The U.S. global AIDS initiative has provided therapy and brought testing and counseling to millions around the world. Now the challenge is to move from emergency to sustained efforts, the Institute of Medicine said Friday.

Launched three years ago, the President's Emergency Plan for AIDS Relief is active in 120 countries, with a concentrated focus on 15, where it seeks to have an impact at the national level, the institute said.

In those focus countries, 800,000 people have received AIDS drugs through the program, another 19 million got testing and counseling, and therapy was able to block transmission of the disease from mother to infant in an estimated 100,000 cases, the report said.

A problem area, however, has been spending rules imposed by Congress in the law setting up the program.

Because of these restrictions "the budget allocations have made spending money in a particular way an end in itself rather than a means to an end," the report warned.

Congress should remove these allocations and replace them with a better way of ensuring accountability, the institute said.

The continuing challenge, the report went on, will be to maintain the urgency and intensity of the startup years while placing a greater emphasis on long-term planning and building the ability to sustain the work.

The AIDS initiative was launched with five-year performance targets and the current report was requested by Congress to assess progress so far.

As the program looks to the longer term, a particular need will be the vulnerability of women and girls to AIDS.

Efforts to reduce this need to focus on such areas as increasing the equality of men and women, reducing violence and sexual coercion and increasing income, education and legal protection for women and girls, the report said.

The focus countries for the program are Botswana, Ethiopia, Guyana, Haiti, Ivory Coast, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda, Vietnam and Zambia.

The Institute of Medicine is an arm of the National Academy of Sciences, an independent organization chartered to advise the government on scientific issues.