Rwanda study: AIDS funding influx does not hurt response to other health issues

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Despite fears that disproportionate resources devoted to HIV have crowded out other health services, global HIV/AIDS program funding does not subtract from other health issues, according to a study that appeared in the May edition of the American Journal of Tropical Medicine and Hygiene.

Experts have disagreed over whether money injected into the global HIV/AIDS response has strengthened health systems and their ability to respond to other health issues. After a six-year investigation of health clinics in rural Rwanda, researchers at Brandeis University in Boston found that expanding AIDS services had no adverse effects on other types of health care – and in some cases, “There is even evidence that clinics that have received funding for HIV/AIDS services provide better care for all patients, including superior prevention services, than do clinics without AIDS programs,” said Donald S. Shepard, PhD, a professor at Brandeis’ Schneider Institute for Health Policy and the study’s lead author, in a press release.

Investigators looked at variables such as the number of vaccines administered, visits for child growth monitoring, and non-HIV/AIDS hospitalizations to assess the performance of the rural health centers. The intervention group consisted of 25 randomly selected rural health centers that started providing antiretroviral therapy (ART) services between 2002 and 2006, and 25 “matching” centers (based on ownership, performance-based financing, and income of the health center’s home district) that had not started ART services provision by the end of 2007. Trained research teams then paid one-day visits to the clinics to collect data between June and September of 2008 – filling in gaps with phone calls and utilizing ministry of health records on vaccinations.

“This study shows that for most indicators examined, there were neither prominent diversion nor enhancement effects after AIDS services were inaugurated in [health centers] in Rwanda,” according to the article. The authors report that their results are consistent with several other studies from several countries in Africa that received a substantial influx of AIDS funding and did not show an adverse effect on non-AIDS services, including in U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) program “focus” countries. “For example, in Ethiopia, although the influx of funding for HIV/AIDS might have encouraged physician migration from the public to the non-governmental organization sectors, there is no evidence of adverse effects for the health system overall: mortality decreased, coverage of immunization increased, and antenatal care coverage increased over the four-year period of HIV expansion (2003–2007),” the article reads.

Interestingly, the study authors noted that administration of the BCG vaccine (used to vaccinate children against tuberculosis) was the only health service that showed a statistically significant interaction term – and showed that the number of vaccinations decreased in both the intervention and non-intervention health centers, with a lower decrease in the centers providing ART services. National reports from the World Health Organization and the United Nations Children’s Fund, however, showed a 2.5 percent increase in BCG vaccinations in Rwanda in 2006 and 2007.

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