Bendavid Eran, Bhattacharya Jayanta
Stanford University, Stanford, California, USA.
Ann Intern Med. 2009 May 19;150(10):688-95. doi: 10.7326/0003-4819-150-10-200905190-00117. Epub 2009 Apr 6.
Since 2003, the President's Emergency Plan for AIDS Relief (PEPFAR) has been the most ambitious initiative to address the global HIV epidemic. However, the effect of PEPFAR on HIV-related outcomes is unknown.
To assess the effect of PEPFAR on HIV-related deaths, the number of people living with HIV, and HIV prevalence in sub-Saharan Africa.
Comparison of trends before and after the initiation of PEPFAR's activities.
12 African focus countries and 29 control countries with a generalized HIV epidemic from 1997 to 2007 (451 country-year observations).
A 5-year, $15 billion program for HIV treatment, prevention, and care that started in late 2003.
HIV-related deaths, the number of people living with HIV, and HIV prevalence.
Between 2004 and 2007, the difference in the annual change in the number of HIV-related deaths was 10.5% lower in the focus countries than in the control countries (P = 0.001). The difference in trends between the groups before 2003 was not significant. The annual growth in the number of people living with HIV was 3.7% slower in the focus countries than in the control countries from 1997 to 2002 (P = 0.05), but during PEPFAR's activities, the difference was no longer significant. The difference in the change in HIV prevalence did not significantly differ throughout the study period. These estimates were stable after sensitivity analysis.
The selection of the focus countries was not random, which limits the generalizability of the results.
After 4 years of PEPFAR activity, HIV-related deaths decreased in sub-Saharan African focus countries compared with control countries, but trends in adult prevalence did not differ. Assessment of epidemiologic effectiveness should be part of PEPFAR's evaluation programs.
Agency for Healthcare Research and Quality.
自2003年以来，总统艾滋病紧急救援计划（PEPFAR）一直是应对全球艾滋病毒疫情最具雄心的举措。然而，PEPFAR对与艾滋病毒相关结果的影响尚不清楚。
评估PEPFAR对撒哈拉以南非洲地区与艾滋病毒相关的死亡、艾滋病毒感染者人数及艾滋病毒流行率的影响。
比较PEPFAR活动启动前后的趋势。
12个非洲重点国家和29个对照国家，1997年至2007年期间存在广泛的艾滋病毒疫情（451个国家年观察数据）。
一项为期5年、耗资150亿美元的艾滋病毒治疗、预防和护理计划，于2003年末启动。
与艾滋病毒相关的死亡、艾滋病毒感染者人数及艾滋病毒流行率。
2004年至2007年期间，重点国家与艾滋病毒相关死亡人数的年变化差异比对照国家低10.5%（P = 0.001）。2003年之前两组之间的趋势差异不显著。1997年至2002年期间，重点国家艾滋病毒感染者人数的年增长率比对照国家慢3.7%（P = 0.05），但在PEPFAR活动期间，差异不再显著。在整个研究期间，艾滋病毒流行率变化的差异无显著不同。敏感性分析后，这些估计值是稳定的。
重点国家的选择并非随机，这限制了结果的普遍性。
经过4年的PEPFAR活动后，与对照国家相比，撒哈拉以南非洲重点国家与艾滋病毒相关的死亡人数有所下降，但成人流行率趋势没有差异。流行病学有效性评估应成为PEPFAR评估计划的一部分。
医疗保健研究与质量局。
