Behind HRSA’s Global HIV/AIDS Coordination

HRSA and the Ryan White HIV/AIDS Program Behind PEPFAR Since Its 2003 Start

The U.S. Department of Health and Human Resources and Services Administration (HRSA), Office of Global Health (OGH) strengthens health systems in countries where the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) provides prevention, care, and treatment services to people living with HIV in more than 50 countries. HRSA is one of the 7 U.S. government departments and agencies supporting PEPFAR, which has saved 25 million lives through clinical HIV service delivery and health systems strengthening investments.

Many of the service delivery innovations and system approaches behind PEPFAR’s success originated with HRSA’s Ryan White HIV/AIDS Program (RWHAP), which provides services for over 50 percent of people living with HIV in the U.S. When PEPFAR launched in 2003, HRSA helped 15 countries rapidly establish emergency HIV/AIDS services, building on RWHAP tools and experience reaching high-need communities in the U.S.—from treatment guidelines and clinical standards of care to training curricula, continuous quality improvement techniques, medical education mentorship models, and technical assistance frameworks to assess and strengthen community organizations’ capacity for sustainable, locally-led services. Since then, governments and local PEPFAR partners in 30 countries have leveraged HRSA resources and partnerships to establish and accelerate country programs and results.

Abt has supported HRSA’s HIV/AIDS initiatives in the U.S. for decades—since the 1990s—as well as global health bidirectional learning and capacity building initiatives to identify interventions and strategies that can be replicated in new settings. All HIV programs benefit from learning from successful interventions that keep people engaged in treatment, reduce new infections, and improve health care, outcomes, and HIV-related health disparities. As PEPFAR programs have matured and now support 20.2 million people on treatment, they have likewise generated reciprocal strategies that can benefit U.S. efforts to engage diverse client populations in long-term care.

WHAT WE'VE DONE 

Abt led HRSA’s Global Technical Assistance Program (G-TAP), which worked to enhance a portfolio of PEPFAR grant recipients and partners in several focus countries. 

To achieve and sustain global 95-95-95 targets and improve service quality while transitioning to locally-managed programs, PEPFAR’s implementing partners and country health teams need increased capacity in data analysis, monitoring, and evaluation.  Abt led HRSA’s Global Technical Assistance Program (G-TAP), which worked to enhance a portfolio of PEPFAR grant recipients and partners in several focus countries. The project provided tailored technical assistance (TA) to equip local PEPFAR grantees and HRSA staff with actionable data, knowledge transfer, and programmatic support as they work to achieve epidemic control and an AIDS-free generation. Through customized TA, Abt and HRSA strengthened partners’ ability to generate and use data to improve program accuracy and efficiency, and to better use reporting standards to enhance routine monitoring of clinics’ and national programs’ performance.

One of the most common needs is for data analytics and visualization for learning and adaptative management. Data and information are crucial to managing patient- and clinic-level care to ensure treatment adherence, as well as reporting to national health systems to track and resource HIV progress. We developed and implemented innovative data analysis solutions—including dashboards to visually depict complex information and adaptive management approaches to use data for decision making—to strengthen the capacity of client and local counterparts to achieve epidemic control. 

REACH & RESULTS

Abt responded to numerous data requests over two-and-a-half years to help local partners and institutions contribute to decision making and information sharing in the countries where HRSA supports PEPFAR programs. Our teams provided on-site technical assistance in Ivory Coast, Jamaica, Panama, Malawi and Zambia, and virtual TA across the portfolio. Since 2021, we developed ten manuals, tools, and training resources to build HRSA and PEPFAR stakeholders’ capacity to use data to plan, improve monitoring and evaluation activities, and make evidence-based programming decisions. In our core activities, we:

• Developed custom Tableau dashboards for priority countries using PEPFAR data sets.
• Developed technical content on research methodologies and sampling strategies and supported the data design, extraction, analysis, visualization and use of data collected because of PEPFAR program implementation. 
• Developed and delivered learning sessions on specific programmatic areas for OGH staff and implementing partners. 
• Contributed to knowledge exchange between PEPFAR implementing agencies through collaborations with Strategic Information teams.

WHAT WE'VE LEARNED

The G-TAP model allowed HRSA U.S. staff and PEPFAR country partners to commission TA in targeted, locally-driven and -relevant ways, ensuring efficient use of funds for the most critical needs. This differs from, and complements, other HIV/AIDS and health systems strengthening investments Abt leads. G-TAP and HRSA’s efforts for bidirectional exchange of health innovations, emerging strategies, and models of care are critical to maximize HIV system investments to reach and keep more people in treatment and virally suppressed.