Five Ways USAID is Leading Efforts to Reach HIV Epidemic Control

What the HIV Response Will Look Like in the Next Phase of PEPFAR

USAID has been a leader in the global fight against HIV since the mid-1990s and a key implementing agency of the President’s Emergency Plan for AIDS Relief (PEPFAR) since it was established by President George W. Bush in 2003. After nearly 20 years of PEPFAR – and as more countries reach and sustain HIV epidemic control – the global HIV response and USAID’s programming must shift from an emergency to an institutionalized and sustained HIV epidemic control approach.?

This move requires us to reframe and innovate our approach and to center it on advancing equity and supporting disproportionately affected communities.

In support of the new draft PEPFAR five-year strategic vision , here are five ways that USAID is working with countries and communities to reach and sustain HIV epidemic control – and what the response will look like in order to achieve the Sustainable Development Goal target of ending the global AIDS epidemic as a public threat by 2030.?

1. A simplified and comprehensive response: USAID will draw on its extensive experience in successfully integrating family planning and reproductive health, malaria, maternal and child health and nutrition, and tuberculosis into primary health to integrate HIV as well, and will focus on providing person-centered service delivery.

Historically, people living with HIV were required to engage with the healthcare system on a monthly basis to receive their HIV medication. Long wait times, stigma, lack of transportation, and inability to take time off from work were – and are – all contributing factors that keep people living with HIV from picking up their medication on time, resulting in treatment interruptions which can cause them to become ill.

To minimize these barriers and increase flexibility, USAID’s approaches will tailor healthcare to meet the unique needs of people living with HIV, keeping them simple and easy for people to use.

From a patient perspective and for long-term sustainability, single-disease health services are not only inefficient but, in many cases, create barriers to people receiving healthcare. Integrating HIV services into routine primary health care services (where appropriate) and local health systems will assist in sustaining HIV epidemic control and also ensure that people living with HIV have their broader health needs met.

2. A response that empowers adolescents & youth: USAID will increase options for and expand access to health and HIV prevention and treatment for young people and link them to jobs and education opportunities.

Over 30 percent of new HIV infections occur in young women between the ages of 15 and 25, and young women are twice as likely to acquire HIV as their male peers. This makes it imperative that adolescents and young women have safe, effective, and acceptable choices for HIV prevention that fit their lifestyles. USAID’s experience engaging youth in decision-making and program implementation will help meet the health, education, and economic needs of adolescents and youth.

It’s this approach that we use with our DREAMS Ambassadors – adolescent girls and young women who have learned about sexual reproductive health and HIV prevention services, completed specialized leadership training, and now work with their peers to help mentor and educate other young women on sexual and reproductive health issues. And, through our NextGen Squad members, a team of paid youth advocates under age 30 who provide input for new HIV prevention products developed with USAID that address the unique needs of adolescent girls and young women.

3. A response that is locally led: USAID will continue strong partnerships with governments at national and local levels – including civil society, private sector, and academia – to ensure that country health systems are locally-led, optimized, and resourced to support access to and delivery of HIV services for all.

Achieving sustained control of the HIV epidemic depends on the countries we work with to fully own and lead their national response, and local partners to implement it. USAID is also working closely with country health systems for effective budget allocation, spending, and tracking of resources.?

Robust civil society groups are another essential element for sustainable HIV epidemic control. They are the link to communities, and are also leading interventions that prevent HIV and ensure people stay on their treatment. USAID partnerships with civil society organizations continue to develop sustainable business approaches that help sustain them into the future and decrease overall reliance on external funding.?

4. A response with a person-centered supply chain: USAID will promote regional manufacturing, leading toward a more diversified, sustainable, and potentially lower cost supply chain for our partner countries.

COVID-19 taught us many lessons, one of which is the need for strong and resilient supply chains.?

What does this look like in action? In 2020, USAID launched a global purchasing and standardized service level agreement in Nigeria, Mozambique, Uganda, Tanzania, Kenya, and Zambia. The agreement covered important commodities and services – for HIV viral load and early infant diagnosis – and resulted in improved system performance, cost reductions, more transparent pricing, and enhanced supply chain security. It has also saved more than $30 million and will be expanded to an additional 20 countries in 2023.?

5. A response that takes into account future pandemics: USAID will draw on its expertise in humanitarian assistance to ensure continuity of services.

USAID will protect people living with HIV and communities affected by the epidemic from the disproportionate effects of other pandemic threats and shocks as well as natural disasters and political crises. We will also continue to support partner country government health systems to plan strategically for mitigating the impact of pandemics.?

ABOUT THE AUTHOR: Han Kang is the director of USAID’s Office of HIV/AIDS