In Africa, PEPFAR countries test more for COVID-19, showing impact of investment
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Key takeaways:
- PEPFAR countries in Africa reported nearly three times the SARS-CoV-2 test results than non-PEPFAR countries.
- PEPFAR investments have strengthened local health care systems to respond to non-HIV emergencies.
BOSTON — Sub-Saharan African countries supported by the U.S. President’s Emergency Plan for AIDS Relief, or PEPFAR, tested for COVID-19 at three times the rate of non-PEPFAR nations, according to data presented at IDWeek.
The finding is another indication that PEPFAR infrastructure has benefits beyond the global HIV pandemic, researchers said.
During its first 10 years, PEPFAR invested about one-fifth of its country budgets on governance and improving public health care systems, including surveillance, laboratories and training health care workers, according to Benjamin C. Johnson, MD, a third-year internal medicine resident at the Johns Hopkins School of Medicine, and colleagues.
In their analysis, they found that these investments allowed PEPFAR countries to quickly pivot to COVID-19 diagnosis and care as the pandemic grew in 2020.
“Beyond enabling massive and transformative scale-up of HIV treatment and prevention services, it’s been widely argued that these investments increased local capacity to respond to public health emergencies ranging from Ebola to COVID-19, more recently,” Johnson said during a presentation at IDWeek. “During the COVID-19 pandemic, HIV laboratory and surveillance systems in sub-Saharan Africa quickly pivoted to test for the coronavirus and, eventually, when vaccines were available, PEPFAR service delivery platforms were used to distribute and administer COVID-19 vaccinations.”
PEPFAR was established in 2003 by President George W. Bush and has invested more than $100 billion in the last 2 decades to save roughly 25 million lives and prevent millions of HIV infections in more than 50 countries, according to the U.S. State Department.
In September, PEPFAR expanded its efforts by setting a goal to “dramatically” increase testing and treatment for tuberculosis, aiming to prevent at least 500,000 TB-related deaths among people living with HIV.
“Building off prior arguments that PEPFAR investments in health systems has strengthened global health security, we theorized that PEPFAR countries would be better prepared to both test for a novel pathogen and then also to report the results in order to inform data-driven public health responses,” Johnson said.
Johnson and colleagues analyzed COVID-19 testing data from the online database Our World In Data collected between Jan. 1, 2020, and Feb. 15, 2021, in 34 countries in sub-Saharan Africa. They cross-referenced the data against publicly reported data from Africa CDC, PEPFAR and WHO.
Of 18 countries that reported testing, 16 (88.9%) were PEPFAR countries. Among PEPFAR countries in the region, 16 of 27 (59.3%) reported SARS-CoV-2 testing compared with two of 21 non-PEPFAR countries (9.5%).
In addition to more PEPFAR countries reporting testing, PEPFAR countries had a per-capita test rate nearly three times that of non-PEPFAR countries: 28.7 tests per 1,000 people in PEPFAR countries compared with 9.6 tests per 1,000 people in non-PEPFAR countries.
“These preliminary findings support anecdotal evidence that PEPFAR’s historic investments in health infrastructure strengthened the local capacity to respond to non-HIV public health emergencies such as COVID-19,” Johnson said.
PEPFAR was originally funded by Congress with a 5-year, $15 billion budget and then reauthorized in 2008 with an increased budget of $48 billion, but funding remained flat in the two subsequent reauthorizations in 2013 and 2018.
Congress has yet to reauthorize PEPFAR, with the 2018 reauthorization expiring on Sept. 30, 2023, and a 1-year reauthorization held up because of Republican and conservative concerns about PEPFAR funds being used for sexual and reproductive health, according to members of Congress.
The bulk of the program is expected to continue under permanent law, although a gap in authorization could alter or endanger the care PEPFAR says it provides for more than 65 million people globally, Matthew Miller, spokesperson for the U.S. State Department, said on Oct. 2, 2023.
References:
- Johnson BC, et al. Abstract 1036. Presented at IDWeek; Oct. 11-15, 2023; Boston.
- PEPFAR launches new effort to fight TB: Goal to detect two million cases and prevent 500,000 deaths. https://www.state.gov/pepfar-launches-new-effort-to-fight-tb-goal-to-detect-two-million-cases-and-prevent-500000-deaths/. Published Sept. 22, 2023. Accessed Oct. 17, 2023.
- The United States President’s Emergency Plan for AIDS Relief. https://www.state.gov/pepfar/. Accessed Oct. 17, 2023.
- The US President’s Emergency Plan for AIDS Relief celebrates 20 years of unprecedented global impact in the fight to end HIV/AIDS. https://www.state.gov/pepfar-celebrates-20-years-of-unprecedented-global-impact-in-the-fight-to-end-hiv-aids/. Published Jan. 28, 2023. Accessed Oct. 17, 2023.State Department press briefing — October 2, 2023. https://www.state.gov/briefings/department-press-briefing-october-2-2023/. Published Oct. 2, 2023. Accessed Oct. 20, 2023.
Perspective
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The PEPFAR program has revolutionized HIV medical care in Africa. The HIV medications provided through this program to HIV/AIDS patients in Africa have saved many lives, prevented many infections and helped transform the worldwide HIV epidemic. Now, this study has demonstrated that the PEPFAR program has also strengthened the health care laboratory structure in African countries with the PEPFAR program.
This study demonstrates that sub-Saharan countries in Africa with the PEPFAR program, when compared with those countries without PEPFAR, were able to quickly pivot to offering COVID-19 testing during the COVID-19 pandemic at substantial testing rates per capita. This demonstrates that the PEPFAR program has strengthened the health care infrastructure with benefits that extend beyond HIV care.
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