Measuring the Performance of Global Fund and PEPFAR Monies on the Expansion of Art Coverage

Abstract

Rationale: New global funding mechanisms for HIV/AIDS have arisen in the wake of a concerted global effort to mobilize support for the fight against HIV/AIDS - namely, the Global Fund for AIDS, Tuberculosis and Malaria (GFATM) in 2001 and the Presidents Emergency Plan for AIDS Relief (PEPFAR) in 2003. In 2003, WHO initiated "3 by 5", a campaign to place 3 million individuals, or roughly 50% of those in need, on ART by December 2005. Although the targets set by 3 by 5 have not been achieved, the demonstrated efficacy of ART in rich countries and in resource-poor setting provides a strong rationale for continued emphasis on expanding coverage. External funding to support the rapid scale-up of ART has signifcantly increased. However, questions remain regarding the actual increase in treatment coverage of the population in need that has been achieved, and the possible overestimation of the numbe of people receiving treatment, claimed by different programs.

Objective: In this analysis, we will analyze the impact of spending on HIV/AIDS on targets set by global health organizations. Specifically, we will assess the relative contributions and overall impact of Global Fund and PEPFAR spending on observed trends in ART coverage.

Methods: To quantify the impact of Global Fund and PEPFAR spending on scaling up ART coverage, we use ART coverage - the ratio of treatment utilization to estimated need for ART - as the outcome variable in analysis. We obtain these variables separately from UNAIDS country-specific epidemiological fact sheets and from online databases available from the WHO. The consistency of estimates across sources is investigated. Disbursement information for HIV/AIDS was obtained from the Global Fund and PEPFAR websites. Additional covariates - GDP per capita and indicators of government effectiveness - were included in the model to investigate the influence of other country-level determinants.

Results: Our preliminary findings suggest that countries receiving concurrent assistance from the Global Fund and PEPFAR are experiencing increases in rates of ART coverage.

Conclusion: We find that Global Fund and PEPFAR spending are having a positive impact on the expansion of ART coverage. These results must be interpreted with caution due to data quality issues such as cross-country discrepancies in how coverage data was collected and reported. Because the organizations function differently in ways that might influence spending outcomes, future work to disentangle the relative contributions of Global Fund and PEPFAR to these outcomes is especially important.