Jones Austin, Honermann Brian, Lankiewicz Elise, Sherwood Jennifer, Millett Greg
Public Policy Office, amfAR, the Foundation for AIDS Research, Washington, DC, USA.
J Int AIDS Soc. 2021 Jul;24 Suppl 3(Suppl 3):e25753. doi: 10.1002/jia2.25753.
The United States President's Emergency Plan for AIDS Relief (PEPFAR) is a large bilateral funder of the global HIV response whose policy decisions on key populations (KPs) programming determine the shape of the key populations' response in many countries. Understanding the size and relative share of PEPFAR funds going to KPs and the connection between PEPFAR's targets and resulting programming is crucial for successfully serving key populations.
Publicly available PEPFAR budgets for key populations' services were assessed by country and geographical region for all 52 countries with budget data in fiscal year (FY) 2020. For the 23 countries which completed a full planning process in FY 2018 and 2019, PEPFAR targets for HIV testing and treatment initiation for key populations were assessed. Expenditures for KP programming were calculated to determine whether shifts in targets translated into programming. Implementing partners were characterized by the level of specialization using the share of assigned targets made up by KPs. The average target per year and implementing partner was calculated for each KP group and indicator.
PEPFAR country KP budgets ranged from US$35,000 to $15.2 million, and the proportion of funding to key populations varied by region, with Eastern and Southern African countries having the lowest proportion. Between FY 2018 and 2019, the KP targets for HIV testing and treatment among KPs increased, whereas expenditures on key populations decreased from US$115.4 to $111.0 million. Of the 11 countries with an increase in HIV testing targets, seven had a decrease in KP expenditures. Of the nine countries with an increase in treatment initiation targets, five had a decrease in KP expenditures. The proportion of targets assigned to partners which do not specialize in key populations increased from FY 2018 to 2019.
Current key population policies have not resulted in a tight connection between targets and expenditures. This includes assigning a large proportion of key populations programming to partners who do not specialize in key populations, which may weaken the performance management role of the targets. These results signal that a new approach to key populations programming is needed.
美国总统艾滋病紧急救援计划（PEPFAR）是全球应对艾滋病的一个大型双边资助机构，其对重点人群项目的政策决策决定了许多国家重点人群应对措施的形式。了解分配给重点人群的PEPFAR资金规模和相对份额，以及PEPFAR的目标与最终项目之间的联系，对于成功服务重点人群至关重要。
对2020财年有预算数据的所有52个国家，按国家和地理区域评估公开可得的PEPFAR重点人群服务预算。对于在2018财年和2019财年完成全面规划流程的23个国家，评估PEPFAR对重点人群的艾滋病毒检测和治疗启动目标。计算重点人群项目的支出，以确定目标的变化是否转化为项目实施。根据重点人群在分配目标中所占份额，以专业化程度对实施伙伴进行分类。计算每个重点人群组和指标每年的平均目标和实施伙伴情况。
PEPFAR各国重点人群预算从3.5万美元到1520万美元不等，对重点人群的资金比例因地区而异，东部和南部非洲国家的比例最低。在2018财年至2019财年期间，重点人群中艾滋病毒检测和治疗的目标有所增加，而重点人群的支出从1.154亿美元降至1.11亿美元。在艾滋病毒检测目标增加的11个国家中，有7个国家重点人群支出减少。在治疗启动目标增加的9个国家中，有5个国家重点人群支出减少。2018财年至2019财年期间，分配给非重点人群专业伙伴的目标比例有所增加。
当前的重点人群政策并未使目标与支出紧密联系。这包括将很大一部分重点人群项目分配给非重点人群专业的伙伴，这可能会削弱目标的绩效管理作用。这些结果表明需要一种新的重点人群项目实施方法。
