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Abstract
The President’s Emergency Plan for AIDS Relief (PEPFAR), started in 2003, has been instrumental in the global fight against HIV, providing lifesaving HIV treatment to 20.6 million people, saving 26 million lives, and contributing towards the exceptional progress made in reducing the global burden of HIV/AIDS. U.S. investments in global health security (GHS) have increased the capacities of partner countries to stop outbreaks at their source, limiting their impact within countries and across borders. Although both PEPFAR and the U.S. GHS program strengthen capacities to prevent, detect, and respond to infectious disease outbreaks, they currently operate separately. Integrating the GHS and PEPFAR programs could build on the successes of both programs, create efficiencies in management and oversight, and more clearly link to the current foreign policy goals of making the U.S. safer, stronger, and more prosperous.This mixed-methods study aimed to provide evidence to support integrating the PEPFAR and U.S. GHS programs as a feasible policy solution to address the need for improved sustainability of the global HIV response, increased efficiency of U.S. foreign policy programs, and stronger links to the foreign policy goals of making America safer, stronger, and more prosperous. The study found a significant association between the number of years of PEPFAR program support and higher Global Health Security Index scores, highlighting PEPFAR’s contribution to strengthening country capacities to respond to outbreaks of disease beyond HIV. This result suggests that PEPFAR is already contributing to increased global health security in its partner countries and an integrated approach between PEPFAR and the U.S. GHS programs could achieve even greater results than each program is currently achieving alone. The study also found that both PEPFAR’s legislation and strategy contain numerous global health security-related concepts, providing evidence to support expanding the focus of the PEPFAR program to include global health security. Expanding PEPFAR's mandate to include strengthening health security in addition to preventing and controlling HIV would maximize the return on investment and ensure that health systems in partner countries are better prepared for future pandemics, while ensuring the program is meeting the United States’ foreign policy goals.