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Activity Number: 655 - Improving Power and Generalizability in Causal Effect Estimation Using Multicenter and Network Designs
Type: Topic Contributed
Date/Time: Thursday, August 2, 2018 : 10:30 AM to 12:20 PM
Sponsor: Biometrics Section
Abstract #329908
Title: The Impact of PEPFAR PMTCT Funding on Reduced Infant Mortality and Improved ANC Care in Kenya: a Quasi-Experimental Evaluation
Author(s): Donna Spiegelman* and Dale Barnhart and Isaac Tsikhutsu and Fredrick Sawe and Jane Muli and Duncan Kirui and William Sugut and Nareen Abboud and Tiffany Hamm and Peter Coakley and Patrick W. Hickey and Vanessa Wolfman and Elizabeth Lee
Companies: Harvard T.H. Chan School of Public Health and Harvard T.H Chan School of Public Health and Walter Reed Program-Kericho, Kenya; U.S. Military HIV Research Program, Silver Spring, MD and Walter Reed Program-Kericho, Kenya; U.S. Military HIV Research Program, Silver Spring, MD and Walter Reed Program-Kericho, Kenya; U.S. Military HIV Research Program, Silver Spring, MD and Walter Reed Program-Kericho, Kenya; U.S. Military HIV Research Program, Silver Spring, MD and Walter Reed Program-Kericho, Kenya; U.S. Military HIV Research Program, Silver Spring, MD and Office of the U.S. Global AIDs Coordinator and Health Diplomacy and U.S. Military HIV Research Program, Walter Reed Army Institute of Research and U.S. Military HIV Research Program, Walter Reed Army Institute of Research and U.S. Military HIV Research Program, Walter Reed Army Institute of Research and U.S. Military HIV Research Program, Walter Reed Army Institute of Research and U.S. Military HIV Research Program, Walter Reed Army Institute of Research
Keywords: Causal Inference ; Health Impact Evaluation; HIV/AIDs; Quasi-experiments
Abstract:

From 2004-2014, the President's Emergency Plan for AIDS Relief (PEPFAR) invested over $240 million in Prevention of Mother to Child Transmission of HIV (PMTCT) in Kenya and child mortality in Kenya decreased by half. Using a quasi-experimental dose-response secondary analysis, we estimated the impact of annual (ANN) and cumulative (CUM) per capita PMTCT funding on infant and neonatal mortality and HIV counseling, testing, and receipt of test results during antenatal care (ANC testing), adjusting for year, province, and respondent characteristics. Among 30,424 infants and 21,048 mothers, a 1 interquartile range (IQR) difference in ANN was associated with an 11% reduction in infant mortality, a 1 IQR difference in CUM was associated with a 31% decrease in infant mortality, and a 1 IQR difference in ANN was associated with a 6% increase in ANC testing, with similar findings for CUM. Using publicly-available data to assess causal effects of programs on health outcomes, we found that PMTCT funding is likely to have been causally associated with reduced infant mortality and increased ANC testing in Kenya. The full impact of funding was only felt at least one year after allocation.


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