U.S. emergency plan for AIDS relief in Africa has reduced HIV-related deaths, but not HIV prevalence
In 2003, the President's Emergency Plan for AIDS Relief (PEPFAR) launched an ambitious initiative to address the global HIV epidemic in countries heavily burdened by the disease. The 5-year, $15 billion program included HIV treatment, prevention, and care. After 4 years of PEPFAR activity, HIV-related deaths declined in sub-Saharan African focus countries compared with control countries not served by the program, according to a new study. However, trends in adult prevalence did not differ between focus and control countries. To assess the effect of PEPFAR on HIV-related deaths, number of people living with HIV, and HIV prevalence in sub-Saharan Africa, the researchers compared trends before (1997-2002) and after the initiation of PEPFAR's activities (2004-2007) among 12 African focus countries and 29 control countries suffering from an HIV epidemic from 1997 to 2007.
Between 2004 and 2007, the difference in the annual change in the number of HIV-related deaths was 10.5 percent lower in the focus than in the control countries. The difference in trends between groups before 2003 was not significant. The number of people living with HIV or AIDS accelerated in the later study period in focus compared with control countries, perhaps reflecting greater HIV survival rates. However, the difference in the change in HIV prevalence did not significantly differ throughout the study period. The reduction in HIV-related deaths was probably due to the improved treatment and care of HIV-infected persons in the focus countries, especially the greater availability of highly active antiretroviral therapy. The added funding for antiretrovirals in the focus countries made an appreciable impact on HIV-related deaths. This indicates the power of these drugs to improve survival in a relatively short period, note the researchers.
Their study was supported in part by the Agency for Healthcare Research and Quality (T32 HS00028). More details are in "The President's emergency plan for AIDS relief in Africa: An evaluation of outcomes," by Eran Bendavid, M.D., and Jayanta Bhattacharya, M.D., Ph.D., in the May 19, 2009, Annals of Internal Medicine 150, pp. 688-695.
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