MedicalResearch.com Interview with:
Professor Donna Spiegelman ScD
Susan Dwight Bliss Professor of Biostatistics
Director, Center for Methods in Implementation and Prevention Science (CMIPS),
Yale School of Public Health
Professor, Department of Statistics and Data Science, Yale University
Director, Interdisciplinary Methods Core, Center for Interdisciplinary Research on AIDS
Yale School of Medicine
MedicalResearch.com: What is the background for this study?
Response: HIV infections can be transmitted from mothers to their infants during pregnancy, childbirth, and breastfeeding. Without access to a package of health services that includes antiretroviral medicines and counseling on best breastfeeding practices, it is estimated that 25% of children born to HIV-positive mothers become infected with HIV.In low-resource settings, 50% of these children die before their second birthday.
A 32% increase in under-five mortality between 1988 and 2003 prompted the Kenyan government to establish Prevention of Mother to Child Transmission of HIV (PMTCT) programs
in over 10,000 health facilities.
This achievement was supported by U.S.President’s Emergency Fund for AIDS Relief
(PEPFAR), the which contributed over $248 million to PMTCT programs in Kenya between 2004 and 2014.
Although this investments in PMTCT coincided with a remarkable halving of Kenya’s under-five mortality rate, it is unknown whether this improvement can be causally attributed to PEPFAR funding for PMTCT. During the 2000s, child mortality decreased across most of sub-Saharan African countries. These regional trends, rather than PEPFAR funding, may explain all or part of Kenya’s reduction in over 10,000 in child mortality. To help identify whether PEPFAR’s investments in PMTCT made a causal contribution to this reduction in child mortality, we used statistical methods to assess whether the amount or “dose” of PEPFAR funding provided to different provinces in Kenya was associated with increased HIV testing among pregnant women, which is a critical first step in identifying which women need PMTCT, and reduced infant mortality in Kenya.
MedicalResearch.com: What are the main findings?
Response: Among 30,424 infants and 21,048 mothers, we found that a 1 interquartile range (IQR) difference in annual PEPFAR funding for PMTCT was significantly associated with an 11% reduction in infant mortality, that a 1 IQR difference in cumulative PEPFAR funding was significantly associated with a 31% decrease in infant mortality, and that a 1 IQR difference in annual and cumulative PEPFAR funding was associated with a 6% increase in ANC testing.
MedicalResearch.com: What should readers take away from your report?
Response: The greater the funding allocation to PMTCT activities in Kenya, the more children whose lives were saved. This effect cannot be explained by background time trends due to the rigor of the study design and analytic strategy.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: It would be of great interest to see if these results could be replicated in other PEPFAR countries, and for other health outcomes, such as adult mortality, in relation to other types of PEPFAR expenditures.
MedicalResearch.com: Is there anything else you would like to add?
Response: This work is a result of an exemplary collaboration between academic statisticians at Harvard and Yale Universities, Kenyan NGOs implementing PEPFAR programs, and the US government who is the funder of PEPFAR.
Presented at the Joint Statistical Meetings (JSM) 2018 July 28-August 2, 2018, in Vancouver
The Impact of PEPFAR PMTCT Funding on Reduced Infant Mortality and Improved ANC Care in Kenya: a Quasi-Experimental Evaluation
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