PEPFAR Activities Have a Beneficial Effect on Overall Health Outcomes

Summary and Comment |
April 8, 2013

PEPFAR Activities Have a Beneficial Effect on Overall Health Outcomes

  1. Salim S. Abdool Karim, MD, PhD

In the 12 PEPFAR focus countries in sub-Saharan Africa, the program has been associated with improvements in TB indicators and overall life expectancy, as well as in HIV indicators.

  1. Salim S. Abdool Karim, MD, PhD

The President's Emergency Plan for AIDS Relief (PEPFAR) initiative has been criticized for being too focused on one disease and not working to strengthen health systems in partner countries. In a recent analysis, researchers evaluated whether PEPFAR activities have been directly associated with system-wide improvements.

The researchers compared 12 non-HIV World Bank database indicators of health-system strengthening between 12 sub-Saharan African countries that had generalized HIV epidemics and had received PEPFAR funding (focus countries) and 29 such countries not included in the program (control countries) over two time periods: 1995 to 2002 (pre-PEPFAR) and 2004 to 2010 (during PEPFAR).

Proximal indicators of health-system strengthening such as tuberculosis (TB) prevalence, TB case detection, and TB treatment–completion rates were significantly improved in focus countries after PEPFAR implementation. Life expectancy, a distal indicator of health-system strengthening, increased significantly faster in focus countries than in control countries after PEPFAR implementation. Although other distal indicators such as infant and under-5 mortality rates decreased faster in focus countries than in control countries after PEPFAR implementation, the difference was not significant. The implementation of PEPFAR did not appear to have an effect on vaccination rates but did not divert resources from other public health activities.

Comment

This analysis shows that the President's Emergency Plan for AIDS Relief initiative, in addition to enabling initiation of antiretroviral therapy in more than 4 million HIV-infected people, has had a broad global health impact. The 12 PEPFAR focus countries in sub-Saharan Africa have shown consistent declines in TB morbidity and mortality, and significant increases in life expectancy.

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