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This year represents an important milestone toward achieving HIV epidemic control [3 MB] and the shared  global 90-90-90 goals . We are proud of PEPFAR’s life-saving impact over the past 17 years, which has been accomplished through the American people’s generosity and commitment alongside our partnership with governments, communities, multilateral institutions, and other partners.

PEPFAR has never been satisfied with success; instead, we constantly strive to learn – broadening, deepening, and improving upon the program to save more lives with each dollar we invest. As we push toward epidemic control, we must ensure that all individuals diagnosed with HIV, regardless of their symptoms, are linked to and initiate antiretroviral treatment (ART) and continue our efforts to drive down new HIV infections.

In the early days of PEPFAR, expanding ART access was largely about reaching those who were among the sickest. Today, with 16.5 million men, women, and children on PEPFAR-supported life-saving treatment, we are increasingly identifying individuals living with HIV who have yet to exhibit major symptoms. This can make them less likely to access HIV testing, initiate treatment, or to stay on treatment, especially if services are – or are perceived as – unfriendly or inconvenient.

We see evidence of this challenge in PEPFAR’s program data . Many countries struggle to retain recently initiated clients on HIV treatment, particularly those who are young, feel well, and in their first six months of ART. Therefore, strengthening retention is a major PEPFAR priority.

Client-centered service provision [474 KB] is essential to improving our efforts. We must ensure key policies are in place – and implemented at scale – so clients feel HIV services are convenient, supportive, and directly responsive to their needs. We must deliver quality, client-centered services that reach people where they are and PEPFAR has established a series of program and site-level requirements to do just that.

We can only know if our services are working by opening the space for meaningful engagement of, as well as contributions and input from, the communities that we serve.  We strive to hear directly from our clients and beneficiaries, using their insights to continuously adapt and improve our programs. This perspective has been an essential missing piece to address ongoing retention challenges and to enhance the quality of our HIV programs. That is why, beginning with our 2020 Country Operational Plans, PEPFAR requires every operating unit to develop and fund community-led monitoring (CLM) for HIV services in close collaboration with independent civil society organizations and partner country governments.

CLM is a technique initiated and implemented by local community-based organizations and other civil society groups that gathers quantitative and qualitative data about HIV services in a routine and systematic manner; the data are then utilized to drive change in service provision. We want to diagnose and overcome barriers to HIV service uptake and retention quickly.

Last month, during the 23rd International AIDS Conference, civil society organizations from South Africa, Mozambique, and Vietnam presented different models  of PEPFAR-supported CLM and reflected on its critical ingredients. Presenters described the importance of ensuring communities lead the design of the CLM system and indicators. They also reflected on the necessity of establishing trust between communities and health facilities so that findings could be constructively and collaboratively addressed, ultimately leading to improved client outcomes.

CLM is but one element of PEPFAR’s broader commitment to empowering communities and delivering client-centered services. In recent years, we have also significantly increased the proportion of PEPFAR funding that goes to local partners. Local partners are often closest to the community and the client, which can improve their ability to meet clients where they are with what they need – not only today but sustainably well into the future. By the end of fiscal year 2020, PEPFAR aims to reach 70 percent funding of local partners at each of its implementing agencies, and we have made tremendous strides toward reaching this goal.

Going forward, PEPFAR will continue to work collaboratively with civil society organizations, communities, multilateral institutions, partner country governments, and other donors to identify and document best practices and useful tools . PEPFAR has delivered remarkable life-saving results over the past 17 years. Now, we want to ensure these gains are not only expanded but also sustained, which means finding new and improved ways of empowering communities, delivering for clients, and putting them both in the lead.

U.S. Department of State

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