Study Documents GREAT THINGS ABOUT AIDS Relief Program

Between 2004 and 2008, PEPFAR was associated with a decrease in the chances of loss of life of almost 20 percent in the countries where it managed. The researchers discovered that more than 740,000 lives were preserved during this time period in nine countries targeted by the scheduled program. Eran Bendavid, MD, assistant professor of medicine. The scholarly study is the first ever to show a drop in all-cause mortality related to this program. It will be published in the May 16 issue of the Journal of the American Medical Association. Bendavid is the lead writer of the scholarly research. 15 billion investment in global AIDS and a focus on treatment and prevention in 15 countries.

It was reauthorized by Congress in 2008 and has extended its reach to 31 countries. To measure the impact of this program, Bendavid, and his colleagues analyzed health and survival information to get more than 1.5 million adults in 27 African countries, including nine countries where PEPFAR has focused its efforts. The researchers analyzed data available in the Demographic and Health Surveys, a USAID-funded project that involves a representative sampling of in-person interviews among women in that they discuss their health insurance and the fitness of their family. These research forms the foundation of several health measurements in developing countries. They found the chances of death from any cause among adults were 16 to 20 percent lower in the PEPFAR-targeted countries.

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To bolster the results, the researchers do another evaluation using specific data on PEPFAR programs in Rwanda and Tanzania. They compared regions of the two countries where PEPFAR’s investments led to widespread increases in the number and size of sites providing antiretroviral therapy, with areas where PEPFAR had fewer services available. Bendavid said. In Tanzania, the odds of death were found to be 17 percent lower and in Rwanda 25 percent lower in the districts with higher support from PEPFAR.

Bendavid speculates that the program’s dedication to building health-care delivery infrastructure — including new drug distribution systems and new clinics, pharmacies, laboratories and testing facilities — has been a significant factor for its success. Bendavid, who’s an affiliate at Stanford Health Policy, the area of the Freeman Spogli Institute for International Studies. Although this program was targeted to address HIV, these services could have benefitted patients with a number of other health concerns. For example, one study found that some uninfected, women that are pregnant in Ethiopia, Rwanda, and Tanzania thought we would deliver their babies in facilities supported by PEPFAR, Bendavid said.

Some have argued that focusing resources on a particular disease, such as AIDS, may detract attempts from other diseases and activities, undermining some of the benefits of such programs. But the latest study will not support this debate; indeed, it suggests that PEPFAR helped to avoid additional deaths from causes apart from HIV/AIDS. Grant Miller, PhD, MPP, associate professor of medicine and the senior writer of the paper. Bendavid said the program was able to accomplish the reduction in mortality in the face of enormous issues — from persuading visitors to go for HIV assessment and treatment to dealing with problems of drug shortages and medication resistance.

Historically, few other large-scale health initiatives have succeeded to this extent; smallpox, which was eradicated by 1979, is probably the uncommon and more notable examples. In 2009 2009, PEPFAR was folded into a new Global Health Initiative that demands a broader plan, with some resources redistributed to other programs, such as child and maternal health. Its budget, which rose in the early years dramatically, has remained relatively flat or declined slightly since then. 6.6 billion in fiscal years 2011 and 2012, respectively, according to figures from the Kaiser Family Foundation.

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