Center for Global Health

Division of Global HIV/AIDS

John Pitman Division of Global HIV/AIDS,

Center for Global Health, CDC

Summary

• Funding amounts and thematic priorities in PEPFAR I (2004-2009) and PEPFAR II (2010-2014)

• Changes under PEPFAR III (2015)• Successes• Challenges for the future

The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR)

Treatment for more than 6.7 million people as of Sept 30, 2013

Male circumcision procedures for ~ 4.7 million men as of December 2013

HIV counseling and testing for more than 57.7 million people

*Fiscal year 2013 unless otherwise noted Source: PEPFAR, 2013

PEPFAR Progress

HIV/AIDS$766.6 mil.

44%

Malaria$146.2 m.

9%

Maternal & Child Health$295.3 mil.

17%

Other Global Health

$519.6 mil. 30%

HIV/AIDS(PEPFAR since

2004)$6,729.6 million

75%

Malaria (PMI since 2005)$842.9 mil.

9%

Maternal & Child Health

$680 mil. 7%

Other Global Health$774 mil.

9%

2001$1.8 billion

2014$8.9 billion

The Trade OffChanges in USG Global Health funding priorities, 2001 - 2014

Source: U.S. Government data compiled by the Kaiser Family Foundation. A complete

table is available at:

http://kaiserfamilyfoundation.files.wordpress.com/2013/05/ghi-budget-fs-historical-fu

nding-table-fy14-request-5-21-13.pdf

.

PEPFAR funding for blood safety over time

PEPFAR data: www.pepfar.gov

PEPFAR funding for blood safety over time (2)

PEPFAR data: www.pepfar.gov

Fiscal Year Care

Governance & Systems

Management & Operations Prevention Treatment Total Blood Safety

% Prevention

sub-total% PEPFAR

total

2004 $ 119,900,000 $ 107,000,000 $ 62,100,000 $ 268,500,000 $ 230,400,000 $ 787,900,000 $ 27,600,000 10.3% 3.5%

2005 $ 186,100,000 $ 166,500,000 $ 73,300,000 $ 383,300,000 $ 395,800,000 $ 1,205,000,000 $ 53,400,000 13.9% 4.4%

2006 $ 290,600,000 $ 213,600,000 $ 93,400,000 $ 455,200,000 $ 650,400,000 $ 1,703,200,000 $ 31,000,000 6.8% 1.8%

2007 $ 560,700,000 $ 381,400,000 $ 132,500,000 $ 749,800,000 $1,026,200,000 $ 2,850,600,000 $ 48,200,000 6.4% 1.7%

2008 $ 772,600,000 $ 535,200,000 $ 196,800,000 $1,018,400,000 $1,379,600,000 $ 3,902,600,000 $ 56,100,000 5.5% 1.4%

2009 $ 805,600,000 $ 604,500,000 $ 222,000,000 $ 990,800,000 $1,205,200,000 $ 3,828,100,000 $ 55,400,000 5.6% 1.4%

2010 $ 851,100,000 $ 638,800,000 $ 349,300,000 $1,129,400,000 $1,136,100,000 $ 4,104,700,000 $ 52,500,000 4.6% 1.3%

2011 $ 864,300,000 $ 735,400,000 $ 354,600,000 $1,151,800,000 $1,102,600,000 $ 4,208,700,000 $ 50,700,000 4.4% 1.2%

2012 $ 680,500,000 $ 705,800,000 $ 218,300,000 $1,012,000,000 $ 961,000,000 $ 3,577,600,000 $ 42,400,000 4.2% 1.2%

2013 $ 719,400,000 $ 670,200,000 $ 209,600,000 $1,025,200,000 $1,051,300,000 $ 3,675,700,000 $ 38,000,000 3.7% 1.0%

Total $5,850,800,000 $4,758,400,000 $1,911,900,000 $8,184,400,000 $9,138,600,000 $29,844,100,000 $ 455,300,000 5.6% 1.5%

Who else funds blood safety? Global Fund: $92 million for blood safety in

56 countries (2002-2009) 20% of total was awarded to China

Other bi-lateral grants from OECD member states

Projects with “blood safety” in the description ($358 million since 2002) Canada: $5.5 million (Malawi & Mozambique, 2005-

2007) Italy ($61,200, DR Congo, Uganda, 2005, 2008, 2010) Japan ($109,063, Senegal, 2010) Norway ($668,605, Tanzania, 2006, 2007, 2009) Spain (DR Congo, $326,369, 2010) United States (Benin, DRC, Guinea, Lesotho, Liberia,

Mali, Mozambique, Nigeria, Senegal, Uganda, $15 million, 2008-2010)

2005

2006

2007

2008

2009

2010

2011

2005

2006

2007

2008

2009

2010

2011

2005

2006

2007

2008

2009

2010

2011

2005

2006

2007

2008

2009

2010

2011

2005

2006

2007

2008

2009

2010

2011

2005

2006

2007

2008

2009

2010

2011

2005

2006

2007

2008

2009

2010

2011

2005

2006

2007

2008

2009

2010

2011

2005

2006

2007

2008

2009

2010

2011

2005

2006

2007

2008

2009

2010

2011

2005

2006

2007

2008

2009

2010

2011

Botswana Cote d'Ivoire

Ethiopia Kenya Mozambique

Namibia Nigeria Rwanda Tanzania Uganda Zambia

0

1

2

3

4

5

6

7

8

9

10H

IV p

reva

lence

in c

olle

cted u

nits

PEPFAR’s impact: Safety (11 countries)

Source: WHO Global Database on Blood Safety

PEPFAR’s impact: Adequacy9 PEPFAR-supported countries in Africa

Source: WHO Global Database on Blood Safety

2003 2004 2005 2006 2007 2008 2009 2010 2003 2004 2005 2006 2007 2008 2009 2010

Blood Collections

396498

419836

518592

547123

592848

612035

706578

737054

Mean

3.90937722397466

4.07864545031799

4.96068520437445

4.87493224433207

5.03832190109576

5.09125379061272

5.68169999016943

5.56933187651339

Maximum

9.10598546685346

9.62710571533143

11.0037313432836

11.0719167279992

11.5276913503423

10.0956717486954

11.750302907916

10.1649227703039

Minimum

0.229684103247115

0.233422199548006

0.243724034885587

0.260240625470719

0.268374263104381

0.41126165529891

0.441615503012888

0.50157498388664

0.5

2.5

4.5

6.5

8.5

10.5

50,000150,000250,000350,000450,000550,000650,000750,000

Num

ber of units collected per 1,000 population

Aggregate num

ber of units collected per year

PEPFAR’s impact: Sustainability

Country

Total estimated funding (US$) for

operating the blood centres covered in this report (incl.

staffing and operations)

Proportion of total funding

from the national

government

Proportion of funding from

fees and cost-

recovery

Proportion of funding from

external donors

[Country A] $80,000 37.5% 0.0% 62.5%[Country B] $700,000 100.0% 0.0% 0.0%[Country C] $937,447 2.5% 95.8% 1.7%[Country D] $1,043,000 42.8% 0.0% 57.2%[Country E] $1,528,608 34.6% 0.0% 65.4%[Country F] $1,600,000 68.8% 0.0% 31.3%[Country G] $2,062,553 30.9% 5.4% 63.7%[Country H] $2,141,910 100.0% 0.0% 0.0%[Country I] $3,038,151 23.3% 15.6% 61.1%[Country J] $3,200,000 15.6% 0.0% 84.4%[Country K] $3,220,478 0.0% 84.1% 15.9%[Country L] $4,150,000 24.1% 0.0% 75.9%[Country M] $5,863,461 5.7% 7.1% 87.2%[Country N] $5,706,023 7.2% 0.0% 92.8%[Country O] $6,324,600 32.8% 0.0% 67.2%[Country P] $6,510,124 48.7% 8.1% 43.2%[Country Q] $8,195,381 6.2% 67.8% 26.1%[Country R] $25,000,000 0.0% 100.0% 0.0%[Country S] $59,577,500 100.0% 0.0% 0.0%

10 of 19 PEPFAR-supported countries remain >50% dependent on external donor support to

conduct routine operations

GDBS, 2012

Epidemic Control – PEPFAR’s priority Focus on the Right Thing, Right Place,

Right Time

The right thing Core interventions: highest impact

on AIDS-Free Generation, 90-90-90 goals

The right place Geographically focused Effectively reaching the most

vulnerable The right time – an

expanding HIV epidemic is not financially sustainable

What does PEPFAR’s new focusmean for blood safety?

Clear implications for funding

Need to demonstrate impact on priority indicators

Incidence

Referral to confirmatory testing and the rest of the cascade

Accreditation (“foundational” for PEPFAR-supported

laboratories)

Quality

Data systems

Reframing PEPFAR’s blood safety contributions

…from comprehensive to targeted

Remaining relevant within PEPFARA need for creative thinking

Sources: DHS, AIS reports, GDBS, PEPFAR indicators

Country DemographicsNew adult infections

% of newly diagnosed

infections did not know their

HIV status

Estimated number of new adult

infections among people who did not

know their HIV status ¹

Number of new HIV infections

detected/year among blood donors who reported no or low behavioral risks for HIV infection (2012)

Potential proportion of new adult

infections among people who do not

know their status that could be attributed to blood bank screening

Kenya *

All adults 88,622 53.1% 47,058 1,000 2.1%

Male adults 38,088 61.9% 23,576 700 3.0%

Female adults 50,534 47.8% 24,155 300 1.2%

Uganda**

All adults 131,279 96.4% 126,613 1,209 1.0%

Male adults 59,076 97.4% 57,557 846 1.5%

Female adults‡

72,203 95.7% 69,065 592 0.9%

Botswana***

All adults 9,170 55.0% § 5,044 331 6.6%

Male adults 3,485 60.0% 2,091 232 11.1%

Female adults 5,685† 50.0% 2,843 99 3.5%

Conclusion

PEPFAR can no longer support a comprehensive blood systems strengthening approach

PEPFAR can and will continue to support countries to build quality management systems, collect and use better data, and achieve accreditation

A new research agenda is needed to better understand countries’ needs, especially for adequacy and access

Resource mobilization must be a priority for countries and others interested in sustaining the achievements of the last 10 years

Thank You

Center for Global Health

Division of Global HIV/AIDS

For more information please contact Centers for Disease Control and Prevention1600 Clifton Road NE, Atlanta, GA 30333Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: cdcinfo@cdc.gov Web: www.cdc.gov

The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention.