Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, California, USA.
J Int AIDS Soc. 2010 Jun 12;13:21. doi: 10.1186/1758-2652-13-21.
The US President's Emergency Plan for AIDS Relief (PEPFAR) was reauthorized in June 2008 with a three-fold increase in funds, and a broader, more explicit mandate to improve health in the low- and middle-income countries that it funded. However, the ability of a disease-specific, or vertical, programme to have a spill-over effect and improve health outcomes has been questioned. In this study, we sought to examine associations between being designated as a PEPFAR focus country (and receiving increased PEPFAR funding) and non-HIV-specific health outcomes in the World Health Organization (WHO) Africa Region, the area most affected by the HIV/AIDS epidemic.
A retrospective analysis of publicly available health outcomes data published by the World Health Organization was performed for all countries in the WHO Africa Region. Fractional changes in health indicators between 2000 and 2006 were calculated, and PEPFAR focus and non-focus countries were then compared.
Overall, countries in the WHO Africa Region showed a small worsening in health outcomes status when all indicators were analyzed together and weighted equally. However, more health indicators improved than worsened over this six-year period. A comparison of PEPFAR focus and non-focus countries found no significant difference in the fractional change among 13 of 14 health indicators during the study period.
This study suggests that vertical programmes, even one that is the scale of PEPFAR, may have little or no impact on health outcomes not explicitly targeted.
美国总统艾滋病紧急救援计划（PEPFAR）于 2008 年 6 月获得再授权，资金增加了两倍，并扩大了范围，更明确地授权为其资助的中低收入国家改善卫生条件。然而，一个针对特定疾病的、或垂直的计划是否能够产生溢出效应并改善卫生结果一直受到质疑。在这项研究中，我们试图研究在世界卫生组织（WHO）非洲区域，即受艾滋病毒/艾滋病流行影响最大的地区，被指定为 PEPFAR 重点国家（并获得更多 PEPFAR 资金）与非艾滋病毒特定健康结果之间的关联。
对世界卫生组织公布的所有在世卫组织非洲区域的国家的公开卫生结果数据进行了回顾性分析。计算了 2000 年至 2006 年期间卫生指标的分数变化，并比较了 PEPFAR 重点国家和非重点国家。
总体而言，当所有指标一起分析并平等加权时，世卫组织非洲区域的国家的卫生结果状况略有恶化。然而，在这六年期间，更多的卫生指标有所改善而不是恶化。对 PEPFAR 重点国家和非重点国家的比较发现，在研究期间的 13 个健康指标中有 14 个指标的分数变化没有显著差异。
这项研究表明，即使是像 PEPFAR 这样规模的垂直计划，对未明确针对的健康结果可能影响很小或没有影响。
