2.1. Data sources

PEPFAR’s annual Country/Regional Operational Plan (COP/ROP) process involves most operating units (OUs) developing detailed programme budgets and allocating funding to implementing partners. OUs are either individual country or regional programmes that are treated equivalently for PEPFAR planning purposes. For this paper, all data points of interest are available at country‐level, even when the programme is administered as a regional programme, so we refer to countries instead of OUs. Country programme budgets are combined with targets set according to PEPFAR’s Monitoring, Evaluation and Reporting (MER) system [13] that cover a range of metrics PEPFAR utilizes to monitor performance. PEPFAR separately tracks expenditures by implementing partners during the implementation phase.

The COP/ROP budgets are released by PEPFAR online [14]. COP budget years are implemented in the following fiscal year (FY) such that the COP2018 budget corresponds to expenditures incurred and programmes implemented in FY 2019 (October 2018 to September 2019). Throughout this paper, we will refer to the COP budgets based on their year of implementation rather than their budget year. These budget data are at the country level. PEPFAR does release implementing partner level budgets, but they are insufficiently detailed for inclusion in this analysis. Budget data were downloaded on 30 July 2020.

Following a recent change in financial information systems, budget data for FY 2020 and expenditure data since FY 2018 are categorized according to the programme’s intended beneficiary population (Females; Males; Key Populations; Orphans and Vulnerable Children; Pregnant and Breastfeeding Women; Priority Populations; and Non‐Targeted Programming), among other categorizations [15].

Budgets for 52 countries were available for FY 2020, of which 49 reported non‐zero KP budgets (Table 1).

Summary of data used, for included countries

As part of the annual COP/ROP process, PEPFAR has historically released several reports on their plans in each country [16], including Budget and Target (B&T) Reports. B&T Reports provide country‐level MER targets as well as targets for each implementing partner in a country. Both national and partner targets were extracted for use on the PEPFAR Country/Regional Operational Plans Database developed by amfAR, and were downloaded for this analysis on 13 March 2020 [17]. Throughout this paper, except when directly assessing partner targets, we utilize the country‐level targets.

We include targets for the 23 countries who completed the full COP/ROP process in both FY 2018 and FY 2019 to enable comparisons between the years. Not all countries and regions participate in a full planning process each year, and those that do not are generally smaller programmes. B&T reports for FY 2018 and FY 2019 included disaggregated target information by age, sex and key population for many indicators. We include indicators which have country‐level targets for all included countries in both years, and are provided to both KPs and other populations. Counts of individuals receiving HIV testing services and newly initiated on ARV treatment meet these criteria. For safety reasons, PEPFAR does not release results against these disaggregated targets and thus we do not include results data [13].

Implementing mechanism agreements are not always finalized at the time PEPFAR publishes B&T reports, and mechanism targets are therefore incomplete. Country‐level targets are final, so we compare the total mechanism targets to the total country targets to assess missingness. The completeness of mechanism targets varies by indicator and year from 70.2% to 87.1%, and country‐level missingness for each indicator and year are documented in the supplement (Table S1).

Additionally, while FY2020 target data have been publicly released, PEPFAR has reduced the specificity of the targets data being released – eliminating transparency into the organizations being assigned KP‐specific targets for HIV testing and treatment initiation.

PEPFAR tracks expenditures utilizing the same financial classification system described above for budgets. These data are released at the OU level for FY2018 and FY2019. As we compare PEPFAR targets to expenditures in these years, we have limited expenditure data to the 23 countries included in the target analysis [18].