Implementation of All-inclusive Global Purchasing Agreements for Viral Load and Infant Diagnosis in PEPFAR-Supported Countries

The US President's Emergency Plan for AIDS Relief (PEPFAR) continues to support scaling up of human immunodeficiency virus (HIV) viral load (VL) and early infant diagnosis (EID) tests to meet UNAIDS 95-95-95 global targets. To improve price transparency and standardization of service-level agreements, and avoid outright purchase of laboratory instruments, PEPFAR in the 2018 Country Operational Plan recommended the transition of HIV VL and EID commodities to "all-inclusive" pricing agreements. This article highlights the process used in implementing this diagnostics procurement shift. Key benefits realized include significant cost savings of >$130 M; overall improvement of the health system by reducing the occurrence of reagent stock outs, unplanned instrument downtime, and test sample backlog and rejections; increased availability of VL and EID tests; and shortened turn-around time for delivery of test results. In this article, ee describe this process, along with the challenges faced, future opportunities, and recommendations.