Association of the US President’s Emergency Plan for AIDS Relief’s Funding With Prevention of Mother-to-Child Transmission of HIV in Kenya

Barnhart, Dale A.; Tsikhutsu, Isaac; Kirui, D K; Sawe, Fredrick; Muli, Jane; Sugut, William; Abboud, Nareen; Birx, Deborah L.; Hamm, Tiffany E.; Coakley, Peter; Hickey, Patrick W.; Wolfman, Vanessa; Lee, Elizabeth; Spiegelman, Donna

doi:10.1001/jamanetworkopen.2019.11318

Cited by 4 publications

(6 citation statements)

References 26 publications

(59 reference statements)

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“…We find large and significant impacts of PEPFAR on child mortality across all country segments and models. This confirms one earlier study done in Kenya27 and differs from three earlier studies that all showed insignificant relationships between PEPFAR and child mortality 24–26. Our findings are particularly strong for child and maternal mortality.…”

Section: Discussionsupporting

confidence: 85%

“…One of these studies shows favourable impacts on child mortality by the President’s Malaria Initiative in 19 countries in SSA from 2006 to 2014, but the PEPFAR covariate was found to be insignificant in influencing child mortality 26. However, in a recent Kenya study of prevention of mother-to-child transmission (PMTCT) impacts, the authors found favourable infant mortality declines associated with PEPFAR 27…”

Section: Introduction and Objectivesmentioning

confidence: 99%

“… 26 However, in a recent Kenya study of prevention of mother-to-child transmission (PMTCT) impacts, the authors found favourable infant mortality declines associated with PEPFAR. 27 …”

Section: Introduction and Objectivesmentioning

confidence: 99%

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Analysis of maternal and child health spillover effects in PEPFAR countries

Gaumer,

Crown,

Kates

et al. 2023

BMJ Open

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ObjectivesThis study examined whether the US President’s Emergency Plan for AIDS Relief (PEPFAR) funding had effects beyond HIV, specifically on several measures of maternal and child health in low-income and middle-income countries (LMICs). The results of previous research on the question of PEPFAR health spillovers have been inconsistent. This study, using a large, multicountry panel data set of 157 LMICs including 90 recipient countries, adds to the literature.DesignSeven indicators including child and maternal mortality, several child vaccination rates and anaemia among childbearing-age women are important population health indicators. Panel data and difference-in-differences estimators (DID) were used to estimate the impact of the PEPFAR programme from inception in 2004 to 2018 using a comparison group of 67 LMICs. Several different models of baseline (2004) covariates were used to help balance the comparison and treatment groups. Staggered DID was used to estimate impacts since all countries did not start receiving aid at PEPFAR’s inception.SettingAll 157 LMICs from 1990 to 2018.Participants90 LMICs receiving PEPFAR aid and cohorts of those countries, including those required to submit annual country operational plans (COP), other recipient countries (non-COP), and three groupings of countries based on cumulative amount of per capita aid received (high, medium, low).InterventionsPEPFAR aid to combat the HIV epidemic.Primary outcome measuresMaternal mortality and child mortality rates, vaccination rates to protect children for diphtheria, whooping cough and tetanus, measles, HepB3, and tetanus, and prevalence of anaemia in women of childbearing age.ResultsAcross PEPFAR recipient countries, large, favourable PEPFAR health effects were found for rates of childhood immunisation, child mortality and maternal mortality. These beneficial health effects were large and significant in all segments of PEPFAR recipient countries studied. We also found significant and favourable programme effects on the prevalence of anaemia in women of childbearing age in PEPFAR recipient countries receiving the most intensive financial support from the PEPFAR programme. Other recipient countries did not demonstrate significant effects on anaemia.ConclusionsThis study demonstrated that important health indicators, beyond HIV, have been consistently and favourably influenced by PEPFAR presence. Child and maternal mortality have been substantially reduced, and childhood immunisation rates increased. We also found no evidence of ‘crowding out’ or negative spillovers in these resource-poor countries. These findings add to the body of evidence that PEPFAR has had favourable health effects beyond HIV. The implications of these findings are that foreign aid for health in one area may have favourable health effects in other areas in recipient countries. More research is needed on the influence of the mechanisms at work that create these spillover health effects of PEPFAR.

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Section: Discussionsupporting

confidence: 85%

Section: Introduction and Objectivesmentioning

confidence: 99%

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Analysis of maternal and child health spillover effects in PEPFAR countries

Gaumer,

Crown,

Kates

et al. 2023

BMJ Open

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“…22 38 Beginning 2000, there was an expansion of HIV prevention interventions including an increase in facilities offering prevention of mother-tochild transmission (PMTCT) interventions and increased uptake of antiretrovirals (ARVs) drugs. [41][42][43] In 1996/1997, the Integrated Management of Childhood Illness was introduced aiming to improve the management of childhood illness such as diarrhoea, pneumonia, malaria, measles and malnutrition. It involves: (i) strengthening health worker skills in managing illnesses, (ii) strengthening health systems (drug availability, supervision, referral and Health Management Information System (HMIS)) and (iii) the improvement of family and community health practices through community involvement and awareness on measures to improve child health.…”

Section: Country Health Contextmentioning

confidence: 99%

Subnational estimates of factors associated with under-five mortality in Kenya: a spatio-temporal analysis, 1993–2014

et al. 2021

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BackgroundTo improve child survival, it is necessary to describe and understand the spatial and temporal variation of factors associated with child survival beyond national aggregates, anchored at decentralised health planning units. Therefore, we aimed to provide subnational estimates of factors associated with child survival while elucidating areas of progress, stagnation and decline in Kenya.MethodsTwenty household surveys and three population censuses conducted since 1989 were assembled and spatially aligned to 47 subnational Kenyan county boundaries. Bayesian spatio-temporal Gaussian process regression models accounting for inadequate sample size and spatio-temporal relatedness were fitted for 43 factors at county level between 1993 and 2014.ResultsNationally, the coverage and prevalence were highly variable with 38 factors recording an improvement. The absolute percentage change (1993–2014) was heterogeneous ranging between 1% and 898%. At the county level, the estimates varied across space and over time with a majority showing improvements after 2008 which was preceded by a period of deterioration (late-1990 to early-2000). Counties in Northern Kenya were consistently observed to have lower coverage of interventions and remained disadvantaged in 2014 while areas around Central Kenya had and historically have had higher coverage across all intervention domains. Most factors in Western and South-East Kenya recorded moderate intervention coverage although having a high infection prevalence of both HIV and malaria.ConclusionThe heterogeneous estimates necessitates prioritisation of the marginalised counties to achieve health equity and improve child survival uniformly across the country. Efforts are required to narrow the gap between counties across all the drivers of child survival. The generated estimates will facilitate improved benchmarking and establish a baseline for monitoring child development goals at subnational level.

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“…16 In collaboration with Harvard University, WRAIR and its Kericho site in Kenya helped estimate that 273,924 infant deaths were averted in Kenya between 2004 and 2014 through PEPFAR PMTCT funding, or that a $0.33 increase in per capita PEPFAR PMTCT funding was associated with a 14-16% reduction in infant mortality (RV516). 17 In partnership with Boston University, the WRAIR explored the impact of adding mentor mothers versus standard care alone on maternal and infant outcomes (RV465), and demonstrated that maternal and child health clinics offered a lower cost alternative for initiating pregnant women on ART (RV342). 18,19 The 20 The Walter Reed Army Institute of Research routinely evaluates program testing performance across testing modalities at facilities and in communities disaggregated by age-group, gender, and key populations, with special emphasis on adolescents, young adults, and adult men.…”

Section: Rv516mentioning

confidence: 99%

Attaining 95-95-95 through Implementation Science: 15 Years of Insights and Best Practices from the Walter Reed Army Institute of Research’s Implementation of the U.S. President’s Emergency Plan for AIDS Relief

Lee

Ganesan

Khamadi

et al. 2021

The American Journal of Tropical Medicine and Hygiene

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The Walter Reed Army Institute of Research (WRAIR) supports more than 350,000 people on lifesaving HIV treatment in Kenya, Nigeria, Tanzania, and Uganda through funding from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). Here, we review and synthesize the range of impacts WRAIR’s implementation science portfolio has had on PEPFAR service delivery for military and civilian populations since 2003. We also explore how investments in implementation science create institutional synergies within the U.S. Department of Defense, contributing to broad global health engagements and improving health outcomes for populations served. Finally, we discuss WRAIR’s contributions to PEPFAR priorities through use of data to drive and improve programming in real time in the era of HIV epidemic control and public health messaging that includes prevention, the 95-95-95 goals, and comorbidities.

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Association of the US President’s Emergency Plan for AIDS Relief’s Funding With Prevention of Mother-to-Child Transmission of HIV in Kenya

Cited by 4 publications

References 26 publications

Analysis of maternal and child health spillover effects in PEPFAR countries

Analysis of maternal and child health spillover effects in PEPFAR countries

Subnational estimates of factors associated with under-five mortality in Kenya: a spatio-temporal analysis, 1993–2014

Attaining 95-95-95 through Implementation Science: 15 Years of Insights and Best Practices from the Walter Reed Army Institute of Research’s Implementation of the U.S. President’s Emergency Plan for AIDS Relief

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