An audit of the $15 billion President's Emergency Plan for AIDS Relief (PEPFAR) found the program has both undercounted -- by lacking documentation -- and overestimated the thousands of patients it has helped overseas. The program was unable to verify claims of success made by local groups that received money.

The audit, conducted by the US Agency for International Development's inspector general, focused on care and prevention from 2004 to 2005 but did not highlight drug treatment. Joe Farinella, USAID's assistant inspector general who oversaw the investigations, said many grant recipients failed to provide documents that would give "reasonable assurances that what they say was done was in fact carried out." USAID is recommending the administration improve reporting methods and clarify its directives.

Ambassador Mark Dybul, the U.S. global AIDS coordinator, said the administration has worked to fix the problems the audit revealed, in part by imposing tighter reporting systems to improve the accuracy of information. Dybul said some of the poor record keeping was due to the eagerness of program officials to get the money into the field to help patients.

"Our approach was, 'Get the services out, start moving the programs,'" said Dybul. "You could've waited for three years to get all these systems in place and an awful lot of people would have died," he said, adding that he has "extraordinary confidence" in PEPFAR's overall numbers.

The figures are important because Congress and others are closely tracking PEPFAR's strategies as it pumps unprecedented sums into AIDS-hit nations in Africa and elsewhere. "The accuracy of the numbers is essential and is something Congress should look at," said Rep. Henry Waxman (D-Calif.), the incoming chairperson of the House Government Reform Committee.

Win Brown, a data quality consultant to Dybul's office, said the current counts of people helped country-by-country are "within scientifically acceptable ranges of numbers."

"We are putting into place reporting mechanisms that have never existed," said Dybul. "Our numbers are the tightest in the world. Yes, we have problems around the margins. We've put enormous effort into them and are improving them all the time."

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