PEPFAR May Be More Effective in HIV Prevention Than Study Suggested

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An editorial due out next week in the Annals of Internal Medicine raises a provocative new question about the recent study of PEPFAR’s effectiveness.

The initial study, by Stanford researchers Eran Bendavid and Jayanta Bhattacharya, found that while PEPFAR decreased the HIV/AIDS death toll in targeted countries by more than 10 percent between 2004 and 2007, the program had no apparent impact on HIV prevalence among adults.

In the forthcoming Annals editorial, Drs. Robert Gross and Gregory Bisson, both of the University of Pennsylvania School of Medicine, argue that disease prevalence is “a misleading metric” to judge PEPFAR’s performance and that in future assessments, researchers should look at incidence—the rate of new infections—instead.

 The effects of PEPFAR on prevalence will have “opposing near-term effects,” Gross and Bisson write. While treatment and prevention components of PEPFAR reduce mother-to-child transmission and may prevent new infections, the program’s success in putting people on ARVs “prevents AIDS-related deaths and increases prevalence.”

So PEPFAR could be preventing new infections without affecting prevalence rates, the authors argue.

Gross and Bisson also urge more rigorous future evaluations of PEPFAR. They write that “to maintain public confidence, PEPFAR must rapidly scale up efforts to evaluate its impact” and that thorough, sound evaluation of the program is “a scientific, moral, and political necessity.”

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