Date and Time
February 20, 2008
1:30 PM - 3:00 PM

Availability
Open to the public
No RSVP required

Speaker
Eran Bendavid - Stanford University

Background: Since 2003, the President's Emergency Plan for AIDS Relief (PEPFAR) has been the most ambitious initiative to address the global HIV epidemic. To date, no one evaluated PEPFAR's impact on epidemiologic trends.

Methods: We obtained longitudinal data (1997 to 2006) on six outcomes for sub-Saharan countries with a generalized HIV epidemic: HIV prevalence in the adult population, number of deaths due to HIV/AIDS, the number of orphans due to HIV, and the number of adults, number of women, and number of children living with HIV. We used a mixed-effects model to compare the difference in percentage change in the outcomes between PEPFAR's focus countries and other countries in sub-Saharan Africa with a generalized epidemic, prior to and after the beginning of PEPFAR's activities.

Results: There was no difference in the change in the number of deaths due to HIV between the groups of countries before 2003, but afterwards the annual percentage change was lower by 5.8% in the focus countries compared to the controls (p=0.04). The difference in the annual percentage change in the number of children living with HIV was lower by 2.6% in the focus countries since 2003 (p=0.05) but not before, and a there was a nearly significant difference in the annual percentage change in the number of orphans (4.2% slower increase in focus countries, p=0.056) after the onset of PEPFAR. There were no significant differences in the percentage change in the prevalence or the number of adults and women living with HIV between the groups of countries before and after PEPFAR.

Conclusions: We found evidence to suggest that after only three years of activity, PEPFAR led to more rapid progress in some HIV outcomes in the focus countries compared with sub-Saharan African controls. Assessing epidemiologic outcomes and economic efficiency should be a part of PEPFAR's evaluation programs.