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AIDS Relief Assistance Linked to Greater Decline in Mortality

African countries receiving more intensive assistance saw greater declines in death rates

TUESDAY, May 15 (HealthDay News) -- All-cause adult mortality declined more substantially in African countries in which the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) program operated more intensively between 2004 and 2008, according to a study published in the May 16 issue of the Journal of the American Medical Association, a theme issue on global health.

Eran Bendavid, M.D., from Stanford University in California, and colleagues analyzed person-level data from the Demographic and Health Surveys to investigate whether intensive efforts of PEPFAR were related to changes in adult mortality. The African focus countries were Ethiopia, Kenya, Mozambique, Namibia, Nigeria, Rwanda, Tanzania, Uganda, and Zambia.

The researchers found that, among the 1,538,612 adults analyzed, there were 60,303 deaths, from 41 surveys in 27 countries, including nine focus countries. From 2003 to 2008, the age-adjusted adult mortality dropped from 8.3 to 4.1 per 1,000 adults in the focus countries. In nonfocus countries, the mortality dropped from 8.5 to 6.9 per 1,000 adults over the same time period. Among adults living in focus countries compared with nonfocus countries, the adjusted odds ratio of mortality was 0.84 (95 percent confidence interval [CI], 0.72 to 0.99; P = 0.03) between 2004 and 2008. For adults living in districts within Tanzania and Rwanda where PEPFAR operated more intensively, the adjusted odds ratio of mortality was 0.83 (95 percent CI, 0.72 to 0.97; P = 0.02) and 0.75 (95 percent CI, 0.56 to 0.99; P = 0.04), respectively, compared with districts within which PEPFAR operated less intensively.

"Between 2004 and 2008, all-cause adult mortality declined more in PEPFAR focus countries relative to nonfocus countries," the authors conclude.

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