July 27, 2018
2 min read

PEPFAR funding directly reduces maternal HIV transmission, infant mortality

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Photo of Donna Spiegelman
Donna Spiegelman

Researchers said that annual funding of the President’s Emergency Plan for AIDS Relief decreased infant mortality related to mother-to-child HIV transmission in Kenya by more than 10%. They suggested that when funding was examined on a cumulative basis, infant mortality dropped by nearly one-third.

According to the President’s Emergency Plan for AIDS Relief (PEPFAR), the organization provides more than 14 million people with antiretroviral treatment in 50 countries. A report issued in late 2017 by ONE — an international, nonpartisan, nonprofit organization that addresses extreme poverty and preventable diseases — indicates that $800 million was cut to bilateral HIV/AIDS efforts and an additional $225 million was cut to the Global Fund by the U.S. federal government. These cuts, according to ONE, could result in approximately 300,000 deaths and more than 1.75 million new infections annually.

“PEPFAR expenditures in Kenya to prevent the transmission of HIV from mother to child reduced mortality among children in their first year of life by approximately 30%,” Donna Spiegelman, ScD, Dwight Bliss Professor of Biostatistics at the Yale School of Public Health, told Infectious Diseases in Children. “Clearly, this program is saving many lives, and further expansion in other countries such as Kenya, where the program has had success, will save many more lives.”

According to the researchers, more than $240 million was invested in PEPFAR to target mother-to-child HIV transmission in Kenya. This funding, provided between 2004 and 2014, reduced child mortality in the country by half.

Spiegelman and colleagues examined how annual and cumulative per capita funding for the prevention of mother-to-child HIV transmission affected neonatal and infant mortality, as well as HIV counseling, testing and the number of receipts gathered for these services while women received prenatal care.

Of the 30,424 infants included in the research and the 21,048 mothers, a 1-interquartile range (IQR) difference in annual per capita funding was connected to an 11% decrease in infant mortality. Infant mortality dropped by 31% when a 1-IQR difference was made in cumulative funding.

The researchers were also able to link a 1-IQR difference in annual funding to a 6% increase in prenatal testing for HIV. They found a similar increase when they examined cumulative funding. The funding, according to Spiegelman and colleagues, is likely to have a causal effect on reduced infant mortality and increased prenatal HIV testing among mothers in Kenya.

“It has been estimated that without interventions such as those supported by PEPFAR in Kenya, approximately 35% of children will become infected with HIV before birth, after birth or while breastfeeding,” Spiegelman said. “Preventing HIV infection in these children is critical for full-scale HIV prevention and the end to the global AIDS epidemic.” – by Katherine Bortz


Spiegelman D, et al. Abstract 329908. Presented at: The American Statistical Association’s 2018 Joint Statistical Meetings; July 28-Aug. 2, 2018; Vancouver, British Columbia.

ONE: Red Ribbon or White Flag? - The Future of the U.S. Global AIDS Response. https://www.one.org/us/2017/11/29/aids-report-2017/. Accessed: July 26, 2018.

Disclosure: Spiegelman reports no relevant financial disclosures.