Making Every Dollar Count to Reach the Most People in Need and Save the Most Lives

For more than 40 years, CDC has been a leader in the fight against HIV and tuberculosis (TB) in the United States and across the world. CDC plays a vital role in the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), working to end HIV and TB in more than 50 countries.

CDC’s approach to implementing PEPFAR is very effective, saving millions of lives each year and making the most of every dollar spent. While receiving roughly 50% of PEPFAR funding for HIV treatment worldwide, CDC and its partners support more than 60 percent (62%) of all people with HIV on PEPFAR-supported antiretroviral treatment. For every $1 CDC spends on treatment, other agencies spend $1.50, making CDC the most efficient agency implementing PEPFAR.

Commitment to Indigenous Partnerships

CDC’s commitment to supporting indigenous partners is a multiplier of our efforts and empowers local leadership to sustain our collective impact into the future. In 2021, more than 70% of CDC direct funds went to local and indigenous partners with proven credibility and expertise versus 40-50% spent by other PEPFAR agencies. This approach strengthens local expertise and provides a cost-effective model for lasting change.

Interventions Based on Local Evidence

As a scientific agency, CDC bases its PEPFAR work on evidence, constantly monitoring and evaluating our programs, and innovating to provide the most impactful interventions using efficient methods. We also tailor our interventions to the specific needs of local communities, avoiding one-size-fits-all approaches that may be less effective and more costly.

In Nigeria, CDC and partners effectively used the 2018 Nigeria AIDS Indicator and Impact Survey, a population-based HIV impact assessment, to find previously unidentified populations of people living with HIV (PLHIV). They reached out to these communities with innovative HIV testing services and interventions, both in the community and at healthcare facilities during the “HIV treatment surge” from 2019 to 2022. Local CDC implementing partners forged partnerships with indigenous community-based organizations in underserved areas, expanding programs that included testing and initiating treatment through community treatment models and facilitating individuals’ connection to healthcare facilities.

This collaborative effort notably reduced the treatment gap in all 19 CDC-supported states. Local implementing partners, in coordination with CDC experts, dedicated efforts to improve data quality and its utilization at the site level for program improvement. Nigeria employed its inventive Retention Revolution, which involved conducting a satisfaction survey to pinpoint the causes of treatment interruptions and inform targeted interventions. This led to a decrease in treatment interruptions to below 2% in the supported states and a remarkable increase in viral suppression from 84% pre-surge to 96% currently among PLHIV. Thanks to these locally data-driven approaches, Nigeria is making significant progress toward reaching its goals for ending its HIV epidemic.

Partner Support and Engagement

CDC collaborates with National Public Health Institutes in various countries, drawing on our collective experience to guide decisions on HIV and TB treatment and prevention based on over 40 years of collective HIV experience, and over 60 years of collective TB experience at CDC.

In Botswana, CDC has recently initiated a mentorship program that includes clinical, laboratory, and strategic information mentorship, extending its reach across the entire country. This approach enhances efficiency and sustainability by transitioning PEPFAR support from direct service delivery to providing technical assistance, thereby empowering the government with the necessary structures and expertise to ensure the consistent delivery of high-quality, standardized HIV services nationwide.

The creation of this framework within the Ministry of Health was crucial, providing a model for ongoing PEPFAR support in the years to come. The Government of Botswana is committed to expanding its financial support for its HIV programs, with PEPFAR offering technical assistance to maintain the high-quality services and build upon the progress achieved over the years with support from PEPFAR.