PEPFAR integration with primary health care
The President’s Emergency Plan for AIDS Relief (PEPFAR) was launched 20 years ago and is the largest U.S. global health aid program. It is funded at over $6 billion/year and has saved over 20 million lives. While PEPFAR has historically delivered HIV services in separate facilities, the program recognizes the need to integrate HIV care with existing health services and is moving in that direction. Studies show that integrated care delivers better outcomes for both HIV and other conditions. Integration is also essential for sustainability, since it’s not feasible or cost-effective for a country to continue delivering HIV services separately after it “graduates” from the need for aid.
Fund for Global Health recently sent the organizational sign-on letter below to the leaders of the Congressional subcommittees that fund foreign aid:
Chris Coons, Chair
State and Foreign Operations Subcommittee of Appropriations
U.S. Senate
Washington, DC
Mario Diaz-Balart, Chair
State and Foreign Operations Subcommittee of Appropriations
U.S House of Representatives
Washington, DC
Lindsey Graham, Ranking Member
State and Foreign Operations Subcommittee of Appropriations
U.S. Senate
Washington DC
Barbara Lee, Ranking Member
State and Foreign Operations Subcommittee of Appropriations
U.S. House of Representatives
Washington, DC
Dear Chairs and Ranking Members,
The undersigned organizations urge you to have the President’s Emergency Plan for AIDS Relief (PEPFAR) provide detailed transparency around its policy initiative to accelerate the integration of HIV services into existing broad-based frontline health services. This request is regarding the implementation of an existing PEPFAR policy; it does not involve changing PEPFAR policy.
PEPFAR’s Five-year Strategy, “Fulfilling America’s Promise to End the HIV/AIDS Pandemic by 2030”, includes a focus on accelerating integration of HIV services into local health systems to achieve sustainability.
PEPFAR’s 2023 Country and Regional Operational Plan Guidance (COP/ROP23) states that “accelerating integration of HIV care into existing health services is key to sustaining the HIV response… Integrated health services, when based on strong primary care and essential public health functions, strengthen people-centered health systems and contribute to the best use of resources.”
To support human resources for health, PEPFAR aims to “advance integration of HIV services into broader health services through integrated care delivery teams.”
The Operational Plan Guidance makes clear that “PEPFAR should also strengthen health service delivery platforms in COP/ROP23, supporting partner government capabilities in service delivery for HIV, other health conditions, and outbreak response.”
Numerous studies have shown that integrating HIV care with other health services results in better outcomes both for HIV patients and for those with other health conditions.
As proponents of integrated frontline health service delivery in the U.S. and abroad, we are very encouraged by PEPFAR’s increasing focus on integrating HIV services with existing primary care services and believe Congress and the interested public should have access to the details of how this is being carried out.
We request that the State and Foreign Operations subcommittees of Appropriations require PEPFAR to provide the following information on how it is planning to increase support for integration: the Office of the Global AIDS Coordinator should provide a target for increasing the proportion of PEPFAR funding that goes towards broad-based service delivery covering HIV, other priority health conditions in the community, and outbreak prevention and response in existing integrated health services.
Best regards,
American Academy of Family Physicians
American College of Osteopathic Family Physicians
Society of Teachers of Family Medicine
Christian Connections for International Health
Catholic Medical Mission Board
Association of Departments of Family Medicine
Association of Family Medicine Residency Directors
NAPCRG (a national primary care research organization)
Illinois Public Health Association
MedChi, The Maryland State Medical Society
South Carolina Public Health Association
Fund for Global Health
Health Horizons International (Connecticut)
Global Care Force (Kansas)
Heart to Heart International (Kansas)
Partners for World Health (Maine)
Institute for International Medicine (Missouri)
ParticipAid (Oregon)
OneWorld Health (South Carolina)
Addis Clinic (Tennessee)
Blood:Water (Tennessee)
Individual Health Leaders:
Dr. Pierre Alexandre, PhD, Director, Health Administration Programs, Florida Atlantic University
Dr. Kristin Yarris, PhD, Department of Global Studies, University of Oregon