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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
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 (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
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: [email protected] 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.