PEPFAR has “met or even surpassed most” of its “bold goals,” including “saving the lives of millions of people; supporting the scale-up of HIV prevention, care, and treatment; and strengthening systems and policies for the HIV response,” Robert Black of the Johns Hopkins Bloomberg School of Public Health writes in a Lancet opinion piece, noting the release of the Institute of Medicine’s (IOM) “Evaluation of PEPFAR” on Wednesday. Black, who served as chair of the IOM evaluation committee, continues, “Despite a decade of investment from the U.S. government, other international donors, and countries themselves, many challenges remain. Even with PEPFAR’s contribution to the substantial scale-up of HIV services in countries with restricted resources and infrastructure, the most profound challenge is simply the unmet need.” He describes this and other challenges, including “fostering sustainable management and enhancing country ownership.” Black concludes, “The pace of the transition to this new era and the necessary steps to achieve it will vary by country. The resulting progress will take time, but the evolution is vital to ensure the sustainability and completeness of the response to HIV” (2/20).