Institute of Medicine experts urge action towards developing sustainable international HIV prevention programs. (Alyssa Howard/Medill)

Institute of Medicine experts urge action towards developing sustainable international HIV prevention programs. (Alyssa Howard/Medill)

WASHINGTON– The U.S. government’s $28 billion international AIDS relief plan should focus on helping partner countries around the world develop self-sufficient HIV/AIDS prevention programs, according to an evaluation Wednesday by the Institute of Medicine.

The initiative, called the President’s Emergency Plan for AIDS Relief, or PEPFAR, has “saved and improved the lives of millions” of people around the world through its prevention and response programs since its launch in 2003, according to the report. Although the plan has been “transformative” in combating the global pandemic, there is significant room for improvement, said Ann Kurth of the New York University College of Nursing at the National Academy of Sciences.

“It moved the goal post, but the work’s unfinished,” Kurth said. Kurth was on the evaluation team from the Institute of Medicine, which is the health branch of the National Academy of Sciences.

The evaluation outlined four main recommendations for further progress: increasing the number of HIV programs, improving knowledge surrounding HIV, bolstering HIV-response systems in partner countries and making those systems more sustainable.

The initiative, whose funding makes the U.S. the largest donor to AIDS relief in the world, should also prioritize AIDS response systems in populations that need it most, she added.

Under President George W. Bush, PEPFAR was created through legislation that pledged $15 billion for HIV/AIDS and other global health issues over its first five years. In 2008, Congress committed another $13 billion for the program. As part of the reauthorization, Congress requested that the Institute of Medicine assess the initiative. A similar evaluation was performed in 2007.

Today, PEPFAR funds HIV prevention efforts in more than 100 countries, and has partnerships with 33 countries and regions that receive the lion’s share of the money. PEPFAR supports HIV prevention and care, increases awareness in partner countries and helps children affected by the epidemic.

The success of the plan illustrates that generous financial support, used effectively, can turn the tide in countries ravaged by HIV/AIDS, the report said.

“You can succeed in countries with high rates of disease,” said Jennifer Kates, the Kaiser Family Foundation’s director of Global Health and HIV Policy and another member of the evaluation team. “That was not the international consensus, but this program has proven that that is indeed the case.”

PEPFAR has made HIV testing, counseling, and diagnosis more accessible, allowing many to learn their HIV status, the report found. The initiative has surpassed its original goals: To treat 2 million HIV-infected people in resource-limited settings, prevent 7 million new infections and support care for 10 million people.

One of the largest challenges PEPFAR will face is linking HIV-positive individuals to care and sustaining their treatments, Kurth said.

She also suggested that the initiative concentrate on improving cooperation between countries and establishing more outcome-oriented HIV-response systems.

“We’re moving into a new arena here, a new era … where we’re looking at systems collaboratively,” Kurth said. “That’s a huge opportunity, and we would see it as a quiet revolution, in a way.”