Monday, October 31, 2011

Another WH (EEOB 430A) meeting regarding above topic. Chaired by Gayle Smith. Also there was Amy Batson (USAID), Lois Quam, and Tom Frieden by phone. Cold crisp day in DC. Fall is here! Again the tension between USAID goals and PEPFAR goals become clear. USAID is trying to enhance their own agenda, which in my opinion has failed with their spending millions on prevention messages that do not work. They are trying to derail the PEPFAR “scale up by efficiencies” initiative. Ariel is turning out to either be naïve or nefarious. I always heard that he was a good guy, but he and USAID team keep insisting that the efficiency money should go either to a broader GHI or to enhancing the non-treatment prevention agenda (PMTCT, AMMC, condoms, etc.). The PEPFAR/Fauci/CDC agenda is to use the efficiencies to scale up Tx from 4.2 million by 2013 to 6+ million by 2013. This should reach 8 million by 2015 without any additional funds. If you go to “blue Sky” of +$2.5 billion from 2013 to 2015, you will go from 8 million in 2013 to 10 million in 2015. The PEPFAR model also assumes and enacts a maxing out of the non-treatment prevention modalities. USAID disagrees and want to use efficiency money to favor non-treatment as Prevention. This is what Ariel is saying. After meeting with Eric Goosby, Ariel seems more convinced that the PEPFAR model may be OK. However, what does Raj Shah think????