title: Estimating the impact of the US President's Emergency Plan for AIDS Relief on HIV treatment and prevention programmes in Africa.
abstract: BACKGROUND
  Since 2004, the US President's Emergency Plan for AIDS Relief (PEPFAR) has supported the tremendous scale-up of HIV prevention, care and treatment services, primarily in sub-Saharan Africa. We evaluate the impact of antiretroviral treatment (ART), prevention of mother-to-child transmission (PMTCT) and voluntary medical male circumcision (VMMC) programmes on survival, mortality, new infections and the number of orphans from 2004 to 2013 in 16 PEPFAR countries in Africa.
  
  
  METHODS
  PEPFAR indicators tracking the number of persons receiving ART for their own health, ART regimens for PMTCT and biomedical prevention of HIV through VMMC were collected across 16 PEPFAR countries. To estimate the impact of PEPFAR programmes for ART, PMTCT and VMMC, we compared the current scenario of PEPFAR-supported interventions to a counterfactual scenario without PEPFAR, and assessed the number of life years gained (LYG), number of orphans averted and HIV infections averted. Mathematical modelling was conducted using the SPECTRUM modelling suite V.5.03.
  
  
  RESULTS
  From 2004 to 2013, PEPFAR programmes provided support for a cumulative number of 24 565 127 adults and children on ART, 4 154 878 medical male circumcisions, and ART for PMTCT among 4 154 478 pregnant women in 16 PEPFAR countries. Based on findings from the model, these efforts have helped avert 2.9 million HIV infections in the same period. During 2004-2013, PEPFAR ART programmes alone helped avert almost 9 million orphans in 16 PEPFAR countries and resulted in 11.6 million LYG.
  
  
  CONCLUSIONS
  Modelling results suggest that the rapid scale-up of PEPFAR-funded ART, PMTCT and VMMC programmes in Africa during 2004-2013 led to substantially fewer new HIV infections and orphaned children during that time and longer lives among people living with HIV. Our estimates do not account for the impact of the PEPFAR-funded non-biomedical interventions such as behavioural and structural interventions included in the comprehensive HIV prevention, care and treatment strategy used by PEPFAR countries. Therefore, the number of HIV infections and orphans averted and LYG may be underestimated by these models.
authors.affiliation: Population Division, U.S. Census Bureau, Washington DC, USA.
authors.forename: Laura M
authors.initials: LM
authors.lastname: Heaton
authors.affiliation: Department of State, Country Impact, Office of the U.S. Global AIDS Coordinator, Washington DC, USA.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Bouey
authors.affiliation: Health Policy, Children's Action Alliance, Phoenix, Arizona, USA.
authors.forename: Joe
authors.initials: J
authors.lastname: Fu
authors.affiliation: Center for Modeling and Analysis, Avenir Health, Glastonbury, Connecticut, USA.
authors.forename: John
authors.initials: J
authors.lastname: Stover
authors.affiliation: Population Division, U.S. Census Bureau, Washington DC, USA.
authors.forename: Timothy B
authors.initials: TB
authors.lastname: Fowler
authors.affiliation: Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality, Rockville, Maryland, USA.
authors.forename: Rob
authors.initials: R
authors.lastname: Lyerla
authors.affiliation: Strategic Information and Evaluation Department, Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland.
authors.forename: Mary
authors.initials: M
authors.lastname: Mahy
mesh_terms: D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D003140:Communicable Disease Control / Q000458:organization & administration*; D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D007391:International Cooperation; D008297:Male; D011247:Pregnancy; D015397:Program Evaluation; D055818:Public-Private Sector Partnerships / Q000458:organization & administration; D014481:United States / Q000453:epidemiology
keywords: AFRICA; AIDS; ANTERETROVIRAL THERAPY; HIV; MATHEMATICAL MODEL