6 Questions for Dr. Deborah Birx, global AIDS coordinator nominee

PEPFAR has helped put millions of HIV-positive people in the developing world on ARV treatment, allowing them to live healthy lives and have HIV-free children like Bethwel Nyangweso and his son.

After months of holding our breath, we were pleased that the Obama Administration recently nominated Dr. Deborah Birx to be the new US Global AIDS Coordinator in charge of PEPFAR.  As a well-respected medical expert who has led the CDC’s Division of Global HIV/AIDS and has three decades of experience, Dr. Deborah Birx is well-positioned to lead PEPFAR’s historic program into the future.

Now that Dr. Deborah Birx has been nominated, she will go through a confirmation process, which includes a Senate Foreign Relations Committee hearing, webcast live today at 2 PM ET.  PEPFAR has always enjoyed bipartisan support, and we hope that this process will be swift and painless so that Dr. Deborah Birx can quickly get to work.  But in the meantime, one advantage to the hearing process is that it provides those of us tuning in the first public glimpses of her vision for the program moving forward.

Here are 6 key questions about the US’ global AIDS efforts that we hope will be asked—and answered—today at Dr. Deborah Birx’s hearing:

1. Funding: PEFPAR remains the largest program ever by one country to fight a single disease.  But its high-water mark for funding came in 2010; since then, funding has dipped and then plateaued (although other US resources to fight AIDS have increased through the Global Fund).  Just this week, the trend continued, when the White House’s budget included flat funding for PEPFAR.  What is Dr. Birx’s vision for scaling up PEPFAR’s critical work in an environment of no new funding increases?  And how can we work together collectively to ensure new resources for PEPFAR in the years to come?

2. Targets: PEPFAR has used target-setting around treatment and prevention services to help drive support for the program.  On World AIDS Day 2013, President Obama announced that PEPFAR had surpassed its treatment target by supporting 6.7 million people on life-saving antiretroviral treatment, above the 6 million target set in 2011.  Yet since those 2011 targets have expired, the Administration has not set new targets, leaving PEPFAR without the critical focus that targets can create.  How important is it to Dr. Birx to establish a new set of bold, PEPFAR-specific targets?  By what date in 2014 does Dr. Birx expect we could see such targets, and how can those targets be framed to focus on outcomes rather than inputs?

3. Impact Data:  Many global AIDS stakeholders including PEPFAR, the Global Fund, and host country governments are increasingly working together on the ground in an integrated fashion.  While this may lead to more cost-effective programming and streamlined delivery, it has also become more difficult to tease apart who takes credit for impact achieved on the ground.  Under Dr. Birx’s leadership, how will this tension be addressed, such that host governments are incentivized to increase their domestic funding for AIDS and donors are given the appropriate credit for their investments?

4. The Blueprint: In 2012, then-Secretary of State Clinton unveiled the “Blueprint for Creating an AIDS-Free Generation”—a roadmap that showed how PEPFAR would bring together new science and smarter planning to help, together with other countries, bend the curve of the AIDS epidemic.  Since then, there has not been any formal update on how the Blueprint has been implemented.  Does Dr. Birx plan to commission a Blueprint status update, and if so, when?

5. Marginalized Populations: Increasingly, new HIV infections are concentrated among marginalized populations, including members of the LGBT community, who may be more difficult to reach.  Particularly in light of troubling anti-homosexuality legislation passed in Uganda and Nigeria in recent months, how will PEPFAR work to ensure improved access to treatment, prevention, and care services for marginalized and at-risk populations?

6. Transparency: PEPFAR was recently ranked one of the least-transparent aid mechanisms in a recent Publish What You Fund analysis, and it has made less and less data public over the years.  Does Dr. Birx see this as a problem?  And if so, what steps will she take to address it?

Did we miss any major topics?  Are there other questions you hope might be addressed?  Add them in the comments section below.

Watch the live webcast of Dr. Deborah Birx’s confirmation hearing here.