How effective is PEPFAR? That’s been a contentious question of late.
Now, a new study highlights one stunning success, and another troubling failure, of the global AIDS programs started by ex-President George W. Bush in 2003.
First, the good news: PEPFAR decreased the HIV/AIDS death toll in targeted countries by more than 10 percent, between 2004 and 2007, according to the study, published in the Annals of Internal Medicine and written by Stanford researchers Eran Bendavid and Jayanta Bhattacharya.
Now the bad news: the authors found “no evidence” that PEPFAR made a dent in new HIV infection rates.
The study is the first major assessment of PEPFAR, coming more than five years after its launch and nearly one year after Congress reauthorized the program with an expanded mandate.
“The number of human lives affected and the financial stakes make it essential to assess the impact of PEPFAR’s investment in Africa,” the authors write. “Although the full impact of PEPFAR may not be felt for years, an ongoing evaluation of programmatic outcomes is central to the direction of future policies.”
To be sure, this kind of research, and any ensuing debate, could be pivotal as President Barack Obama and Congress consider whether to fully fund PEPFAR for 2010.
As the authors note, one vexing funding problem is that as PEPFAR succeeds in treating HIV, but not in preventing new cases, the costs of the program will continue to grow.
“As the number of people receiving antiretroviral therapy and the deaths averted in the focus countries continue to increase, the cost of providing treatment is expected to increase as well,” the authors write. “Projections of financial resources needed to sustain the treatment scale-up suggest that even with PEPFAR’s greater commitment, the gap between the available funds and those needed will continue to increase unless the incidence of HIV in Africa is substantially reduced. Striking the right balance between treatment and prevention with insufficient resources for the burden of the epidemic is a major challenge for comprehensive care programs, such as PEPFAR.”