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Evaluating the President's Emergency Plan for AIDS Relief: Time to Scale It Up

Robert Gross, MD, MSCE; and Gregory Bisson, MD, MSCE
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From Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA 19104.


Potential Financial Conflicts of Interest:Grants received: R. Gross (National Institutes of Health [National Institute of Mental Health and National Institute of Allergy and Infectious Diseases], Agency for Healthcare Research and Quality, Abbott Laboratories, Bristol-Myers Squibb, Doris Duke Charitable Foundation), G.P. Bisson (National Institutes of Health [National Institute of Allergy and Infectious Diseases], Doris Duke Charitable Foundation). Other: Drs. Gross and Bisson conduct research in Botswana under the auspices of the Botswana-UPenn Partnership, which receives support from PEPFAR to provide care to HIV-infected persons in Botswana. Neither author receives funds from PEPFAR.

Requests for Single Reprints: Robert Gross, MD, MSCE, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, 8th Floor, Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6021; e-mail, grossr@mail.med.upenn.edu.

Current Author Addresses: Drs. Gross and Bisson: Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, 8th Floor, Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6021.


Ann Intern Med. 2009;150(10):727-728. doi:10.7326/0003-4819-150-10-200905190-00012
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In 2003, the U.S. government embarked on the largest public health program ever created by 1 country to fight a single disease: HIV/AIDS. The nucleus of the program, framed in the context of urgent need, was aptly named the President's Emergency Plan for AIDS Relief (PEPFAR). The initial goals of PEPFAR were to confront HIV and AIDS on multiple fronts by scaling up services to prevent vertical and horizontal HIV transmission, to provide medical therapy through the procurement and distribution of antiretroviral and ancillary drugs, and to support care for HIV-uninfected persons whose lives had become unstable because of HIV/AIDS. Although PEPFAR money flows to more than 120 nations, 15 focus countries, 12 of which are in Africa, get most of the money. From the beginning, PEPFAR has been a goal-driven program, with initial 5-year performance targets of providing antiretroviral therapy to 2 million people, preventing 7 million new HIV infections, and delivering supportive care to 10 million people affected directly or indirectly by HIV/AIDS (1). Initially conceived as a moral imperative, PEPFAR was historic in both its scale and the compressed time scale for meeting its objectives.

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