PEPFARs enabling legislation and strategy included defined, measurable performance targets. Staff members in focus countries report semi-annually to OGAC on program-, outcome-, and impact-level indicators for each program. Outcome measures include behavior change, health infrastructure capacity and quality, care and support, and impact of care and treatment, including morbidity and mortality. This reporting mechanism is critical to PEPFARs operation and has enabled the initiative to show progress in a quantifiable way, although critics have sometimes taken issue with the true value of the indicators. Still, OGAC staff and decision-makers pay attention to these indicators. Country operational plans are reviewed annually, and OGAC requires justification when countries do not reach agreed-upon targets.
PEPFAR staff has begun discussions of how to measure impacts effectively but data are not yet available to determine the impact of its services. However, according to an evaluation of PEPFAR implementation conducted by the National Research Council at the Institute of Medicine (IOM) and released in 2007, PEPFAR has demonstrated that HIV/AIDS services, particularly treatment, can be scaled up rapidly in challenging environments, such as those existing in the focus countries.
By the time PEPFAR was reauthorized in 2008, OGAC staff reported that its treatment goals had been nearly reached, with PEPFAR supporting treatment for more than 1.7 million people worldwide, compared to a goal of 2 million. PEPFAR also reported supporting care for more than 6.6 million people, somewhat shy of the initial 5-year goal of 10 million (PEPFAR 2008b).