A PEPFAR transition that works?

Science Speaks: HIV & TB News | May 27, 2014

As the President’s Emergency Plan For AIDS began its shift from emergency to sustainable response in 2009, international organizations supplying life-saving programs faced a daunting deadline.

In three years, according to the plan, groups like the U.S.-based Elizabeth Glaser Pediatric AIDS Foundation, which by then had provided HIV testing and counseling to two and a half million pregnant women, care and support to more than a million patients, and antiretroviral treatment for more than half a million people during the previous five years, would need to turn responsibility for the programs making that possible over to local organizations in resource-poor countries.

“It felt forced, unreasonable, and unrealistic,” Chip Lyons of EGPAF said Friday.

In some countries, where PEPFAR-funded efforts were most critical, it may also have seemed impossible.

In Côte d’Ivoire, Tanzania and Mozambique, three of the countries where EGPAF worked, no local organization with the capacities to manage multi-million dollar grants existed, Dr. Anja Giphart, the organization’s executive vice president, said.

Lyons and Giphart talked about how EGPAF met that challenge Friday at the Center for Strategic and International Studies, in Washington, D.C. They were joined by Dr. Paula Vaz, who heads Fundação Ariel Glaser contra o SIDA Pediátrico a Mozambican organization founded with EGPAF support in 2011.

Dr. Vaz, who equated the transition from international to local control of HIV prevention, treatment and care programs to “jumping on a train that is going fast — naked,” said EGPAF’s answer to the challenge, supporting the creation of independent, nationally based affiliate organizations had produced a transition with no gap in services.

Local knowledge and experience was part of the reason for that, according to Giphart: “We learn as much from the affiliates as they learn from us, hopefully.”

Fundação Ariel Glaser, named for Elizabeth Glaser’s daughter who died of AIDS-related illnesses in 1988, is one of three EGPAF affiliates. The other two are The Fondation Ariel Glaser pour la Lutte contre le SIDA Pédiatrique  in Côte d’Ivoire and Ariel Glaser Pediatric AIDS Healthcare Initiative in Tanzania. Since 2011, Paz said, Fundação Ariel has supported HIV testing for more than 300,000 pregnant women, all of whom received their results. In the process, local capacities have grown, with EGPAF supplying training in areas that included financial management and governance, fund-raising and advocacy, as well as grants.EGPAF also evaluates its affiliates with regular accreditation reviews, that include detailed feedback and support, Giphart said.

With the lifelong responsibility of those for whom the organization has initiated antiretroviral treatment, the future remains challenging, Vaz acknowledged in answer to a question from moderator Todd Summers of CSIS. But, she added, Fundação Ariel is working toward a second phase of transition with the government of Mozambique. And, while unmet need continues, Lyons said, he believes affiliates making their own case will increase government involvement.

The need to find a solution produced one that shows promise for sustainability, Lyons said.

“We, like many others might have been kicking the can down the road if we hadn’t been given a hard deadline.”