Abstract
Before PEPFAR was created, more than 20 million people had died of AIDS, nearly 5 million acquired HIV annually, and health systems were severely weakened as HIV ravaged communities. Since 2003, PEPFAR's investments have enabled a vast expansion of HIV treatment and prevention in partner countries. Building nursing leadership capacity across PEPFAR programmes to tackle systematic barriers that impede high-quality, client-centred care is, therefore, a top priority.6 Empowering nurses not only strengthens service delivery but also promotes more resilient health systems that are responsive to community needs and capable of detecting and responding to new outbreaks of HIV or other disease threats. Low-income, high-burden countries and their donor partners contributed approximately US$1·1 billion (adjusted for inflation) towards the smallpox eradication effort.18 The USA, as the largest single donor, recovers this investment every 26 days through ongoing savings from vaccination programmes and health-care costs—a benefit that continues even today.19 Similarly, PEPFAR has been exceptional value for money, one of the most rewarding investments of US taxpayer dollars since the Marshall Plan.20 PEPFAR's investment has not only saved millions of lives but will also continue to yield substantial economic returns for recipient countries over the coming decades.