Why We Did This Audit
Before Russia’s full-scale invasion in February 2022, an estimated 260,000 people in Ukraine were living with HIV, the second-highest number of cases in Europe. USAID and other government agencies implement U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) programs to support Ukraine’s efforts to end HIV as a public health threat by 2030.
The ongoing war has altered the landscape of the country’s HIV/AIDS epidemic and created significant challenges in providing essential HIV services. To address the healthcare needs of people living with HIV during wartime conditions, USAID’s Mission in Ukraine (USAID/Ukraine) continued to fund Healthlink and Community Action for HIV Control, two programs that aim to improve HIV testing in Ukraine.
We conducted this audit to assess the extent to which USAID/Ukraine implemented and monitored selected PEPFAR programs to achieve its intended results.
We assessed USAID/Ukraine’s implementation and monitoring of the two programs from January 2022 through September 2023 and focused on PEPFAR indicators for HIV testing and HIV case identification.
What We Found
USAID/Ukraine did not achieve all its intended results when implementing PEPFAR-funded programs due to wartime challenges. Throughout fiscal years 2022 and 2023, HealthLink and Community Action for HIV Control continued to operate, but the programs did not fully achieve USAID/Ukraine intended results for HIV testing and HIV case identification. Mission and implementer staff reported a range of war-related challenges that hindered full achievement of the intended results.
Types of War-Related Challenges Described by PEPFAR Program Implementers
- Infrastructure Damage
- Continuous Population Migration
- Program Site Staffing
- Safety and Security
USAID/Ukraine did not conduct independent performance monitoring or adapt its monitoring practices in response to the war. USAID/Ukraine officials stated that for fiscal years 2022 and 2023, they generally relied on PEPFAR program implementers to conduct self-monitoring of activities, report program data, and perform data quality assessments. The mission did not conduct independent performance monitoring as required by the Agency or adapt its monitoring practices to the wartime environment by using remote, virtual, or third-party monitoring.
What We Recommend
We made one recommendation for USAID/Ukraine to implement independent performance monitoring methods to verify activity and performance data reported by PEPFAR implementers in Ukraine. The Agency agreed with the recommendation.