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

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  • Additional Information
    • Affiliation:
      Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
      Henry M. Jackson Foundation Medical Research International, Kericho, Kenya
      Office of the Global AIDS Coordinator and Health Diplomacy Department of State, Washington, DC
      Henry M. Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland
      US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
      Department of Pediatrics, Uniformed Services University, Bethesda, Maryland
      Center for Methods in Implementation and Prevention Science, Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
      Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
      Department of Global Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
      Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
    • Subject Terms:
    • Subject Terms:
    • Abstract:
      Key Points: Question: Is funding by the US President's Emergency Plan for AIDS Relief for prevention of mother-to-child transmission of HIV associated with improvements in key prevention of mother-to-child transmission of HIV–related health outcomes in Kenya? Findings: Using publicly available data sources, this population-based survey study found evidence that a $0.33 increase in the annual levels of President's Emergency Plan for AIDS Relief funding for prevention of mother-to-child transmission of HIV per capita was associated with a significant 14% to 16% reduction in infant mortality in Kenya between 2004 and 2014. Meaning: Identifying specific HIV prevention approaches, such as prevention of mother-to-child transmission of HIV, that are associated with improvements in health outcomes may help policy makers allocate funds to evidence-based approaches that are most likely to be effective. Importance: From 2004 to 2014, the US President's Emergency Plan for AIDS Relief (PEPFAR) invested more than $248 000 000 in the prevention of mother-to-child transmission (PMTCT) of HIV in Kenya. Concurrently, child mortality in Kenya decreased by half. Objective: To identify the extent to which the decrease in child mortality in Kenya is associated with PEPFAR funding for PMTCT of HIV. Design, Setting, and Participants: This population-based survey study conducted in Kenya estimated the association between annual per capita PEPFAR funding for PMTCT (annual PCF) and cumulative per capita PEPFAR funding for PMTCT (cumulative PCF), extracted using 2004-2014 country operational reports as well as individual-level health outcomes, extracted from the 2003, 2008-2009, and 2014 Kenya Demographic and Health Surveys and the 2007 and 2012 Kenya AIDS Indicator Surveys. The study included children of female respondents to the 2003, 2008-2009, and 2014 Kenya Demographic and Health Surveys who were born 1 to 60 months (for neonatal mortality) or 12 to 60 months (for infant mortality) before the survey, as well as female respondents who had recently given birth and reported on HIV testing during antenatal care (ANC) during the 2007-2014 surveys. Results were adjusted for year, province, and survey respondent characteristics. Statistical analysis was performed from July 8, 2016, to December 10, 2018. Main Outcomes and Measures: Neonatal mortality was defined as death within the first month of life and infant mortality was defined as death within the first year of life. HIV testing during ANC was defined as receiving counseling on PMTCT, undergoing an HIV test, and receiving test results during ANC. Results: The analysis included 33 181 neonates (16 870 boys), 26 876 infants (13 679 boys), and 20 775 mothers (mean [SD] age, 28.0 [6.7] years). PEPFAR funding was not associated with neonatal mortality. A $0.33 increase in annual PCF, corresponding to the difference between the 75th and 25th (interquartile range) percentiles of funding, was significantly associated with a 16% (95% CI, 4%-27%) reduction in infant mortality after a 1-year lag. A 14% to 16% reduction persisted after 2- and 3-year lags, and comparable reductions were observed for unlagged and 1-year lagged cumulative PCF. An increase of 1 interquartile range in cumulative PCF was associated with a 7% (95% CI, 3%-11%) increase in HIV testing during ANC, which intensified with subsequent lags. Between 2004 and 2014, sustained funding levels of $0.33 annual PCF could have averted 118 039 to 273 924 infant deaths. Conclusions and Relevance: Evidence from publicly available data suggests that PEPFAR's PMTCT funding was associated with a reduction in infant mortality and an increase in HIV testing during ANC in Kenya. The full outcome of funding may not be realized until several years after allocation. This population-based survey study examines the extent to which the decrease in child mortality in Kenya is associated with the US President's Emergency Plan for AIDS Relief (PEPFAR) funding for prevention of mother-to-child transmission of HIV.
    • Grant Information:
      This study was funded by grant DP1ES025459 from the US National Institute of Environmental Health Sciences and grant R01AI112339 from the US National Institute of Allergy and Infectious Diseases, by PEPFAR, and by a cooperative agreement (W81XWH-07-2-0067) between the Henry M. Jackson Foundation for the Advancement of Military Medicine Inc and the US Department of Defense.
    • Publication Date:
      20190918
    • Publication Date:
      20191120
    • DOI:
      http://dx.doi.org/10.1001/jamanetworkopen.2019.11318
    • Accession Number:
      138617304
  • Citations
    • ABNT:
      BARNHART, D. A. et al. Association of the US President’s Emergency Plan for AIDS Relief’s Funding With Prevention of Mother-to-Child Transmission of HIV in Kenya. JAMA Network Open, [s. l.], v. 2, n. 9, p. e1911318, 2019. DOI 10.1001/jamanetworkopen.2019.11318. Disponível em: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=rzh&AN=138617304. Acesso em: 12 ago. 2020.
    • AMA:
      Barnhart DA, Tsikhutsu I, Kirui D, et al. Association of the US President’s Emergency Plan for AIDS Relief’s Funding With Prevention of Mother-to-Child Transmission of HIV in Kenya. JAMA Network Open. 2019;2(9):e1911318. doi:10.1001/jamanetworkopen.2019.11318
    • APA:
      Barnhart, D. A., Tsikhutsu, I., Kirui, D., Sawe, F., Muli, J., Sugut, W., Abboud, N., Birx, D., Hamm, T., Coakley, P., Hickey, P. W., Wolfman, V., Lee, E., & Spiegelman, D. (2019). Association of the US President’s Emergency Plan for AIDS Relief’s Funding With Prevention of Mother-to-Child Transmission of HIV in Kenya. JAMA Network Open, 2(9), e1911318. https://doi.org/10.1001/jamanetworkopen.2019.11318
    • Chicago/Turabian: Author-Date:
      Barnhart, Dale A., Isaac Tsikhutsu, Duncan Kirui, Fredrick Sawe, Jane Muli, William Sugut, Nareen Abboud, et al. 2019. “Association of the US President’s Emergency Plan for AIDS Relief’s Funding With Prevention of Mother-to-Child Transmission of HIV in Kenya.” JAMA Network Open 2 (9): e1911318. doi:10.1001/jamanetworkopen.2019.11318.
    • Harvard:
      Barnhart, D. A. et al. (2019) ‘Association of the US President’s Emergency Plan for AIDS Relief’s Funding With Prevention of Mother-to-Child Transmission of HIV in Kenya’, JAMA Network Open, 2(9), p. e1911318. doi: 10.1001/jamanetworkopen.2019.11318.
    • Harvard: Australian:
      Barnhart, DA, Tsikhutsu, I, Kirui, D, Sawe, F, Muli, J, Sugut, W, Abboud, N, Birx, D, Hamm, T, Coakley, P, Hickey, PW, Wolfman, V, Lee, E & Spiegelman, D 2019, ‘Association of the US President’s Emergency Plan for AIDS Relief’s Funding With Prevention of Mother-to-Child Transmission of HIV in Kenya’, JAMA Network Open, vol. 2, no. 9, p. e1911318, viewed 12 August 2020, .
    • MLA:
      Barnhart, Dale A., et al. “Association of the US President’s Emergency Plan for AIDS Relief’s Funding With Prevention of Mother-to-Child Transmission of HIV in Kenya.” JAMA Network Open, vol. 2, no. 9, Sept. 2019, p. e1911318. EBSCOhost, doi:10.1001/jamanetworkopen.2019.11318.
    • Chicago/Turabian: Humanities:
      Barnhart, Dale A., Isaac Tsikhutsu, Duncan Kirui, Fredrick Sawe, Jane Muli, William Sugut, Nareen Abboud, et al. “Association of the US President’s Emergency Plan for AIDS Relief’s Funding With Prevention of Mother-to-Child Transmission of HIV in Kenya.” JAMA Network Open 2, no. 9 (September 13, 2019): e1911318. doi:10.1001/jamanetworkopen.2019.11318.
    • Vancouver/ICMJE:
      Barnhart DA, Tsikhutsu I, Kirui D, Sawe F, Muli J, Sugut W, et al. Association of the US President’s Emergency Plan for AIDS Relief’s Funding With Prevention of Mother-to-Child Transmission of HIV in Kenya. JAMA Network Open [Internet]. 2019 Sep 13 [cited 2020 Aug 12];2(9):e1911318. Available from: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=rzh&AN=138617304