PT  - JOURNAL ARTICLE
AU  - White, Lauren A.
AU  - Avery, Latham
AU  - Bonanno, Lindsay
AU  - Knight, Christy
AU  - Irwin, Courtney
AU  - Hoeflich, Kathryn
AU  - Kaliel, Deborah
AU  - Hijazi, Mai
AU  - Raulfs-Wang, E. Callie
TI  - An Evaluation of Local Implementing Partner Performance During the First 2 Years of the USAID/PEPFAR Transition
AID  - 10.9745/GHSP-D-22-00337
DP  - 2023 Jun 21
TA  - Global Health: Science and Practice
PG  - e2200337
VI  - 11
IP  - 3
4099  - http://www.ghspjournal.org/content/11/3/e2200337.short
4100  - http://www.ghspjournal.org/content/11/3/e2200337.full
SO  - GLOB HEALTH SCI PRACT2023 Jun 21; 11
AB  - Key FindingsGlobally, local partners exceeded targets for orphans and vulnerable children and key populations but met a lower proportion of their treatment targets than international partners and did not meet targets for pre-exposure prophylaxis or voluntary medical male circumcision in fiscal year (FY) 2020.Local partners had higher mean and median testing positivity, linkage rates, and viral load suppression than international partners, although these differences were not statistically significant.Local partners displayed quality of service delivery comparable to international partners across FY2019 and FY2020.Key ImplicationsSufficient time is needed to implement a responsible transition that supports careful oversight, program monitoring, and capacity development.These findings should be interpreted cautiously because of a limited sample size and short time horizon. Continual monitoring of the transition will be critical to sustained progress.This preliminary evaluation is a critical step toward increasing country ownership and localization and supporting local partners’ roles in sustained epidemic control of HIV/AIDS.Introduction:Locally led and owned development is considered the best practice for international aid. As an implementing agency for the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the U.S. Agency for International Development (USAID) supported the goal of transitioning 70% of its portfolio funding directly to local organizations by 2020, including partner country governments. However, limited evidence or evaluation exists on how such a transition can help achieve HIV-related health outcomes.Methods:We evaluated monitoring, evaluation, and reporting performance; calculated indicators; and quality of service across the HIV/AIDS treatment cascade for local and international partners in the USAID/PEPFAR portfolio implementing similar programs during the U.S. Government fiscal years (FY) 2019 to 2020 (October 1, 2018–September 30, 2020). We compared results aggregated globally, by country, and across individual partners.Results:Globally, local partners met a lower proportion of their treatment targets than international partners and did not meet targets for pre-exposure prophylaxis or voluntary medical male circumcision in FY2020. However, local partners exceeded targets in programs supporting orphans, vulnerable children, and key populations affected by HIV/AIDS. Local partners also had testing positivity, linkage rates, and viral load suppression that were equivalent to or higher than that of international partners. Based on available assessments, local partners displayed quality of service delivery comparable to international partners.Conclusion:Local partners faced challenges, including unfamiliarity with USAID funding, increasing targets across several indicators, and the syndemics of HIV/AIDS and COVID-19. A higher percentage of targets and funding led South African local partners to yield an outsized effect on global percent target achievement. While these findings should be interpreted cautiously due to limited sample size and short time horizon, they are a key first step in evaluating the local partner transition support of the long-term goal of sustained epidemic control of HIV/AIDS.