MedicalResearch.com Interview with:
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Dr. Spiegelman[/caption]
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.