Faced with a steep cut to its budget, the President’s Emergency Plan For AIDS Relief (PEPFAR) continues to seek efficient and effective ways to operate.

Testifying at a congressional hearing in Washington recently, Ambassador Deborah Birx questioned funding for supply chain technical assistance. Birx leads PEPFAR and serves as the U.S. government’s global director in combatting HIV/AIDS.

“When you talk to the Global Fund, when you talk to the field, the one comment that continues to come up is the integrity of the supply chain,” Birx told a House subcommittee. “So there is an issue there that persists despite a significant investment.”

USAID administers the supply chain and at issue is a $10 billion contract for development company Chemonics. In November 2017, U.S. Senators Jeff Flake (R-Arizona) and Bob Corker (R-Tennessee) both expressed “great concern” with disruptions in the supply chain’s implementation by Chemonics.

Birx went one step further, telling the House subcommittee that Chemonics' performance has “asked us to step back, to really say … why, 15 years in, are we talking about glitches in the system?”

Last month PEPFAR released its annual report with data from more than 40,000 supported facilities in all 35 country and regional programs. PEPFAR, the report details, reaches more than 14 million people with livesaving treatment and invests $750 million annually in direct prevention activities.

Upon the report’s release, Birx declared “Over the past 15 years, PEPFAR has made tremendous progress toward controlling the HIV/AIDS pandemic through increased transparency, accountability and efficiency.”

Birx, appointed by former U.S. President Barack Obama, added the new report moves the world “one giant step closer to ending HIV/AIDS.”

The Trump administration has repeatedly proposed a budget with drastic cuts to PEPFAR, a program started by President George W. Bush. Since 2009, more than $3 billion has been spent on supply chain technical assistance. At her appearance on Capitol Hill, Birx said a new approach to supply chain technical assistance may be needed.

“Maybe our conceptual framework about how to support a supply chain may be old school and maybe we have to look at this differently,” Birx said. “We are working with USAID on each of those issues.”

Included in the report are country operational plans and strategic direction summaries. In Haiti, for example, 90 percent of HIV infected people received anti-retroviral treatment. In Jamaica, the number of people living with HIV receiving anti-retroviral treatment (ART) is just 35 percent for men and 39 percent for women. Only 14 percent of Jamaican men and 31 percent of Jamaican women have achieved viral suppression.

More data on countries' strategic direction summaries can be found here: Pepfar.gov/countries/cop/fy2017/c76721.htm