Study Details

The President's Emergency Plan for AIDS Relief in Africa: An Evaluation of Outcomes.


Bendavid E.  Bhattacharya J. 


May 2009


Annals of Internal Medicine  Vol 150, Issue 10, pp688-695

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Stanford University


HIV/AIDS Services; Funding; PEPFAR

Study Type

Quantitative analysis of trends of HIV/AIDS services.


To assess the effect of PEPFAR on HIV-related deaths, the number of people living with HIV, and HIV prevalence in sub-Saharan Africa.


Employed a fixed-effects model for longitudinal data with fixed time and country effects to analyze trends in 12 African focus countries and 29 control countries with a generalized HIV epidemic from 1997 to 2007.


By the end of 2007, PEPFAR spent more than $6 billion on HIV care, prevention, and treatment in the 12 focus countries examined in this study. In those countries, a reduction in the death rate of 10.5% implies that about 1.2 million deaths were averted because of PEPFAR's activities. This large benefit cost about $2450 per death averted, assuming that PEPFAR directed half of its budget toward treatment.

  • 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 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 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

Conclusions /

  • 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

Sponsored by DFID, Danida, Irish Aid