A key feature of PEPFAR is its creation of the Office of the U.S. Global AIDS Coordinator, a central coordinating mechanism to synchronize efforts of multiple U.S. government agencies implementing HIV/AIDS activities around the world. Similar to the role of the U.S. Malaria Coordinator established by the Presidents Malaria Initiative (PMI), OGAC was given responsibility for the oversight and coordination of all U.S. government resources and activities to fight HIV/AIDS globally, and has authority for allocation of all PEPFAR funds to U.S. government agencies. Unlike PMI, however, PEPFAR established OGAC as an independent entity housed within the State Department with the AIDS Coordinator as an ambassador-level position appointed by the President.
The establishment of OGAC was deliberately distinct from other government models, such as the Millennium Challenge Corporation, which was created as a new government agency, and PMI, where one existing agency (USAID) retains authority. The placement of OGAC within the Department of State reflects its central purposeto coordinate and not manage programsand, according to one OGAC respondent, the then prevailing view that foreign assistance is central to foreign policy.
The OGAC has a relatively small staff of approximately 75 people. The bulk of resources and staff are allocated toward conducting multilateral diplomacy and supporting program services. Other important initiatives within OGAC include strategic information gathering for dissemination, public-private partnerships, and new partner outreach. PEPFAR is centrally coordinated by OGAC, but is implemented by the teamsdescribed abovein the focus countries (IOM 2007).
Taking a comprehensive approach to address HIV/AIDS, PEPFAR supports three types of interventions in focal countries:
- Efforts related to preventing new infections. Prevention approaches include reducing sexual transmission, the prevention of mother-to-child transmission, preventing transmission through unsafe blood and medial injections, and reducing transmission by promoting male circumcision.
- Support for treatment of infected individuals. Several components of antiretroviral treatment (ART) are supported by PEPFAR, such as obtaining governmental commitment to treatment developing clinical guidelines; establishing training programs for clinical and laboratory staff; and providing space and personnel for clinical care in medical facilities. In the area of pediatric treatment, PEPFAR activities have addressed the high cost of pediatric treatment formulations; regulatory barriers to registering pediatric formulations; and limited information about pediatric doses of medicines at different ages and weights.
- Care for those who are infected. Care and support comprises five categories of services: clinical (including prevention and treatment of opportunistic infections and AIDS-related malignancies, and pain and symptom management), psychological, social, spiritual, and preventive services.
PEPFAR also undertakes efforts to build capacity within focus countries to sustain its interventions.