Diagonal Investments in Health Systems: PEPFAR's Approach to Sustaining the HIV Response and Enhancing Global Health Security

As more countries reach the UNAIDS 95-95-95 goals, the world gets closer to achieving the Sustainable Development Goal of eliminating HIV as a public health threat by 2030. Strong health systems are essential for sustaining progress and preventing other health threats from disrupting and potentially reversing the gains that have been made in the fight against HIV. The US President's Emergency Plan for AIDS Relief has a strong track record of building capabilities in laboratories, the supply chain, disease surveillance, data analytics, and the health workforce; however, the impact on national health systems has been uneven. A diagonal approach should therefore be used going forward, blending disease-specific funding with system-strengthening investments. If this strategy is more intentional on integrating the HIV response into national health systems, including national public health institutions, while increasing resilience to other health threats, it should yield results not only for the HIV response but also for other priority diseases and broader health security.