004.

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  61. These 13 countries are: Botswana, Côte d’Ivoire, Haiti, Kenya, Lesotho, Malawi, Namibia, Rwanda, Swaziland, Tanzania, Uganda, Zambia, and Zimbabwe. Nine are original focus countries.

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  62. U.S. Department of State, Strategy for Accelerating HIV/AIDS Epidemic Control (2017-2020), September 2017, accessed: https://www.state.gov/wp-content/uploads/2019/08/PEPFAR-Strategy-for-Accelerating-HIVAIDS-Epidemic-Control-2017-2020.pdf.

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  63. KFF analysis data from the U.S. Department of State’s U.S. Foreign Assistance Dashboard, accessed: www.foreignassistance.gov (July 2021).

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  64. KFF analysis of UNAIDS 2020 epidemiological data, accessed:  https://www.unaids.org/en/resources/documents/2021/HIV_estimates_with_uncertainty_bounds_1990-present (August 12, 2021).

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  65. UNAIDS, Global AIDS Strategy 2021-2026, End Inequalities. End AIDS, July 2021, accessed: https://www.unaids.org/sites/default/files/media_asset/global-AIDS-strategy-2021-2026_en.pdf (May 16, 2021).

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  66. UNAIDS, 2021 HLM report slides, June 2021, accessed: https://www.unaids.org/en/resources/documents/2021/2021-HLM-report-slides.

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  67. amfAR, PEPFAR Country/Regional Operational Plans (COPs/ROPs) Database, accessed: https://copsdata.amfar.org/s/2020# (August 12, 2021).

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  68. This was a sense of Congress for FY 2004-2005 and a requirement as of FY 2006.

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  69. GAO, Spending Requirement Presents Challenges for Allocating Prevention Funding under the President’s Emergency Plan for AIDS Relief, 2006, GAO-06-395, accessed: https://www.gao.gov/assets/gao-06-395.pdf (March 16, 2021).

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  70. Institute of Medicine, PEPFAR Implementation: Progress and Promise, 2007, accessed: https://www.nap.edu/catalog/11905/pepfar-implementation-progress-and-promise.

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  71. The program is now required to spend at least half of bilateral funding on treatment and care and the 33% abstinence earmark was replaced with a requirement for “balanced funding” for prevention, although PEPFAR is still required to report to Congress if it spends less than 50% of its prevention funding on abstinence and related activities.

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  72. U.S. Department of State, DREAMS Partnership Fact Sheet 2019, accessed: https://www.state.gov/wp-content/uploads/2020/01/DREAMS-Partnership-Fact-Sheet_WAD_2019.pdf (May 16, 2021).

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  73. U.S. Department of State, DREAMS Partnership (webpage), accessed: https://www.state.gov/pepfar-dreams-partnership/ (August 13, 2021).

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  74. Fleischman J., Five Years of DREAMS and What Lies Ahead: How to Address the Intersecting Crises of HIV, Gender Inequality, and Health Security, May 2021, Center for Strategic & International Studies, accessed: https://www.csis.org/analysis/five-years-dreams-and-what-lies-ahead.

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  75. UNAIDS, Global AIDS Strategy 2021-2026, End Inequalities. End AIDS, July 2021, accessed: https://www.unaids.org/sites/default/files/media_asset/global-AIDS-strategy-2021-2026_en.pdf (May 16, 2021).

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  76. UNAIDS, Global Commitments, Local Action: After 40 years of AIDS, charting a course to end the pandemic, 2021, accessed: https://www.unaids.org/sites/default/files/media_asset/global-commitments-local-action_en.pdf (June 4, 2021).

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  77. U.S. Department of State, Draft Overview – PEPFAR Strategy: Vision 2025, accessed: https://www.state.gov/development-of-the-next-pepfar-strategy-vision-2025/ (September 10, 2021).

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  78. Institute of Medicine, Evaluation of PEPFAR, 5. Prevention, 2013, accessed: https://www.ncbi.nlm.nih.gov/books/NBK207004/.

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  79. U.S. Department of State, Key Populations (webpage), accessed: https://www.state.gov/key-populations/ (August 13, 2021).

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  80. Based on analysis of data from the PEPFAR Panorama Spotlight Dashboards, accessed: https://data.pepfar.gov/ (September 9, 2021).

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  81. MPact Global Action, “Key Populations Push Secretary of State for Funding,” March 21, 2021, accessed: https://mpactglobal.org/key-populations-push-secretary-of-state-for-funding/.

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  82. UNAIDS, Seizing the Moment: Global AIDS Update 2020, accessed: https://www.unaids.org/sites/default/files/media_asset/2020_global-aids-report_executive-summary_en.pdf.

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  83. Barr D, et al, “Key populations are the future of the African HIV/AIDS pandemic,” Journal of the International AIDS Society, June 30, 2021, accessed: https://onlinelibrary.wiley.com/doi/10.1002/jia2.25750.

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  84. Institute of Medicine, PEPFAR Implementation: Progress and Promise, 2007, accessed: https://www.nap.edu/catalog/11905/pepfar-implementation-progress-and-promise.

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  85. Fleischman J., Time to Address the Intersecting Crises of Covid-19, HIV, and Gender Inequality, November 2020, Center for Strategic & International Studies, accessed: https://www.csis.org/analysis/time-address-intersecting-crises-covid-19-hiv-and-gender-inequality.

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  86. Fleischman J., Five Years of DREAMS and What Lies Ahead: How to Address the Intersecting Crises of HIV, Gender Inequality, and Health Security, May 2021, Center for Strategic & International Studies, accessed: https://www.csis.org/analysis/five-years-dreams-and-what-lies-ahead.

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  87. UNAIDS, Confronting Inequalities: Lessons for pandemic responses from 40 years of AIDS: Global AIDS Update 2021, accessed: https://www.unaids.org/sites/default/files/media_asset/2021-global-aids-update_en.pdf (August 4, 2021).

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  88. UNAIDS, Evidence Review: Implementation of the 2016-2021 UNAIDS Strategy On the Fast Track to End AIDS, 47th meeting of the UNAIDS Program Coordinating Board, UNAIDS/PCB(47)/CRP3, accessed: https://www.unaids.org/sites/default/files/media_asset/PCB47_CRP3_Evidence_Review_EN.pdf (May 16, 2021).

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  89. Fleischman J., Five Years of DREAMS and What Lies Ahead: How to Address the Intersecting Crises of HIV, Gender Inequality, and Health Security, May 2021, Center for Strategic & International Studies, accessed: https://www.csis.org/analysis/five-years-dreams-and-what-lies-ahead.

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  90. Milanga M and Volgina A, “Opinion: PEPFAR and the Global Fund must improve care for HIV-positive children,” January 27, 2021, Devex, accessed: https://www.devex.com/news/opinion-pepfar-and-the-global-fund-must-improve-care-for-hiv-positive-children-98860.

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  91. U.S. Department of State, PEPFAR 2021 Annual Report to Congress, accessed: https://www.state.gov/wp-content/uploads/2021/02/PEPFAR2021AnnualReporttoCongress.pdf.

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  92. UNAIDS, “Joint statement calling for urgent country scale-up of access to optimal HIV treatment for infants and children living with HIV,” December 22, 2020, accessed: https://www.unaids.org/en/resources/presscentre/featurestories/2020/december/treatment-for-children-living-with-hiv.

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  93. UNAIDS, Start Free, Stay Free, AIDS Free: Final report on 2020 targets, 2021, accessed: https://www.unaids.org/sites/default/files/media_asset/2021_start-free-stay-free-aids-free-final-report-on-2020-targets_en.pdf (August 4, 2021).

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  94. U.S. Department of State, Men (webpage), accessed: https://www.state.gov/populations/men/ (August 14, 2021).

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  95. Fleischman J., Five Years of DREAMS and What Lies Ahead: How to Address the Intersecting Crises of HIV, Gender Inequality, and Health Security, May 2021, Center for Strategic & International Studies, accessed: https://www.csis.org/analysis/five-years-dreams-and-what-lies-ahead.

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  96. Caswell G et al., “The continuing role of communities affected by HIV in sustained engagement in health and rights,” June 30, 2021, Journal of the International AIDS Society, accessed: https://onlinelibrary.wiley.com/doi/10.1002/jia2.25724.

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  97. UNAIDS, Global AIDS Strategy 2021-2026, End Inequalities. End AIDS, July 2021, accessed: https://www.unaids.org/sites/default/files/media_asset/global-AIDS-strategy-2021-2026_en.pdf (June 5, 2021).

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  98. U.S. Congress, Public Law No: 110-293, “Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008”, July 30, 2008, accessed: https://www.congress.gov/bill/110th-congress/house-bill/5501.

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  99. USAID’s Health Finance and Governance Project, An Assessment of PEPFAR partnership frameworks and Partnership framework implementation plans, June 2017, accessed: https://www.hfgproject.org/an-assessment-of-pepfar-partnership-frameworks-and-partnership-framework-implementation-plans/.

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  100. U.S. Department of State, FY 2014 Country Operational Plan (COP) Guidance.

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  101. “Index testing” is a testing strategy that works to notify partners of people who test HIV-positive and offer them HIV testing services.

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  102. U.S. Department of State, PEPFAR Guidance on Implementing Safe and Equitable Index Testing Services, July 2020, accessed: https://www.pepfarsolutions.org/tools-2/2020/7/10/pepfar-guidance-on-implementing-safe-and-ethical-index-testing-services (June 7, 2021).

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  103. Health Gap, PEPFAR Watch, Measuring Up: Tracking PEPFAR’s Accountability to People Living with HIV 2020-21, 2021, accessed: https://healthgap.org/wp-content/uploads/2021/02/2020-21-Measuring-Up-FINAL.pdf (June 7, 2021).

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  104. Health Gap, How can you influence PEPFAR plans in your country? April 2016, accessed: https://healthgap.org/wp-content/uploads/2018/11/Fact_Sheet_-_PEPFAR_COP_Engagement.pdf (May 23, 2021).

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  105. U.S. Department of State, PEPFAR 2021 Country & Regional Operational Plan (COP/ROP) Guidance for All PEPFAR Countries, accessed: https://www.state.gov/wp-content/uploads/2021/02/PEPFAR-COP21-Guidance-Final.pdf.

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  106. Cromer C et al., The Family Planning Graduation Experience: Lessons for the Future, October 2014, Poptech, accessed: https://www.rhsupplies.org/uploads/tx_rhscpublications/The_FP_Graduation_Experience-Lessons_for_Future.pdf.

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  107. McDonough A. and Rodríguez DC, “How donors support civil society as government accountability advocates: a review of strategies and implications for transition of donor funding in global health,” November 2020, Globalization and Health, accessed: https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-020-00628-6.

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  108. George G et al., “The Challenges of Transition From Donor-Funded Programs: Results From a Theory-Driven Multi-Country Comparative Case Study of Programs in Eastern Europe and Central Asia Supported by the Global Fund,” June 2019, Global Health: Science and Practice, accessed: https://www.ghspjournal.org/content/7/2/258.

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  109. UNAIDS, Seizing the Moment: Tackling Entrenched Inequalities to End Epidemics, 2020, accessed: https://www.unaids.org/sites/default/files/media_asset/2020_global-aids-report_en.pdf (accessed on May 16, 2021).

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