United States Department of State Washington, DC 20520

SENSITIVE BUT UNCLASSIFIED FEBRUARY 1, 2025

Info Memo for the PEPFAR Implementing Agencies and PEPFAR Country  Coordinators  

FROM: GHSD – Jeff Graham, Senior Bureau Official

SUBJECT: Implementation of Limited Waiver to Pause of U.S. Foreign  Assistance for Life-Saving HIV Service Provision

The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) has been  granted a limited waiver to implement urgent life-saving HIV treatment  services in alignment with the Secretary of State’s January 28 memo  “Emergency Humanitarian Waiver to Foreign Assistance Pause” and subsequent January 30 confirmation to GHSD from the Director of Foreign  Assistance (F). Per the terms of this limited waiver, only the following  activities may be resumed during the 90-day pause or until superseded by  new guidance:  

1. Life-saving HIV care and treatment services, inclusive of HIV testing and  counseling, prevention and treatment of opportunistic infections  including TB, laboratory services, and procurement and supply chain for  commodities/medicines.

2. Prevention of mother-to-child transmission services, inclusive of  commodities/test kits, medicines and PrEP for pregnant and  breastfeeding women.

3. Reasonable implementing agency and implementing partner  administrative costs strictly necessary to deliver and provide oversight  of this assistance, including related country-based data activities and  portions of PEPFAR’s central data platform used for clinical monitoring  and program management.  

PEPFAR implementing agencies should continue to pause foreign assistance,  as stipulated in 25 STATE 6828, for all other activities not covered by the

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Secretary’s waiver until completion of the foreign assistance review or further  guidance. This waiver does not apply to activities that involve abortions,  family planning, conferences, administrative costs other than those covered  above, gender or DEI ideology programs, transgender surgeries, or other non life saving assistance. Any other activities not specifically mentioned in this  guidance may not be resumed without express approval.

Upon receipt of this guidance, all PEPFAR agencies may resume activities  covered by the limited waiver. The following implementation actions may only  be undertaken as necessary to carry out this guidance:

• Disbursements and incremental obligations on existing awards. • New obligations only in cases where pre-planned award transitions  previously existed for the activities listed above or where awards that  have been paused cannot be restarted.

Limited Waiver Accountability Plan:

• The GHSD Senior Bureau Official will review and certify to the State  Department’s Comptroller and Global Financial Services (CGFS) that  any resumption of work, obligation, or disbursement of any PEPFAR  funds held at the State Department is consistent with the activities  listed above.

• For resumption of work, obligation, or disbursement at the PEPFAR  Implementing Agencies, GHSD/PEPFAR is directing PEPFAR  Implementing Agency Lead Deputy Principals to execute a similar  certification process that aligns with their agency policies and  comprehensively report that information to GHSD every 30 days, with  the first report due on February 28, 2025.

GHSD/PEPFAR will stand up an interagency team to provide ongoing guidance. In the interim, please send any questions to your agency DPs.

Thank you for your immediate attention to implementing this guidance in strict  accordance with the terms of the limited waiver. We will update you further if  we receive additional guidance from Department of State leadership.  

Attachment:  

Tab 1: Additional details on approved activities under the waiver

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Tab 1: Additional details on approved activities under the limited waiver

For purposes of this limited waiver, life-saving humanitarian assistance applies only to: • Delivery of life-saving HIV care and treatment services through support for health  workers (doctors, nurses, and other clinical and community health workers, etc.)  delivering or monitoring HIV care and treatment to ensure continuity of service  provision. These workers deliver care at hospitals, primary healthcare clinics, faith based clinics, and community settings.

ο Provision of HIV testing for adults and children in community and facility  settings.  

ο Provision of HIV drugs and support to prevent treatment interruptions for adults  and children in community and facility settings.

ο Provision of care for advanced HIV disease, including CD4 testing (immune  function test), prevention and treatment of opportunistic infections, and HIV  treatment adherence support.

ο Provision of HIV viral load testing, which allows patient monitoring to ensure  that HIV drug treatments are effective.  

ο Provision of tuberculosis preventive therapy (TPT) and Tuberculosis Treatment,  as TB is the largest killer of people living with HIV.

• Support for transportation, storage, distribution, and management of HIV care and  treatment commodity supply chain to ensure timely provision of medications and  tests to patients  

• Procurement of HIV medicines and other commodities required for provision of HIV  care and treatment services to prevent stockouts in national HIV programs (e.g., HIV  drugs, HIV test kits, early infant HIV tests, viral load tests and lab equipment for clinical  monitoring, TB prevention and treatment drugs, opportunistic infection medicines for  advanced HIV disease).

• Prevention of Mother-to-Child Transmission of HIV, which consists of testing and re testing pregnant and breastfeeding women, providing HIV prevention services for  [pregnant] women who are HIV negative including Pre-exposure Prophylaxis (PrEP) and  HIV treatment drugs for [pregnant] women who are positive, HIV testing for partners,  early infant diagnosis tests, and comprehensive care for infants.

• Support for transportation, storage, distribution and management of HIV  commodity supply chain to ensure timely provision of medications for PMTCT. • Focused data and systems maintenance activities in support of the above areas. • Reasonable administrative costs as necessary to deliver such assistance and provide  oversight and compliance.  

This limited waiver does not apply to activities that involve abortions, family planning,  conferences, administrative costs other than those covered by above, gender or DEI  ideology programs, transgender surgeries, or other non-life saving assistance.

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