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The U.S. President's Emergency Plan for AIDS Relief (PEPFAR) ? the U.S. Government initiative to help save the lives of those impacted by HIV/AIDS around the world ? is the largest commitment by any n... The U.S. President's Emergency Plan for AIDS Relief (PEPFAR) ? the U.S. Government initiative to help save the lives of those impacted by HIV/AIDS around the world ? is the largest commitment by any nation in history to combat a single disease internationally. Working in over 50 countries, PEPFAR has saved and improved millions of lives, prevented millions of HIV infections, and changed the course of the global HIV/AIDS epidemic. PEPFAR is driven by a shared responsibility among donor and partner nations and others to make smart investments to save lives. Thanks in large part to U.S. leadership, tremendous progress has been made in the fight against global AIDS. Now in Phase III: Focusing on Sustainable Control of the Epidemic, PEPFAR is focused on the ambitious Joint UN Programs for HIV/AIDS 90-90-90 global goals: 90 percent of people living with HIV know their status, 90 percent of people who know their status are accessing treatment, and 90 percent of people on treatment have suppressed viral loads by 2020. While the USG’s Strategy for Accelerating HIV/AIDS Epidemic Control (2017-2020) focuses primarily on 13 high-burdened countries, PEPFAR aims to support all countries with PEPFAR funding to reach epidemic control by targeting evidenced based interventions for populations at greatest risk of HIV in areas of greatest HIV incidence. PEPFAR's program builds on past strengths and increases efficiencies by scaling up effective interventions and ensuring value. PEPFAR Regionalization Approach – West Africa PEPFAR is undertaking a major shift in West Africa. Starting in FY 2020, a Regional Operational Plan (ROP), which includes activities for Burkina Faso, Togo, Ghana, Liberia, Mali, and Senegal, will begin. Coordination of the development of the ROP will be managed largely from Accra, Ghana by the West Africa Regional PEPFAR Coordinator. This Regional Operation Plan (ROP 19) is the first for the West Africa Region (Burkina Faso, Togo, Ghana, Liberia, Mali, and Senegal), and represents a major pivot from previous HIV programming in each of the countries. The West Africa PEPFAR Vision is to catalyze sustained epidemic control in West Africa by leveraging national and donor investments to implement adaptive, evidence-based interventions to reach, test, treat and retain KPs and PLHIV in settings with the greatest HIV burden. Working in close collaboration with the various Host Country Governments, Civil Society Organizations (CSOs), the Global Fund for HIV/AIDS, TB and Malaria (GFATM), UNAIDS, the World Health Organization (WHO) and other partners, the US President’s Emergency Plan for AIDS Relief (PEPFAR) program in the West Africa Region aims to support the achievement of epidemic control at three different levels by 2021: In Burkina Faso and Togo, with additional “Game Changer” funds, PEPFAR aims to reach nationally the first and second 90 in ROP19, and achieve the third 90 in ROP20 through a targeted focus on the highest burden sites for PLHIV and KPs (Centre, Hauts Bassins, and Centre Ouest Regions in Burkina Faso, Lomé Commune, Maritime, and Plateaux Regions in Togo) with technical assistance to other sites; In Ghana, PEPFAR aims to achieve saturation and reach epidemic control in the Western Region, and; In Liberia, Mali and Senegal, PEPFAR aims to reach epidemic control in Key Population (KP) groups, namely Men who Have Sex with Men (MSM) and Female Sex Workers (FSWs), in the regions of highest prevalence. In West Africa, HIV data availability is improving but still remains fairly limited despite being a region that covers 15 countries and over 350 million people. In 2017, over 4.1 million people were living with HIV, representing 13 percent of the global burden. In the countries under PEPFAR’s West Africa Regionalization approach (Ghana, Togo, Burkina Faso, Mali, Senegal, and Liberia), HIV prevalence in the general population range from 0.4 percent (Senegal) to 2.1 percent (Togo) while according to recent Integrated Biological and Behavioral Surveillance Surveys (IBBS), prevalence among MSMs range from 1.9 percent (Burkina Faso) to 27.4 percent (Senegal). For FSWs prevalence ranges from 5.4 percent (Burkina Faso) to 24.1 percent (Mali). Limited data exists in the region for transgender persons and people who inject drugs. In addition to challenges with availability and use of KP services in West Africa, the other common challenges include significant stigma and discrimination, poor access to HIV services, and poor quality of care, among others. Given PEPFAR’s mandate to leave no population of greatest risk behind, programs under the West Africa Regionalization approach will work with host country governments and other partners to accelerate progress to epidemic control by focusing their limited resources toward KP and PLHIV programming – increasing case finding in these population groups, linking them to treatment and ensuring viral load suppression. In West Africa, PEPFAR programs are implemented by four U.S. Government (USG) agencies: the Department of State, the Department of Defense (DOD), the Department of Health and Human Services through the Centers for Disease Control and Prevention (CDC), and the United States Agency for International Development (USAID). These agencies support a coordinated inter-agency management model which leverages and builds upon agency-specific strengths, expertise, and historical relationships to achieve shared PEPFAR goals.