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Presented by: Anya Shen

MOAE0101. Assessment of PEPFAR’s Impact on Selected Health System Parameters in Sub-Saharan African Countries. Presented by: Anya Shen Viviane D. Lima, Wendy Zhang, Carly Heung, Alexis Palmer, Julio Montaner, Robert Hogg, Nathan Ford, Edward Mills. Overview. PEPFAR results by September 2008

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Presented by: Anya Shen

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  1. MOAE0101 Assessment of PEPFAR’s Impact on Selected Health System Parametersin Sub-Saharan African Countries Presented by: Anya Shen Viviane D. Lima, Wendy Zhang, Carly Heung, Alexis Palmer, Julio Montaner, Robert Hogg, Nathan Ford, Edward Mills

  2. Overview • PEPFAR results by September 2008 • Supported treatment for more than 2.1 million people • Overall HIV prevention estimates unknown. Estimated 240,000 mother-to-child transmissions averted • 10.1 million people received care globally • Other published studies • Decreased HIV-related deaths in PEPFAR focus countries in Sub-Saharan Africa comparing to other countries in the same region1 • ‘The President’s Emergency Plan for AIDS Relief in Africa: An Evaluation of Outcomes’ Bendavid, et all. 2009

  3. Research Objectives • PEPFAR is a vertical program • There is a need to investigate the effect that disease-specific vertical programs have on health systems and population health • The objective: • Assessment of PEPFAR’s impact on selected population health parameters in Sub-Saharan African countries

  4. Methods Focus countries: Botswana, Cote d’lvoire, Ethiopia, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda, Zambia • Control countries: • Angola, Benin, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Congo, Democratic Republic of Congo, Djibouti, Eritrea, Gabon, Gambia, Ghana, Guinea, Guinea-Bissau, Lesotho, Liberia, Madagascar, Malawi, Mali, Niger, Senegal, Sierra Leone, Somalia, Sudan, Swaziland, Togo, Zimbabwe Focus Control

  5. Methods • Longitudinal data collected from WHO, UN, World Bank, US Census Bureau • Time frame • Pre-PEPFAR era [1999-2002] • PEPFAR era [2004-2007] • Comparison of trends in focus and control countries before and after the initiation of PEPFAR programs • Mixed-effects Models, General Linear Regression Models

  6. Limitations • Other confounders - Global Fund • Countries not picked at random & significant baseline differences. • Population-based survey estimates in resource limited countries have the potential for bias and problems with results based on aggregated measures. • Lack of data in key indicators. • Lack of continuous data.

  7. Conclusion • This analysis demonstrates the impact of PEPFAR funding on mortality rates & population health indicators in Sub-Saharan Africa • A significantly improving trend is shown in U5MR and Life Expectancy in PEPFAR-focus countries when compared with control countries • Positive trends are evident in maternal mortality (though non-sig) rates in focus countries from Pre-PEPFAR era to PEPFAR era.

  8. Acknowledgement • The author would like to thank Dr. Viviane D Lima and Wendy Zhang for their statistical support, co-authors and the rest of the BC Centre for Excellence staff for their support and encouragement. • Special thanks to Dr. Edward Mills for his encouragement and guidance for without which this project would not have been started.

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