PEPFAR Funding Leads to Significant Reductions in Adult Mortality

Salim S. Abdool Karim, MD, PhD

AIDS Clinical Care

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Introduction

All-cause mortality rates have declined faster in countries that receive PEPFAR funding than in those that do not.

Between 2003 and 2008, the U.S. invested $20.4 billion in the President's Emergency Plan for AIDS Relief (PEPFAR), which funds HIV treatment and prevention in 15 countries, including 12 in Africa. Previous research has shown that the PEPFAR program in Africa is associated with significant reductions in HIV-specific mortality (JW AIDS Clin Care Jun 29 2009), but less is known about its effects on all-cause mortality.

In the present study, researchers calculated adult all-cause mortality rates for 27 African countries, using survey data from women who were asked about recent deaths in their families. Nine of the 27 countries had received PEPFAR funding (Ethiopia, Kenya, Mozambique, Namibia, Nigeria, Rwanda, Tanzania, Uganda, and Zambia), and 18 had not.

The two groups of countries had similar age-adjusted adult mortality rates at the start of the PEPFAR initiative in 2003 (8.3 and 8.5 deaths per 1000 adults, respectively). However, during the next 5 years, the adult mortality rate in countries receiving PEPFAR funding dropped by 51%, to 4.1 deaths per 1000 adults, while the rate in countries without PEPFAR funding dropped by only 20%, to 6.9 deaths per 1000 adults. A within-country analysis showed significantly lower adult mortality rates in regions with high PEPFAR activity than in those with less PEPFAR activity (adjusted odds ratio, 0.83 in Tanzania and 0.75 in Rwanda).

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