Centers for Disease Control

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Centers for Disease Control

The Centers for Disease Control began to promote male circumcision as a HIV-prevention method as of February 2008.[1] The CDC currently funds mass circumcision campaigns run by BOTUSA and the National Prevention Information Network.[2][3]

Contents

Proposed Guidelines for Counseling Male Patients and Parents

On December 2nd of 2014, the CDC released a proposed guideline for counseling male patients and parents regarding male circumcision and the prevention of HIV infection, STIs and other health outcomes. The proposed guidelines seem to be in line with the AAP's Policy Statement of 2012 and also includes considerations for counseling of adolescents and adults in accordance with their HIV risk behavior, HIV status, sexual preferences and other factors. While the media tried to present these guidelines as an immediate endorsement of circumcision, the guidelines are far from recommending universal circumcision and in fact acknowledge that neonatal circumcision presents ethical concerns over the violation of autonomy. Read our analysis of the guidelines our analysis of the guidelines

Investigations by the Office of Inspector General (OIG)

On the 15 June 2011, the OIG published a report critical of the CDC's failure to oversee recipients’ use of President’s Emergency Plan for AIDS Relief (PEPFAR) funds.[4] The report read in part:

Our review found that CDC did not always monitor recipients’ use of President’s Emergency Plan for AIDS Relief (PEPFAR) funds in accordance with departmental and other Federal requirements. CDC implements PEPFAR, working with ministries of health and other public health partners to combat HIV/AIDS by strengthening health systems and building sustainable HIV/AIDS programs in more than 75 countries in Africa, Asia, Central and South America, and the Caribbean. HHS receives PEPFAR funds from the Department of State through a memorandum of agreement.

There was evidence that CDC performed some monitoring of recipients’ use of PEPFAR funds. However, most of the award files did not include all required documents or evidence to demonstrate that CDC performed required monitoring on all cooperative agreements. Of the 30 cooperative agreements in our sample, the award file for only 1 agreement contained all required documents. The remaining 29 award files were incomplete. In addition, 14 of 21 files were missing audit reports. (A report was not yet due for 9 of the 30 cooperative agreements.) The lack of required documentation demonstrates that CDC has not exercised proper stewardship over Federal PEPFAR funds because it did not consistently follow departmental and other Federal requirements in monitoring PEPFAR recipients.


On 5 June 2012, the OIG published a report identifying vulnerabilities in vaccine management in the CDC's domestic 'Vaccines for Children' (VFC) program. [5] The report read in part:

Although the majority of storage temperatures we independently measured during a 2 week period were within the required ranges, VFC vaccines stored by 76 percent of the 45 selected providers were exposed to inappropriate temperatures for at least 5 cumulative hours during that period. Exposure to inappropriate temperatures can reduce vaccine potency and efficacy, increasing the risk that children are not provided with maximum protection against preventable diseases. Thirteen providers stored expired vaccines together with nonexpired vaccines, increasing the risk of mistakenly administering the expired vaccine. Finally, the selected providers generally did not meet vaccine management requirements or maintain required documentation. Similarly, none of the five selected grantees met all VFC program oversight requirements, and grantee site visits were not effective in ensuring that providers met vaccine management requirements over time.


On the 19 November 2012, the OIG published a report critical of the CDC Namibia Office's failure to properly monitor recipients' use of PEPFAR funds [6]. The report read in part:

CDC's office in Windhoek, Namibia (CDC Namibia), is responsible for PEPFAR funds awarded to government agencies and for-profit and nonprofit organizations (recipients) in Namibia.

Our audit found that CDC Namibia did not always monitor recipients' use of PEPFAR funds in accordance with HHS and other Federal requirements. There was evidence that CDC Namibia performed some monitoring of recipients' use of PEPFAR funds. However, most of the recipient cooperative agreement files did not include required documents or evidence that CDC Namibia had monitored all cooperative agreements. CDC Namibia did not consistently monitor the cooperative agreements in accordance with HHS and other Federal requirements because it did not have written policies and procedures for the monitoring process. As a result, CDC Namibia did not have assurance that PEPFAR funds were used as intended by law.


On the 12 February 2013, the OIG published a report critical of the CDC South Africa Office's failure to properly monitor recipients' use of PEPFAR funds [7]. The report read in part:

Our audit found that CDC South Africa did not always monitor recipients' use of PEPFAR funds in accordance with HHS and other Federal requirements. There was evidence that CDC South Africa performed some monitoring of recipients' use of PEPFAR funds. However, most of the recipient cooperative agreement files did not include required documents or evidence that CDC South Africa had monitored all cooperative agreements.

CDC South Africa did not have written policies and procedures to help ensure that it consistently monitored the cooperative agreements for recipients in accordance with HHS and other Federal requirements. As a result, CDC South Africa did not have assurance that PEPFAR funds were used as intended by law.


More revelations to come

From "Spotlight on... Grants Management and Oversight" published by the OIG on 4 February 2013:[8]

President's Emergency Plan for AIDS Relief Funds

The President's Emergency Plan for AIDS Relief (PEPFAR) program authorized $78 billion from 2003 through 2014 in support of international programs for prevention, treatment, and care to combat HIV/AIDS, tuberculosis, and malaria. OIG examined the funds spent through this program in a 2011 report focusing on whether the Centers for Disease Control and Prevention's (CDC) oversight met departmental and Federal regulations. OIG found that while CDC performed some oversight of recipients' fund use, most of the award files did not include all required documents or evidence to demonstrate that CDC performed required monitoring. Because of these concerns, OIG expanded its audits internationally to include CDC's monitoring of PEPFAR funds by offices in other countries as well as audits of recipient organizations abroad. OIG issued two audits on Namibia, one in 2012 and another in 2013, and has an additional eight audits conducted there and in South Africa and Vietnam that are near completion." OIG is also planning seven more audits of PEPFAR grantees in Ethiopia and Zambia for FY 2013.


CircWatch

Post about the CDC on CircWatch

External Links

References

  1. "Male Circumcision and Risk for HIV Transmission and Other Health Conditions: Implications for the United States". February 2008. http://www.cdc.gov/hiv/resources/factsheets/circumcision.htm. Retrieved 2011-06-01. 
  2. "Success Stories: Male Circumcision: A Question and Answer Session". March 2007. http://www.cdc.gov/botusa/Success-Stories/0307-MaleCircumcision-Botswana.htm. Retrieved 2011-06-01. 
  3. "Funding". 9/1/2011. http://www.cdcnpin.org/Display/FundDisplay.asp?FundNbr=4285. Retrieved 2011-06-01. 
  4. "Review of the Centers for Disease Control and Prevention’s Oversight of the President’s Emergency Plan for AIDS Relief Funds for Fiscal Years 2007 Through 2009 (A-04-10-04006)". June 2011. http://oig.hhs.gov/oas/reports/region4/41004006.pdf. Retrieved 2011-06-25. 
  5. "Vaccines for Children Program: Vulnerabilities in Vaccine Management (Report OEI-04-10-00430)". June 2012. http://oig.hhs.gov/oei/reports/oei-04-10-00430.pdf. Retrieved 2012-06-06. 
  6. "The Centers for Disease Control and Prevention's Namibia Office Did Not Always Properly Monitor Recipients' Use of the President's Emergency Plan for AIDS Relief Funds (A-04-12-04020)". November 2012. https://oig.hhs.gov/oas/reports/region4/41204020.pdf. Retrieved 2012-12-07. 
  7. "The Centers for Disease Control and Prevention's South Africa Office Did Not Always Properly Monitor Recipients' Use of the President's Emergency Plan for AIDS Relief Funds (Audit A-04-12-04022)". February 2013. http://oig.hhs.gov/oas/reports/region4/41204022.pdf. Retrieved 2013-02-27. 
  8. "Spotlight on... Grants Management and Oversight". February 2013. https://oig.hhs.gov/newsroom/spotlight/2013/grants.asp. Retrieved 2013-02-04. 
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