Assessment of PEPFAR's impact on selected health system parameters in Sub-Saharan African countries
Presented by Anya Ting Shen (Canada).
A.T. Shen1,2, V. Lima1, C. Heung3, A. Palmer1, J. Montaner1,4, R. Hogg1,5, N. Ford6, E. Mills1,7
1BC Centre for Excellence in HIV/AIDS, Drug Treatment Program, Vancouver, Canada, 2University of Waterloo, Public Health Program, Waterloo, Canada, 3University of Waterloo, Waterloo, Canada, 4University of British Columbia, Vancouver, Canada, 5Simon Fraser University, School of Public Health, Burnaby, Canada, 6Médecins Sans Frontières / Doctors Without Borders, Vancouver, Canada, 7McMaster University, Clinical Epidemiology and Biostatistics, Hamilton, Canada
Background: Since 2003, the President´s Emergency Plan for AIDS Relief (PEPFAR) has been one of the most ambitious initiatives to address the global HIV epidemic. To date, the impact of PEPFAR on healthcare systems remains to be characterized.
Methods: We obtained data on 12 sub-Saharan PEPFAR focus countries and compared them with 28 sub-Saharan control countries. We then collected longitudinal data (1997 to 2007) on five healthcare indicators from the Millennium Development Goals (MDG), WHO Statistical Information System (WHOSIS) and the WORLD Bank databases: malaria-related death rate, under 5 mortality rate (U5MR), TB mortality rate, meningococcal conjugate vaccine (MCV) and diphtheria-tetanus-pertussis (DTP3) infant immunization rates. We used linear mixed-effects models to compare the difference in percentage change in the outcomes between focus countries and control countries from pre PEPFAR era (1997-2002) to during and post PEPFAR era (2004-2007).
Results: Our results demonstrate no significant difference in the change in the malaria-related death rate, TB mortality rate, MCV and DTP3 infant immunization rates between PEPFAR focus countries and control countries prior to and after PEPFAR activities. The U5MR did decrease by 22.4% (p< 0.0001) in PEPFAR focus countries in comparison to that in control countries after PEPFAR's commencements.
Conclusions: Our results suggest that PEPFAR activities were associated with a significant reduction in the number of deaths among children under 5 years old. We observed no significant difference in the number of malaria-related deaths, TB mortality rate, and the change in measles and DTP3 infant immunization rates following the implementation of PEPFAR activities. Some promising trends are apparent regarding to healthcare outcomes following implementation of PEPFAR activities based on these results. Further efforts are warranted to better characterize the impact of PEPFAR and other such programs, on overall healthcare system performance.
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