PEPFAR treats 20 million people with HIV, but funding has been ‘flat’
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Key takeaways:
- Since 2004, the number of people on ART supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) has increased from 66,550 to more than 20 million.
- PEPFAR infrastructure in more than a dozen countries has also played a significant role in the global responses to COVID-19, Ebola and Zika.
- PEPFAR has not had a budget increase in more than a decade.
Roughly 20 million people with HIV in 54 countries are receiving ART through the President’s Emergency Plan for AIDS Relief, a 300-fold increase in 2 decades, according to a new report.
Since PEPFAR was launched in 2003 by then-President George W. Bush and began providing HIV treatment in 2004, the program has saved 25 million lives, CDC officials noted while presenting data from the report, published in Vital Signs.
They also noted that PEPFAR’s work to strengthen laboratories, staff, distribution and public health systems has helped respond to other health crises.
“We’ve learned from COVID, Zika and Ebola that disease has no borders, and this is why it’s so important that both our domestic work and our global work [go] hand in hand,” Debra Houry, MD, MPH, the CDC’s Chief Medical Officer, said during a press briefing about the upcoming reauthorization of PEPFAR this year.
“Strengthening lab systems, health care systems, working with health care providers, reducing stigma, as well as the surveillance work we’re doing — all of this protects our U.S. citizens domestically and abroad, and really improves health security globally,” Houry said.
PEPFAR was originally funded by Congress in 2003 with a 5-year, $15 billion budget. It was reauthorized for another 5 years in 2008 with a budget increase to $48 billion, but has since been reauthorized twice, in 2013 and 2018, with no increase in budget.
“PEPFAR and the agencies that implement global HIV policies have received an aggregate level of funding that has been flat,” Hank Tomlinson, PhD, director of the CDC’s Division of Global HIV and TB at the CDC, said during the briefing.
“We hope that we will continue to receive bicameral bipartisan support for reauthorization in future appropriations. I think, at this level of support, we’ll be able to continue to maintain the gains that we’ve seen, to aggressively and rapidly address the remaining gaps and to shore up systems that will ensure that these are durable gains,” Tomlinson said.
PEPFAR’s initial goal in Africa was to prevent 7 million infections, treat 2 million people and provide care for people with HIV and children orphaned by it, according to the report, with about 30 million people on the continent estimated to have HIV at the time.
From 2004 to 2022, the number of people with HIV infection in 54 countries receiving PEPFAR-support ART increased 300-fold, researchers wrote, from 66,550 to 20.1 million. Additionally, from 2015 to 2022, the number of people who received a viral load test increased by 605%, and the rate of viral suppression among people being testing increased from 80% to 95%.
The PEPFAR workforce included 371,760 providers in 70,000 community clinics or other facilities in 2022, and since 2017 the number of PEPFAR-supported facilities with molecular laboratories has increased by 115%, the number of supported systems with at least one lab involved in a continuous quality control program increased by 112% and the number of labs that were accredited increased by 194%.
PEPFAR’s work on HIV has also been used for testing, distribution and surveillance for the COVID-19 pandemic and Ebola and Zika virus epidemics. From April 2020 through March 2021, 109 PEPFAR-supported HIV labs and 138 HIV and TB sites conducted about 3.4 million COVID-19 tests across 16 nations, according to the study.
Houry noted that 20 years ago, “an HIV diagnosis in many countries almost certainly meant death. Yet, today, more than 20 million people worldwide are leading healthy, productive lives thanks to lifesaving treatment they receive through PEPFAR.”
According to the study, there were an estimated 38.4 million people with HIV in 2021. Of these, 28.7 million were receiving ART and 92% had suppressed viral loads.
“More than 4 decades ago, since the first cases were reported, HIV is still a leading cause of death and a health threat to millions around the world,” Houry said. “Significant gaps remain in our efforts to reach groups with critically needed HIV treatment services. ... We’ve come a long way in addressing the global HIV epidemic. Eliminating HIV as a global public health threat is within our grasp — we must stay the course so that these decades of progress aren’t reversed.”
References:
- CDC. Zika virus: Statistics and maps. https://www.cdc.gov/zika/reporting/index.html. Accessed Aug. 25, 2021.
- Chun, H. et al. MMWR Morb Mortal Wkly Rep. 2023;doi:10.15585/mmwr.mm7212e1
- George W. Bush Presidential Center. An oral history of PEPFAR. https://www.bushcenter.org/publications/an-oral-history-of-pepfar-how-a-dream-big-partnership-is-saving-the-lives-of-millions. Published Feb. 24, 2023. Accessed March 14, 2023.
- U.S. Department of State. About US — PEPFAR. https://www.state.gov/about-us-pepfar/. Accessed March 14, 2023.
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