[Senate Report 113-112]
[From the U.S. Government Publishing Office]
Calendar No. 202
113th Congress Report
SENATE
1st Session 113-112
======================================================================
PEPFAR STEWARDSHIP AND OVERSIGHT
ACT OF 2013 (S. 1545)
_______
October 2, 2013.--Ordered to be printed
_______
Mr. Menendez, from the Committee on Foreign Relations,
submitted the following
REPORT
[To accompany S. 1545]
The Committee on Foreign Relations, having had under
consideration the bill S. 1545, to extend authorities related
to global HIV/AIDS and to promote oversight of the United
States programs, reports favorably thereon with amendments and
recommends that the bill, as amended, do pass.
CONTENTS
Page
I. Purpose..........................................................1
II. Committee Action.................................................1
III. Discussion.......................................................2
IV. Cost Estimate....................................................5
V. Evaluation of Regulatory Impact..................................5
VI. Changes in Existing Law..........................................5
I. Purpose
The purpose of S. 1545 is to extend provisions of PEPFAR
that would otherwise expire and to update oversight
requirements.
II. Committee Action
S. 1545 was introduced by Senators Menendez and Corker on
September 24, 2013. On September 30, 2013, the committee
considered S. 1545 and ordered it reported, with amendments, by
voice vote.
The committee took the following action with regard to
amendments: A manager's package of amendments was offered to
the introduced bill, including proposed amendments from
Senators Cardin and Durbin (modified by Senators Corker and
Rubio), and was agreed to by voice vote. The subject matter
areas covered by the manager's package of amendments included
non-controversial amendments which require the annual report
from the Office of the Global AIDS Coordinator to include
reporting on HIV co-infections and co-morbidities, including
tuberculosis co-infections; reporting on health care workforce
training and retention; and a clarification that reporting on
engagement with nongovernmental organizations covers engagement
with local partners
III. Discussion
Chairman Menendez and Ranking Member Corker introduced the
PEPFAR Stewardship and Oversight Act of 2013 to extend valuable
provisions of PEPFAR that would otherwise expire, and to update
and refine oversight requirements. These updated and refined
oversight requirements ensure that PEPFAR programs continue to
be implemented efficiently and effectively and address the
evolving HIV/AIDS epidemic.
PEPFAR has saved millions of lives around the world--
especially in Africa--over the last decade. As a result of the
United States' strong commitment to stopping the HIV/AIDS
epidemic through PEPFAR, almost 6 million people are receiving
life-sustaining antiretroviral treatment, more than 11 million
pregnant women received HIV testing and counseling last year,
and--as a result of adequate treatment--this year, the one-
millionth baby was born HIV-free. Because of PEPFAR, 15 million
people--more than 4.5 million orphans and vulnerable children--
have received the care and support they need.
Most provisions from PEPFAR have permanent authority and
are not in need of extension. S. 1545 therefore focuses on
extending expiring provisions in current law and updating
oversight requirements. S. 1545 demonstrates continued
congressional support for PEPFAR, helps guide the transition
toward greater country ownership, and enhances effective
oversight of this life-saving program.
Section-by-Section Summary
Section 1 of S. 1545 provides the short title: the ``PEPFAR
Stewardship and Oversight Act of 2013.''
Section 2 extends for 5 years the requirement that the
Inspectors General of the State Department, the U.S. Agency for
International Development, and the Department of Health and
Human Services develop annual joint oversight and audit plans.
Section 3 extends for 5 years a reporting requirement that
captures per-patient costs for PEPFAR-supported treatment and
care and adds two new requirements for the study: (1) that the
Office of the Global AIDS Coordinator (OGAC) must provide a
plan for conducting a cost study in each partner country; and
(2) that the study include a comprehensive expenditure analysis
by partner country.
Section 4 extends for 5 years the current 33 percent cap on
U.S. contributions to the Global Fund. This cap is a ceiling on
U.S. funding, with the specific amount being set each year
through the appropriations process. It also extends for 5 years
the requirement that funds be withheld from state sponsors of
terrorism, currently prohibiting any funding to Cuba, Iran,
Sudan, and Syria. Additionally, the legislation extends for 5
years a requirement that 20 percent of the Global Fund
contributions be withheld unless the Global Fund fulfills
transparency requirements. New reporting requirements for the
Global Fund contained in S. 1545 include providing new metrics
that the Global Fund has started to collect, including
performance and expenditure data on all of the Global Fund's
principal and sub-recipients, in an open and machine readable
format.
The committee recognizes the Global Fund's work to
implement more timely, detailed, and accurate reporting at both
the principal recipient and sub-recipient level. The committee
also recognizes that the collection of detailed data on the
smallest sub-recipients might not represent an optimal
allocation of staff resources to identify and manage risk
across the entire portfolio. As such, the committee recommends
a threshold for sub-recipient reporting only in countries
receiving $10 million or more in the course of a Global Fund
funding replenishment cycle. In countries receiving $10 million
or greater during a funding replenishment cycle, the Global
Fund should focus on sub-recipients receiving grants in the
amount of $500,000 or greater, annually, or $1 million over a
grant cycle, whichever is lower.
Section 5 of the legislation requires the submission of a
revised annual report regarding the PEPFAR program by striking
the previous report required by 22 U.S.C. 2151b-2(f) and
replacing it with new reporting requirements. Among other
things, the revised report is required to include national and
bilateral program targets. Subsection (f)(3)(B)(iii) requires
the President to establish and subsequently measure progress
toward reaching bilateral programmatic targets across
prevention, treatment, and care. The measurement of progress
must include data on the number of adults and children on HIV
treatment, disaggregated by those directly supported by PEPFAR
and those otherwise supported through PEPFAR.
The committee recognizes that during the emergency phase of
PEPFAR, the need for rapid scale-up of treatment and related
services necessitated high levels of direct support. In this
phase, calculating the number of individuals on HIV treatment
that could be attributed specifically to PEPFAR interventions
was straightforward. However, as PEPFAR continues the
transition from an emergency program toward a program focused
on sustainable outcomes, greater country ownership, and greater
collaboration with multilateral and other funding sources, such
attribution is more difficult. As a result, the committee has
differentiated between individuals that are directly supported
by PEPFAR and those that are otherwise supported through
PEPFAR.
The committee notes that while a definition of ``direct
support'' currently exists, it is too broad for the level of
detail the committee expects in the report. The legislation
therefore requires the President, in subsection (f)(3)(O) of
the revised report, to provide and disseminate a new, clear,
operable definition of direct support that will resolve
outstanding concerns about programmatic attribution and
contribution. While the President is provided the necessary
flexibility to define these terms, it is the committee's
expectation that the definition of direct support will provide
for the measurement of the number of adults and children for
whom the U.S. government provides a majority of the cost of
care and treatment. Care and treatment may include medicines,
clinical and community-based health staff and training,
laboratories, facilities, site-based quality control, clinic-
based information systems, and other essential site-based
services.
Subsection (f)(3)(G) of the revised report requires an
assessment of progress towards achieving targets, including a
report on supportive care. In subsection (f)(3)(G)(vii), the
committee expects that such reporting will include a discussion
of food and nutritional support provided to those affected by
HIV/AIDS.
Subsection (f)(3)(P) of the revised report requires a
description, globally and by country, of specific efforts to
address co-infections and co-morbidities of HIV/AIDS, including
tuberculosis co-infections. The committee expects that this
description will also include a discussion on AIDS-related
cancers, including trends with respect to cervical cancer, and
efforts to address such cancers.
Subsection (f)(3)(K)(iii) of the revised report requires a
description of measures taken to improve partner country
capacity to achieve positive outcomes. The committee expects
that this description will include a discussion of activities
to ensure that the pace of the scale up of core interventions
is sustained as appropriate, that service delivery within
partner countries continues, and that coverage is expanded as
partner countries pursue a sustainable response to the local
epidemic. The committee further expects that the description of
measures required by subsection (f)(3)(K)(iii) of the revised
report will include a specific discussion of measures intended
to increase participation and integration of civil society in
HIV/AIDS planning and implementation.
Subsection (f)(3)(H) of the revised report requires, among
other things, a description of partner country and United
States-funded HIV/AIDS prevention programs. The committee
encourages the Office of the Global AIDS Coordinator to discuss
all relevant methods, including, but not limited to, the role
of door-to-door voluntary testing and provider initiated
counseling and testing, in describing such prevention programs
specifically with respect to the discussion of other
programmatic activities to prevent the transmission of HIV.
Since the beginning of PEPFAR, Congress has demonstrated a
consistent commitment to addressing the unique needs of orphans
and vulnerable children affected by the HIV/AIDS epidemic by
requiring 10 percent of all program funds be specifically
allocated to programs focused on orphans and vulnerable
children. This requirement is continued in section 6 of this
legislation. While recognizing the importance of continued
support for orphans and vulnerable children in the context of
the AIDS pandemic, the committee requests greater transparency
in the use of these funds. The committee therefore expects the
reporting requirement under subsection (f)(3)(K) to provide a
description of the finances of PEPFAR-supported programs for
orphans and vulnerable children, as well as a description of
the goals, scope, and performance indicators used to measure
the effectiveness of such programs.
Subsection (f)(3)(F) of the revised report requires a
description and explanation of changes in guidance or policies
related to the implementation of programs supported under this
section. It is the committee's expectation that the description
required by subsection (f)(3)(F) of the revised report will
include a discussion of any relevant World Health Organization
guidance with respect to HIV/AIDS prevention, treatment, and
care, as well as a description of how any policy changes or
related matters may affect the program. This includes, but is
not limited to, relevant past guidance, such as the June 2013
World Health Organization-issued guidelines on the use of
antiretroviral drugs for treating and preventing HIV infection.
Section 6 extends for 5 years existing requirements that
more than half of funding be used for treatment and care and
that not less than 10 percent be used to support orphans and
vulnerable children.
IV. Cost Estimate
In accordance with Rule XXVI, paragraph 11(a) of the
Standing Rules of the Senate, the committee notes that the cost
estimate provided by the Congressional Budget Office was not
available for inclusion in this report. The estimate will be
printed in either a supplemental report or the Congressional
Record when it is available.
V. Evaluation of Regulatory Impact
In compliance with rule XXVI of the Standing Rules of the
Senate, the committee finds that no significant regulatory
impact will result from the enactment of S. 1545.
VI. Changes in Existing Law
In compliance with Rule XXVI, paragraph 12 of the Standing
Rules of the Senate, changes in existing law made by the bill,
as reported, are shown as follows (existing law proposed to be
omitted is enclosed in black brackets, new matter is printed in
italic, existing law in which no change is proposed is shown in
roman).
Section 101 of the United States Leadership Against HIV/AIDS,
Tuberculosis, and Malaria Act of 2003
SEC. 101. DEVELOPMENT OF A COMPREHENSIVE, FIVE-YEAR, GLOBAL STRATEGY.
* * * * * * *
(f) Inspectors General.--
(1) Oversight plan.--
(A) Development.--The Inspectors General of
the Department of State and Broadcasting Board
of Governors, the Department of Health and
Human Services, and the United States Agency
for International Development shall jointly
develop [5 coordinated annual plans for
oversight activity in each of the fiscal years
2009 through 2013] coordinated annual plans for
oversight activity in each of the fiscal years
2009 through 2018, with regard to the programs
authorized under this Act and sections 104A,
104B, and 104C of the Foreign Assistance Act of
1961.
(B) Contents.--The plans developed under
subparagraph (A) shall include a schedule for
financial audits, inspections, and performance
reviews, as appropriate.
(C) Deadline.--
(i) Initial plan.--The first plan
developed under subparagraph (A) shall
be completed not later than the later
of--
(I) September 1, 2008; or
(II) 60 days after the date
of the enactment of the Tom
Lantos and Henry J. Hyde United
States Global Leadership
Against HIV/AIDS, Tuberculosis,
and Malaria Reauthorization Act
of 2008.
(ii) [Subsequent] 2010 through 2013
plans._Each of [the last four plans]
the plans for fiscal years 2010 through
2013 developed under subparagraph (A)
shall be completed not later than 30
days before each of the fiscal years
2010 through 2013, respectively.
(iii) 2014 plan.--The plan developed
under subparagraph (A) for fiscal year
2014 shall be completed not later than
60 days after the date of the enactment
of the PEPFAR Stewardship and Oversight
Act of 2013.
[(iii)] (iv) Subsequent plans.--Each
of the last four plans developed under
subparagraph (A) shall be completed not
later than 30 days before each of the
fiscal years 2015 through 2018,
respectively.
* * * * * * *
(g) Annual Study.--
(1) In general.--Not later than September 30, 2009,
and annually thereafter [through September 30, 2013]
through September 30, 2019, the Global AIDS Coordinator
shall complete a study of treatment providers that--
(A) represents a range of countries and
service environments;
(B) estimates the per-patient cost of
antiretroviral HIV/AIDS treatment and the care
of people with HIV/AIDS not receiving
antiretroviral treatment, including a
comparison of the costs for equivalent services
provided by programs not receiving assistance
under this Act;
(C) estimates per-patient costs across the
program and in specific categories of service
providers, including--
(i) urban and rural providers;
(ii) country-specific providers; and
(iii) other subcategories, as
appropriate.
(2) 2013 through 2018 studies.--The studies required
to be submitted by September 30, 2014, and annually
thereafter through September 30, 2018, shall include,
in addition to the elements set forth under paragraph
(1), the following elements:
(A) A plan for conducting cost studies of
United States assistance under section 104A of
the Foreign Assistance Act of 1961 (22 U.S.C.
2151b-2) in partner countries, taking into
account the goal for more systematic collection
of data, as well as the demands of such
analysis on available human and fiscal
resources.
(B) A comprehensive and harmonized
expenditure analysis by partner country,
including--
(i) an analysis of Global Fund and
national partner spending and
comparable data across United States,
Global Fund, and national partner
spending; or
(ii) where providing such comparable
data is not currently practicable, an
explanation of why it is not currently
practicable, and when it will be
practicable.
[(2)] (3) Publication.--Not later than 90 days after
the completion of each study under paragraph (1), the
Global AIDS Coordinator shall make the results of such
study available on a publicly accessible Web site.
(4) Partner country defined.--In this subsection, the
term ``partner country'' means a country with a minimum
United States Government investment of HIV/AIDS
assistance of at least $5,000,000 in the prior fiscal
year.
Section 202 of the United States Leadership Against HIV/AIDS,
Tuberculosis, and Malaria Act of 2003
SEC. 202. PARTICIPATION IN THE GLOBAL FUND TO FIGHT AIDS, TUBERCULOSIS
AND MALARIA.
* * * * * * *
(d) United States Financial Participation.--
* * * * * * *
(4) Limitation.--
(A)(i) At any time during fiscal years 2009
through [2013] 2018, no United States
contribution to the Global Fund may cause the
total amount of United States Government
contributions to the Global Fund to exceed 33
percent of the total amount of funds
contributed to the Global Fund from all
sources. Contributions to the Global Fund from
the International Bank for Reconstruction and
Development and the International Monetary Fund
shall not be considered in determining
compliance with this paragraph.
(ii) If, at any time during any of the fiscal
years 2009 through [2013] 2018, the President
determines that the Global Fund has provided
assistance to a country, the government of
which the Secretary of State has determined,
for purposes of section 6(j)(1) of the Export
Administration Act of 1979 (50 U.S.C. App.
2405(j)(1)), has repeatedly provided support
for acts of international terrorism, then the
United States shall withhold from its
contribution for the next fiscal year an amount
equal to the amount expended by the Fund to the
government of each such country. [The President
may waive the application of this clause with
respect to assistance for Sudan that is
overseen by the Southern Country Coordinating
Mechanism, including Southern Sudan, Southern
Kordofan, Blue Nile State, and Abyei, if the
President determines that the national interest
or humanitarian reasons justify such a waiver.
The President shall publish each waiver of this
clause in the Federal Register and, not later
than 15 days before the waiver takes effect,
shall consult with the committee on Foreign
Relations of the Senate and the committee on
Foreign Affairs of the House of Representatives
regarding the proposed waiver.]
(iii) If at any time the President determines
that the expenses of the Governing,
Administrative, and Advisory Bodies (including
the Partnership Forum, the Foundation Board,
the Secretariat, and the Technical Review
Board) of the Global Fund exceed 10 percent of
the total expenditures of the Fund for any 2-
year period, the United States shall withhold
from its contribution for the next fiscal year
an amount equal the to the average annual
amount expended by the Fund for such 2-year
period for the expenses of the Governing,
Administrative, and Advisory Bodies in excess
of 10 percent of the total expenditures of the
Fund.
(iv) The President may waive the application
of clause (iii) if the President determines
that extraordinary circumstances warrant such a
waiver. No waiver under this clause may be for
any period that exceeds 1 year.
(v) If, at any time during any of the fiscal
years 2004 through 2008, the President
determines that the salary of any individual
employed by the Global Fund exceeds the salary
of the Vice President of the United States (as
determined under section 104 of title 3, United
States Code) for that fiscal year, then the
United States shall withhold from its
contribution for the next fiscal year an amount
equal to the aggregate amount by which the
salary of each such individual exceeds the
salary of the Vice President of the United
States.
(vi) For the purposes of clause (i), ``funds
contributed to the Global Fund from all
sources'' means funds contributed to the Global
Fund at any time during fiscal years 2009
through [2013] 2018 that are not contributed to
fulfill a commitment made for a fiscal year
before fiscal year 2009.
(B)(i) Any amount made available [under this
subsection] that is withheld by reason of
subparagraph (A)(i) shall be contributed to the
Global Fund as soon as practicable, subject to
subparagraph (A)(i), after additional
contributions to the Global Fund are made from
other sources.
(ii) Any amount made available [under this
subsection] that is withheld by reason of
subparagraph (A)(iii) shall be transferred to
the Activities to Combat HIV/AIDS Globally Fund
and shall remain available under the same terms
and conditions as funds appropriated [pursuant
to the authorization of appropriations under
section 401] to carry out section 104A of the
Foreign Assistance Act of 1961 for HIV/AIDS
assistance.
(iii) Any amount made available [under this
subsection] that is withheld by reason of
clause (ii) or (iii) of subparagraph (A) is
authorized to be made available to carry out
section 104A of the Foreign Assistance Act of
1961 (as added by section 301 of this Act).
Amounts made available under the preceding
sentence are in addition to amounts
appropriated pursuant to the authorization of
appropriations under section 401 of this Act
for HIV/AIDS assistance.
(iv) Notwithstanding clause (i), after July
31 of each of the fiscal years 2009 through
[2013] 2018, any amount made available [under
this subsection] that is withheld by reason of
subparagraph (A)(i) is authorized to be made
available to carry out sections 104A, 104B, and
104C of the Foreign Assistance Act of 1961 (as
added by title III of this Act).
* * * * * * *
(5) Withholding funds.--Notwithstanding any other
provision of this Act, 20 percent of the amounts
appropriated pursuant to this Act for a contribution to
support the Global Fund for each of the fiscal years
2010 through [2013] 2018 shall be withheld from
obligation to the Global Fund until the Secretary of
State certifies to the appropriate congressional
committees that the Global Fund--
* * * * * * *
(C) has adopted, and is implementing, a
policy to publish on a publicly available Web
site in an open, machine readable format--
(i) grant performance reviews;
(ii) all reports of the Inspector
General of the Global Fund, in a manner
that is consistent with the Policy for
Disclosure of Reports of the Inspector
General, approved at the 16th Meeting
of the Board of the Global Fund;
(iii) decision points of the Board of
the Global Fund;
(iv) reports from Board committees to
the Board; and
[(v) a regular collection and
analysis of performance data and
funding of grants of the Global Fund,
which shall cover all principal
recipients and all subrecipients;]
(v) a regular collection, analysis,
and reporting of performance data and
funding of grants of the Global Fund,
which covers all principal recipients
and all subrecipients on the fiscal
cycle of each grant, and includes the
distribution of resources, by grant and
principal recipient and subrecipient,
for prevention, care, treatment, drugs,
and commodities purchase, and other
purposes as practicable;
(D) is maintaining an independent, well-
staffed Office of the Inspector General that--
(i) reports directly to the Board of
the Global Fund; and
(ii) compiles regular, publicly
published audits, in an open, machine
readable format, of financial,
programmatic, and reporting aspects of
the Global Fund, its grantees, and
LFAs;
(E) has established, and is reporting
publicly, in an open, machine readable format,
on, standard indicators for all program areas;
(F) has established a methodology to track
and is publicly reporting on--
(i) all subrecipients and the amount
of funds disbursed to each subrecipient
on the grant's fiscal cycle[; and];
[(ii) the distribution of resources,
by grant and principal recipient, for
prevention, care, treatment, drugs and
commodities purchase, and other
purposes;]
(ii) all principal recipients and
subrecipients and the amount of funds
disbursed to each principal recipient
and subrecipient on the fiscal cycle of
the grant;
(iii) expenditure data--
(I) tracked by principal
recipients and subrecipients by
program area, where
practicable, prevention, care,
and treatment and reported in a
format that allows comparison
with other funding streams in
each country; or
(II) if such expenditure data
is not available, outlay or
disbursement data, and an
explanation of progress made
toward providing such
expenditure data; and
(iv) high-quality grant performance
evaluations measuring inputs, outputs,
and outcomes, as appropriate, with the
goal of achieving outcome reporting;
[(G) has established a policy on tariffs
imposed by national governments on all goods
and services financed by the Global Fund;]
(G) has published an annual report on a
publicly available Web site in an open, machine
readable format, that includes--
(i) a list of all countries imposing
import duties and internal taxes on any
goods or services financed by the
Global Fund;
(ii) a description of the types of
goods or services on which the import
duties and internal taxes are levied;
(iii) the total cost of the import
duties and internal taxes;
(iv) recovered import duties or
internal taxes; and
(v) the status of country status-
agreements;
Section 104A of the Foreign Assistance Act of 1961
SEC. 104A. ASSISTANCE TO COMBAT HIV/AIDS.
* * * * * * *
[(f) Annual Report.--
[(1) In general.--Not later than January 31 of each
year, the President shall submit to the Committee on
Foreign Relations of the Senate and the Committee on
Foreign Affairs of the House of Representatives a
report on the implementation of this section for the
prior fiscal year.
[(2) Report elements.--Each report shall include--
[(A) a description of efforts made by each
relevant executive branch agency to implement
the policies set forth in this section, section
104B, and section 104C;
[(B) a description of the programs
established pursuant to such sections;
[(C) a detailed breakdown of funding
allocations, by program and by country, for
prevention activities; and
[(D) a detailed assessment of the impact of
programs established pursuant to such sections,
including--
[(i)(I) the effectiveness of such
programs in reducing--
[(aa) the transmission of
HIV, particularly in women and
girls;
[(bb) mother-to-child
transmission of HIV, including
through drug treatment and
therapies, either directly or
by referral; and
[(cc) mortality rates from
HIV/AIDS;
[(II) the number of patients
receiving treatment for AIDS in each
country that receives assistance under
this Act;
[(III) an assessment of progress
towards the achievement of annual goals
set forth in the timetable required
under the 5-year strategy established
under section 101 of the United States
Leadership Against HIV/AIDS,
Tuberculosis, and Malaria Act of 2003
and, if annual goals are not being met,
the reasons for such failure; and
[(IV) retention and attrition data
for programs receiving United States
assistance, including mortality and
loss to follow-up rates, organized
overall and by country;
[(ii) the progress made toward--
[(I) improving health care
delivery systems (including the
training of health care
workers, including doctors,
nurses, midwives, pharmacists,
laboratory technicians, and
compensated community health
workers, and the use of codes
of conduct for ethical
recruiting practices for health
care workers);
[(II) advancing safe working
conditions for health care
workers; and
[(III) improving
infrastructure to promote
progress toward universal
access to HIV/AIDS prevention,
treatment, and care by 2013;
[(iii) a description of coordination
efforts with relevant executive branch
agencies to link HIV/AIDS clinical and
social services with non-HIV/AIDS
services as part of the United States
health and development agenda;
[(iv) a detailed description of
integrated HIV/AIDS and food and
nutrition programs and services,
including--
[(I) the amount spent on food
and nutrition support;
[(II) the types of activities
supported; and
[(III) an assessment of the
effectiveness of interventions
carried out to improve the
health status of persons with
HIV/AIDS receiving food or
nutritional support;
[(v) a description of efforts to
improve harmonization, in terms of
relevant executive branch agencies,
coordination with other public and
private entities, and coordination with
partner countries' national strategic
plans as called for in the ``Three
Ones'';
[(vi) a description of--
[(I) the efforts of partner
countries that were signatories
to the Abuja Declaration on
HIV/AIDS, Tuberculosis, and
Other Related Infectious
Diseases to adhere to the goals
of such Declaration in terms of
investments in public health,
including HIV/AIDS; and
[(II) a description of the
HIV/AIDS investments of partner
countries that were not
signatories to such
Declaration;
[(vii) a detailed description of any
compacts or framework agreements
reached or negotiated between the
United States and any partner
countries, including a description of
the elements of compacts described in
subsection (e);
[(viii) a description of programs
serving women and girls, including--
[(I) HIV/AIDS prevention
programs that address the
vulnerabilities of girls and
women to HIV/AIDS;
[(II) information on the
number of individuals served by
programs aimed at reducing the
vulnerabilities of women and
girls to HIV/AIDS and data on
the types, objectives, and
duration of programs to address
these issues;
[(III) information on
programs to address the
particular needs of adolescent
girls and young women; and
[(IV) programs to prevent
gender-based violence or to
assist victims of gender based
violence as part of, or in
coordination with, HIV/AIDS
programs;
[(ix) a description of strategies,
goals, programs, and interventions to--
[(I) address the needs and
vulnerabilities of youth
populations;
[(II) expand access among
young men and women to
evidence-based HIV/AIDS health
care services and HIV
prevention programs, including
abstinence education programs;
and
[(III) expand community-based
services to meet the needs of
orphans and of children and
adolescents affected by or
vulnerable to HIV/AIDS without
increasing stigmatization;
[(x) a description of--
[(I) the specific strategies
funded to ensure the reduction
of HIV infection among
injection drug users;
[(II) the number of injection
drug users, by country, reached
by such strategies; and
[(III) medication-assisted
drug treatment for individuals
with HIV or at risk of HIV;
[(xi) a detailed description of
program monitoring, operations
research, and impact evaluation
research, including--
[(I) the amount of funding
provided for each research
type;
[(II) an analysis of cost-
effectiveness models; and
[(III) conclusions regarding
the efficiency, effectiveness,
and quality of services as
derived from previous or
ongoing research and monitoring
efforts;
[(xii) building capacity to identify,
investigate, and stop nosocomial
transmission of infectious diseases,
including HIV and tuberculosis; and
[(xiii) a description of staffing
levels of United States government HIV/
AIDS teams in countries with
significant HIV/AIDS programs,
including whether or not a full-time
coordinator was on staff for the year.]
(f) Annual Report.--
(1) In general.--Not later than February 15, 2014,
and annually thereafter, the President shall submit to
the Committee on Foreign Relations of the Senate and
the Committee on Foreign Affairs of the House of
Representatives a report in an open, machine readable
format, on the implementation of this section for the
prior fiscal year.
(2) Report due in 2014.--The report due not later
than February 15, 2014, shall include the elements
required by law prior to the enactment of the PEPFAR
Stewardship and Oversight Act of 2013.
(3) Report elements.--Each report submitted after
February 15, 2014, shall include the following:
(A) A description based on internationally
available data, and where practicable high-
quality country-based data, of the total global
burden and need for HIV/AIDS prevention,
treatment, and care, including--
(i) estimates by partner country of
the global burden and need; and
(ii) HIV incidence, prevalence, and
AIDS deaths for the reporting period.
(B) Reporting on annual targets across
prevention, treatment, and care interventions
in partner countries, including--
(i) a description of how those
targets are designed to--
(I) ensure that the annual
increase in new patients on
antiretroviral treatment
exceeds the number of annual
new HIV infections;
(II) reduce the number of new
HIV infections below the number
of deaths among persons
infected with HIV; and
(III) achieve an AIDS-free
generation;
(ii) national targets across
prevention, treatment, and care that
are--
(I) established by partner
countries; or
(II) where such national
partner country-developed
targets are unavailable, a
description of progress towards
developing national partner
country targets; and
(iii) bilateral programmatic targets
across prevention, treatment, and care,
including--
(I) the number of adults and
children to be directly
supported on HIV treatment
under United States-funded
programs;
(II) the number of adults and
children to be otherwise
supported on HIV treatment
under United States-funded
programs; and
(III) other programmatic
targets for activities directly
and otherwise supported by
United States-funded programs.
(C) A description, by partner country, of
HIV/AIDS funding from all sources, including
funding levels from partner countries, other
donors, and the private sector, as practicable.
(D) A description of how United States-funded
programs, in conjunction with the Global Fund,
other donors, and partner countries, together
set targets, measure progress, and achieve
positive outcomes in partner countries.
(E) An annual assessment of outcome indicator
development, dissemination, and performance for
programs supported under this section,
including ongoing corrective actions to improve
reporting.
(F) A description and explanation of changes
in related guidance or policies related to
implementation of programs supported under this
section.
(G) An assessment and quantification of
progress over the reporting period toward
achieving the targets set forth in subparagraph
(B), including--
(i) the number, by partner country,
of persons on HIV treatment, including
specifically--
(I) the number of adults and
children on HIV treatment
directly supported by United
States-funded programs; and
(II) the number of adults and
children on HIV treatment
otherwise supported by United
States-funded programs;
(ii) HIV treatment coverage rates by
partner country;
(iii) the net increase in persons on
HIV treatment by partner country;
(iv) new infections of HIV by partner
country;
(v) the number of HIV infections
averted;
(vi) antiretroviral treatment program
retention rates by partner country,
including--
(I) performance against
annual targets for program
retention; and
(II) the retention rate of
persons on HIV treatment
directly supported by United
States-funded programs; and
(vii) a description of supportive
care.
(H) A description of partner country and
United States-funded HIV/AIDS prevention
programs and policies, including--
(i) an assessment by country of
progress towards targets set forth in
subparagraph (B), with a detailed
description of the metrics used to
assess--
(I) programs to prevent
mother to child transmission of
HIV/AIDS, including coverage
rates;
(II) programs to provide or
promote voluntary medical male
circumcision, including
coverage rates;
(III) programs for behavior-
change; and
(IV) other programmatic
activities to prevent the
transmission of HIV;
(ii) antiretroviral treatment as
prevention; and
(iii) a description of any new
preventative interventions or
methodologies.
(I) A description of the goals, scope, and
measurement of program efforts aimed at women
and girls.
(J) A description of the goals, scope, and
measurement of program efforts aimed at
orphans, vulnerable children, and youth.
(K) A description of the indicators and
milestones used to assess effective, strategic,
and appropriately timed country ownership,
including--
(i) an explanation of the metrics
used to determine whether the pace of
any transition to such ownership is
appropriate for that country, given
that country's level of readiness for
such transition;
(ii) an analysis of governmental and
local nongovernmental capacity to
sustain positive outcomes;
(iii) a description of measures taken
to improve partner country capacity to
sustain positive outcomes where needed;
and
(iv) for countries undergoing a
transition to greater country
ownership, a description of strategies
to assess and mitigate programmatic and
financial risk and to ensure continued
quality of care for essential services.
(L) A description, globally and by partner
country, of specific efforts to achieve and
incentivize greater programmatic and cost
effectiveness, including--
(i) progress toward establishing
common economic metrics across
prevention, care and treatment with
partner counties and the Global Fund;
(ii) average costs, by country and by
core intervention;
(iii) expenditure reporting in all
program areas, supplemented with
targeted analyses of the cost-
effectiveness of specific
interventions; and
(iv) import duties and internal taxes
imposed on program commodities and
services, by country.
(M) A description of partnership framework
agreements with countries, and regions where
applicable, including--
(i) the objectives and structure of
partnership framework agreements with
countries, including--
(I) how these agreements are
aligned with national HIV/AIDS
plans and public health
strategies and commitments of
such countries; and
(II) how these agreements
incorporate a role for civil
society; and
(ii) a description of what has been
learned in advancing partnership
framework agreements with countries,
and regions as applicable, in terms of
improved coordination and
collaboration, definition of clear
roles and responsibilities of
participants and signers, and
implications for how to further
strengthen these agreements with
mutually accountable measures of
progress.
(N) A description of efforts and activities
to engage new partners, including faith-based,
locally-based, and United States minority-
serving institutions.
(O) A definition and description of the
differentiation between directly and otherwise
supported activities, including specific
efforts to clarify programmatic attribution and
contribution, as well as timelines for
dissemination and implementation.
(P) A description, globally and by country,
of specific efforts to address co-infections
and co-morbidities of HIV/AIDS, including--
(i) the number and percent of people
in HIV care or treatment who started
tuberculosis treatment; and
(ii) the number and percentage of
eligible HIV positive patients starting
isoniazid preventative therapy.
(Q) A description of efforts by partner
countries to train, employ, and retain health
care workers, including efforts to address
workforce shortages.
(4) Partner country defined.--In this subsection, the
term ``partner country'' means a country with a minimum
United States Government investment of HIV/AIDS
assistance of at least $5,000,000 in the prior fiscal
year.
Section 403 of the United States Leadership Against HIV/AIDS,
Tuberculosis, and Malaria Act of 2003
SEC. 403. ALLOCATION OF FUNDS.
* * * * * * *
(b) Orphans and Vulnerable Children.--For fiscal years 2009
through [2013] 2018, not less than 10 percent of the [amounts
appropriated pursuant to the authorization of appropriations
under section 401] amounts appropriated or otherwise made
available to carry out the provisions of section 104A of the
Foreign Assistance Act of 1961 (22 U.S.C. 2151b-2) for HIV/AIDS
assistance for each such fiscal year shall be expended for
assistance for orphans and other children affected by, or
vulnerable to, HIV/AIDS, of which such amount at least 50
percent shall be provided through non-profit, nongovernmental
organizations, including faith-based organizations, that
implement programs on the community level.
(c) Funding Allocation.--For each of the fiscal years 2009
through [2013] 2018, more than half of the [amounts
appropriated for bilateral global HIV/AIDS assistance pursuant
to section 401] amounts appropriated or otherwise made
available to carry out the provisions of section 104A of the
Foreign Assistance Act of 1961 (22 U.S.C. 2151b-2) shall be
expended for--
(1) antiretroviral treatment for HIV/AIDS;
(2) clinical monitoring of HIV-seropositive people
not in need of antiretroviral treatment;
(3) care for associated opportunistic infections;
(4) nutrition and food support for people living with
HIV/AIDS; and
(5) other essential HIV/AIDS-related medical care for
people living with HIV/AIDS.