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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">HIV Development Assistance and Adult Mortality in Africa</title><author><name sortKey="Bendavid, Eran" sort="Bendavid, Eran" uniqKey="Bendavid E" first="Eran" last="Bendavid">Eran Bendavid</name><affiliation><nlm:aff id="A1">Division of General Medical Disciplines, Stanford University Stanford, CA</nlm:aff></affiliation><affiliation><nlm:aff id="A2">Center for Health Policy and the Center for Primary Care and Outcomes Research, Stanford University, Stanford, CA</nlm:aff></affiliation></author><author><name sortKey="Holmes, Charles" sort="Holmes, Charles" uniqKey="Holmes C" first="Charles" last="Holmes">Charles Holmes</name><affiliation><nlm:aff id="A3">Office of the US Global AIDS Coordinator, US Department of State, Washington, DC</nlm:aff></affiliation></author><author><name sortKey="Bhattacharya, Jay" sort="Bhattacharya, Jay" uniqKey="Bhattacharya J" first="Jay" last="Bhattacharya">Jay Bhattacharya</name><affiliation><nlm:aff id="A2">Center for Health Policy and the Center for Primary Care and Outcomes Research, Stanford University, Stanford, CA</nlm:aff></affiliation></author><author><name sortKey="Miller, Grant" sort="Miller, Grant" uniqKey="Miller G" first="Grant" last="Miller">Grant Miller</name><affiliation><nlm:aff id="A2">Center for Health Policy and the Center for Primary Care and Outcomes Research, Stanford University, Stanford, CA</nlm:aff></affiliation><affiliation><nlm:aff id="A4">National Bureau of Economic Research, Cambridge, MA</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">22665105</idno><idno type="pmc">3434229</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3434229</idno><idno type="RBID">PMC:3434229</idno><idno type="doi">10.1001/jama.2012.2001</idno><date when="2012">2012</date><idno type="wicri:Area/Pmc/Corpus">001B53</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">001B53</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">HIV Development Assistance and Adult Mortality in Africa</title><author><name sortKey="Bendavid, Eran" sort="Bendavid, Eran" uniqKey="Bendavid E" first="Eran" last="Bendavid">Eran Bendavid</name><affiliation><nlm:aff id="A1">Division of General Medical Disciplines, Stanford University Stanford, CA</nlm:aff></affiliation><affiliation><nlm:aff id="A2">Center for Health Policy and the Center for Primary Care and Outcomes Research, Stanford University, Stanford, CA</nlm:aff></affiliation></author><author><name sortKey="Holmes, Charles" sort="Holmes, Charles" uniqKey="Holmes C" first="Charles" last="Holmes">Charles Holmes</name><affiliation><nlm:aff id="A3">Office of the US Global AIDS Coordinator, US Department of State, Washington, DC</nlm:aff></affiliation></author><author><name sortKey="Bhattacharya, Jay" sort="Bhattacharya, Jay" uniqKey="Bhattacharya J" first="Jay" last="Bhattacharya">Jay Bhattacharya</name><affiliation><nlm:aff id="A2">Center for Health Policy and the Center for Primary Care and Outcomes Research, Stanford University, Stanford, CA</nlm:aff></affiliation></author><author><name sortKey="Miller, Grant" sort="Miller, Grant" uniqKey="Miller G" first="Grant" last="Miller">Grant Miller</name><affiliation><nlm:aff id="A2">Center for Health Policy and the Center for Primary Care and Outcomes Research, Stanford University, Stanford, CA</nlm:aff></affiliation><affiliation><nlm:aff id="A4">National Bureau of Economic Research, Cambridge, MA</nlm:aff></affiliation></author></analytic><series><title level="j">JAMA : the journal of the American Medical Association</title><idno type="ISSN">0098-7484</idno><idno type="eISSN">1538-3598</idno><imprint><date when="2012">2012</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="S1"><title>Context</title><p id="P1">The effect of global health initiatives on population health is uncertain. Between 2003 and 2008, the US Emergency Plan for AIDS Relief (PEPFAR), the largest initiative ever devoted to a single disease, operated intensively in twelve African focus countries. The initiative's impact on all-cause adult mortality is unknown.</p></sec><sec id="S2"><title>Objective</title><p id="P2">To determine whether PEPFAR was associated with relative changes in adult mortality in the countries and districts where it operated most intensively.</p></sec><sec id="S3"><title>Design, Settings, and Patients</title><p id="P3">Using person-level data from the Demographic and Health Surveys, we conducted cross-country and within-country analyses of adult mortality (annual probability of death per 1,000 adults between 15 and 59 years old) and PEPFAR's activities. Across countries, we compared adult mortality in nine focus countries (Ethiopia, Kenya, Mozambique, Namibia, Nigeria, Rwanda, Tanzania, Uganda, and Zambia) with eighteen non-focus African countries from 1998 to 2008. We performed sub-national analyses using information on PEPFAR's programmatic intensity in Tanzania and Rwanda. We employed difference-in-difference analyses with fixed effects for countries and years as well as personal and time-varying area characteristics.</p></sec><sec id="S4"><title>Main Outcome Measure</title><p id="P4">Adult mortality.</p></sec><sec id="S5"><title>Results</title><p id="P5">We analyzed information on 1,538,612 adults, including 60,303 deaths, from 41 surveys in 27 countries, 9 of them focus countries. In 2003, age-adjusted adult mortality was 8.3 per 1,000 adults in the focus countries (95% CI 8.0–8.6) and 8.5 per 1,000 adults (95% CI 8.3–8.7) in the non-focus countries. In 2008, mortality was 4.1 per 1,000 (95% CI 3.6–4.6) in the focus countries, and 6.9 per 1,000 (95% CI 6.3–7.5) in the non-focus countries. We estimate that the odds ratio of mortality among adults living in focus countries compared with non-focus between 2004 and 2008 was 0.84 (95% CI 0.72–0.99, p=0.03). Within Tanzania, the odds ratio of mortality for adults living in districts where PEPFAR operated more intensively was 0.83 (95% CI 0.72–0.97, p=0.02) compared with districts where it operated less intensively..</p></sec><sec id="S6"><title>Conclusions</title><p id="P6">Between 2004 and 2008, all-cause adult mortality declined more in PEPFAR focus countries relative to non-focus countries. It was not possible to determine whether PEPFAR was associated with mortality effects separate from reductions in HIV-specific deaths. These findings could inform decisions about resource allocation for future development assistance programs.</p></sec></div></front></TEI><pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<pmc-dir>properties manuscript</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-journal-id">7501160</journal-id><journal-id journal-id-type="pubmed-jr-id">5346</journal-id><journal-id journal-id-type="nlm-ta">JAMA</journal-id><journal-id journal-id-type="iso-abbrev">JAMA</journal-id><journal-title-group><journal-title>JAMA : the journal of the American Medical Association</journal-title></journal-title-group><issn pub-type="ppub">0098-7484</issn><issn pub-type="epub">1538-3598</issn></journal-meta><article-meta><article-id pub-id-type="pmid">22665105</article-id><article-id pub-id-type="pmc">3434229</article-id><article-id pub-id-type="doi">10.1001/jama.2012.2001</article-id><article-id pub-id-type="manuscript">NIHMS403953</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>HIV Development Assistance and Adult Mortality in Africa</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Bendavid</surname><given-names>Eran</given-names></name><degrees>MD MS</degrees><xref ref-type="aff" rid="A1">1</xref><xref ref-type="aff" rid="A2">2</xref></contrib><contrib contrib-type="author"><name><surname>Holmes</surname><given-names>Charles</given-names></name><degrees>MD MPH</degrees><xref ref-type="aff" rid="A3">3</xref></contrib><contrib contrib-type="author"><name><surname>Bhattacharya</surname><given-names>Jay</given-names></name><degrees>MD PhD</degrees><xref ref-type="aff" rid="A2">2</xref></contrib><contrib contrib-type="author"><name><surname>Miller</surname><given-names>Grant</given-names></name><degrees>PhD MPP</degrees><xref ref-type="aff" rid="A2">2</xref><xref ref-type="aff" rid="A4">4</xref></contrib></contrib-group><aff id="A1"><label>1</label>Division of General Medical Disciplines, Stanford University Stanford, CA</aff><aff id="A2"><label>2</label>Center for Health Policy and the Center for Primary Care and Outcomes Research, Stanford University, Stanford, CA</aff><aff id="A3"><label>3</label>Office of the US Global AIDS Coordinator, US Department of State, Washington, DC</aff><aff id="A4"><label>4</label>National Bureau of Economic Research, Cambridge, MA</aff><author-notes><corresp id="CR1">Corresponding author: Eran Bendavid MD MS, Division of General Medical Disciplines, Stanford University, Stanford CA 94305. Telephone: +1-650-723-2363, Fax: +1-650-723-1919, <email>ebd@stanford.edu</email>.</corresp></author-notes><pub-date pub-type="nihms-submitted"><day>29</day><month>8</month><year>2012</year></pub-date><pub-date pub-type="ppub"><day>16</day><month>5</month><year>2012</year></pub-date><pub-date pub-type="pmc-release"><day>16</day><month>12</month><year>2012</year></pub-date><volume>307</volume><issue>19</issue><fpage>2060</fpage><lpage>2067</lpage><abstract><sec id="S1"><title>Context</title><p id="P1">The effect of global health initiatives on population health is uncertain. Between 2003 and 2008, the US Emergency Plan for AIDS Relief (PEPFAR), the largest initiative ever devoted to a single disease, operated intensively in twelve African focus countries. The initiative's impact on all-cause adult mortality is unknown.</p></sec><sec id="S2"><title>Objective</title><p id="P2">To determine whether PEPFAR was associated with relative changes in adult mortality in the countries and districts where it operated most intensively.</p></sec><sec id="S3"><title>Design, Settings, and Patients</title><p id="P3">Using person-level data from the Demographic and Health Surveys, we conducted cross-country and within-country analyses of adult mortality (annual probability of death per 1,000 adults between 15 and 59 years old) and PEPFAR's activities. Across countries, we compared adult mortality in nine focus countries (Ethiopia, Kenya, Mozambique, Namibia, Nigeria, Rwanda, Tanzania, Uganda, and Zambia) with eighteen non-focus African countries from 1998 to 2008. We performed sub-national analyses using information on PEPFAR's programmatic intensity in Tanzania and Rwanda. We employed difference-in-difference analyses with fixed effects for countries and years as well as personal and time-varying area characteristics.</p></sec><sec id="S4"><title>Main Outcome Measure</title><p id="P4">Adult mortality.</p></sec><sec id="S5"><title>Results</title><p id="P5">We analyzed information on 1,538,612 adults, including 60,303 deaths, from 41 surveys in 27 countries, 9 of them focus countries. In 2003, age-adjusted adult mortality was 8.3 per 1,000 adults in the focus countries (95% CI 8.0–8.6) and 8.5 per 1,000 adults (95% CI 8.3–8.7) in the non-focus countries. In 2008, mortality was 4.1 per 1,000 (95% CI 3.6–4.6) in the focus countries, and 6.9 per 1,000 (95% CI 6.3–7.5) in the non-focus countries. We estimate that the odds ratio of mortality among adults living in focus countries compared with non-focus between 2004 and 2008 was 0.84 (95% CI 0.72–0.99, p=0.03). Within Tanzania, the odds ratio of mortality for adults living in districts where PEPFAR operated more intensively was 0.83 (95% CI 0.72–0.97, p=0.02) compared with districts where it operated less intensively..</p></sec><sec id="S6"><title>Conclusions</title><p id="P6">Between 2004 and 2008, all-cause adult mortality declined more in PEPFAR focus countries relative to non-focus countries. It was not possible to determine whether PEPFAR was associated with mortality effects separate from reductions in HIV-specific deaths. These findings could inform decisions about resource allocation for future development assistance programs.</p></sec></abstract></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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