title: Is endemic political corruption hampering provision of ART and PMTCT in developing countries?
abstract: BACKGROUND
  Leadership is a key factor in the success of HIV prevention and treatment. Positive HIV-related outcomes are also affected by funding levels for HIV, health sector resources, disease burden and the socio-economic environment. Leadership on HIV as well as these other factors are affected by the quality of political governance of the country, which may be an overarching factor that influences the making of effective responses to the HIV epidemic.
  
  
  OBJECTIVE
  The aim of the study was to investigate the association between quality of political governance, on one hand, and coverage of antiretroviral therapy (ART) and prevention of mother-to-child transmission (PMTCT), on the other, in low- to middle-income countries.
  
  
  METHODS
  This investigation was carried out through a global review, online data sourcing and statistical analyses. We collected data on health burden and resources, the socio-economic environment, HIV prevalence, ART and PMTCT coverage and indicators of political governance. Outcome variables were coverage of ART (from 2004) and PMTCT (from 2007) to 2009 as a percentage of persons needing it. Potential predictors of treatment coverage were fitted with a baseline multilevel model for univariable and multivariable analyses.
  
  
  RESULTS
  Countries with higher levels of political voice and accountability, more political stability and better control of corruption have higher levels of ART coverage but not PMTCT coverage. Control of corruption (in standard deviation units) had a strong association with ART (AOR=1.82, p=0.002) and PMTCT (AOR=1.97, p=0.01) coverage. Indicators of economic development were not significant when control of corruption was included in the multivariable regression model. Many countries in all income groups had high ART but not PMTCT coverage (e.g. Mexico, Brazil and Romania in the upper-middle-income group; Papua New Guinea and Philippines in the lower-middle-income group; and Cambodia, Laos and Comoros in the low-income group). Very few low-income countries (notably, Haiti and Kenya) had high PMTCT coverage.
  
  
  CONCLUSIONS
  Our research found a significant relationship between quality of political governance and treatment coverage. Measures and policies for improving the quality of political governance should be considered as a part of HIV programme implementation to more effectively improve the welfare of people living with HIV, particularly mothers living with HIV and their babies.
authors.affiliation: International HIV Research Group, School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia; Faculty of Health Sciences, University of Sydney, Sydney, Australia.
authors.forename: Wing
authors.initials: W
authors.lastname: Young Nicola Man
authors.affiliation: International HIV Research Group, School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia; h.worth@unsw.edu.au.
authors.forename: Heather
authors.initials: H
authors.lastname: Worth
authors.affiliation: International HIV Research Group, School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia; Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
authors.forename: Angela
authors.initials: A
authors.lastname: Kelly
authors.affiliation: Kirby Institute, University of New South Wales, Sydney, Australia.
authors.forename: David P
authors.initials: DP
authors.lastname: Wilson
authors.affiliation: Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
authors.forename: Peter
authors.initials: P
authors.lastname: Siba
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use*; D003415:Crime / Q000706:statistics & numerical data; D003906:Developing Countries / Q000706:statistics & numerical data; D006076:Government; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D011057:Politics; D015995:Prevalence
chemical_list: D019380:Anti-HIV Agents
keywords: antiretroviral therapy; corruption; governance; leadership; prevention of mother-to-child transmission