The Reach and Limits of the US President’s Emergency Plan for Aids Relief (PEPFAR) Funding of Prevention of Mother-to-Child Transmission (PMTCT) of HIV in Nigeria
), Niamh Stephenson(2),
(1)
(2)
Corresponding Author
Abstract
WHO advocates the use of comprehensive 4-pronged strategy for PMTCT of HIV. It includes HIV prevention, preventing unintended pregnancies in HIV positive women and follows up treatment and support as well as therapeutic interventions around delivery. This study examines PEPFAR’s funding of Nigerian PMTCT, via an analysis of the funded activities of 396 agencies PEPFAR funds to do PMTCT. PEPFAR Sub-partners selected for this study were included because they were funded to do therapeutic intervention around delivery, but significant gaps were identified regarding the other 3 prongs advocated by WHO. Up to 70% were not funded to do any primary prevention. PEPFAR’s own reporting does not allow assessment of Sub-partner involvement in preventing unintended pregnancies. Regarding follow up treatment and care, some Sub-partners were not funded at all. PEPFAR is not supporting a comprehensive approach to PMTCT in the way it funds PMTCT in Nigeria (Afr J Reprod Health 2012; 16[1]:23-34).
RésuméLa portée et les limites du plan d’urgence du Président américain à l’égard du financement des secours au SIDA (PUPFSS) pour la prévention de la Transmission du VIH de la mère à l’enfant (PTME) au Nigéria : L’OMS préconise l’utilisation d’une stratégie compréhensive à quatre fronts pour la PTME du VIH. Elle comprend la prévention du VIH, la prévention des grossesses non-voulues chez les femmes séropositives, le traitement en postcure et d’appui aussi bien que les interventions thérapeutiques autour de l’accouchement. Cette étude examine le financement de la PTME du Nigéria par le PUPFSS à travers une analyse des activités financées auprès des agences financées, elles aussi, par PUPFSS pour réaliser la PTME. Les sous-partenaires du PUPFSS sélectionnés pour cette étude, ont été inclus parce qu’ils étaient financés pour réaliser des interventions thérapeutiques autour de l’accouchement, mais on a identifié d’importants trous à propos des trois autres fronts préconisés par l’OMS. Jusqu’à 70% n’ont pas été financés pour réaliser une prévention primaire. Le reportage par le PUPFSS ne permet pas d’évaluer la participation des sous-partenaires dans la prévention des grossesses non-voulues. En ce qui concerne le traitement en postcure et au soin, certains sous-partenaires n’ont pas été du tout financés. Le PUPFSS ne soutient pas une approche compréhensive à la PTME dans la manière dont il finance la PTME au Nigéria (Afr J Reprod Health 2012; 16[1]:23-34).
Keywords: HIV, PMTCT, Prevention, PEPFAR, Nigeria
References
Joint United Nations Programme on HIV/AIDS. Global report: UNAIDS report on global AIDS Epidemic-2010, http://www.unaids.org/en/media/unaids/cont entassets/documents/unaidspublication/2010/20101 123_globalreport_en[1].pdf (Accessed December 16, 2010).
Kourtis A, Bulterys M., Nesheim S, Lee F. Understanding the Timing of HIV Transmission from Mother to Infant. Journal of American Medical Association, 2001; 285(6): 709-712.
WHO/UNAIDS/UNICEF. Towards universal access: ews/newsitem.aspx?RecordID=03302007. Accessed scaling up priority HIV/AIDS interventions in the January 6, 2011.
health sector. Progress report. http://www.who. 29. Eyakuze C, Jones D, Starrs A, Sorkin N. From PMTCT int/hiv/pub/tuapr_2009_en.pdf (Accessed December to a more comprehensive aids response for women:
, 2010). A much-needed shift. Developing World Bioethics,
National Agency for the Control of AIDS. Fact Sheet: 2008; 8 (1): 33–42.
PMTCT in Nigeria 2011. http://naca.gov.ng/ 30. PEPFAR. Appendix 3 - Description of Budget Codes by content/view/399/lang,en/ (Accessed July 25, 2011). Program Area. n.d, http://www.pepfar.gov
National Agency for the Control of AIDS. National /about/2010/150655.htm (Accessed February 22, HIV/AIDS Response Review 2005-09. 2011). www.naca.gov.ng (Accessed December 18, 2010).
Newell M, Coovadia H, Cortina-Borja M, Rollins N, Gaillard P, & Dabis F. Mortality of infected and uninfected infants born to HIV-infected mothers in Africa: A pooled analysis. The Lancet, 2004; 364: 1236–1243.
World Health Organization. Antiretroviral drugs for treating pregnant women and preventing HIV infection in infants: towards universal access: recommendations for a public health approach, 2010. http://whqlibdoc.who.int/publications/2010/9 789241599818_eng.pdf (Accessed August 19,
.
Chama C, Gashau W, Oguche S. The value of highly active antiretroviral therapy in the prevention of mother-to-child transmission of HIV. Journal of Obstetrics and Gynecology, 2007; 27 (2): 134 – 137.
Shaffer N. Combination prophylaxis for prevention of maternal-infant HIV transmission. Journal of American Medical Association, 2001; 285 (16): 2129 –2131.
World Health Organization. Antiretroviral drugs for treating pregnant women and preventing HIV infection in infants: towards universal access: recommendations for a public health approach, 2006. http://www.who.int/hiv/pub/mtct/arv_guidel ines_mtct.pdf (Accessed January 28, 2011).
The Lancet infectious diseases. Treatment as prevention for HIV (Editorial). The Lancet Infectious Diseases, 2011; 11(9): 651. doi:10.1016/S1473-3099(11)702 19-5.
Kippax S, Stephenson N. Beyond the distinction between biomedical and social dimensions of HIV: Prevention through the lens of a social public health. American Journal of Public Health, Accepted August 2011.
World Health Organization. Essential prevention and care interventions for adults and adolescents living with HIV in resource-limited settings, 2008. http://www.who.int/hiv/pub/prev_care/OMS_EPP_ AFF_en.pdf (Accessed April 27, 2011).
World Health Organization. Meeting report: 2011 Annual Meeting of the Interagency Task Team on Prevention and Treatment of HIV Infection in
Pregnant Women, Mothers and their Children,
http://whqlibdoc.who.int/publications/2011/97 89241501927_eng.pdf (Accessed August 29, 2011).
Federal Ministry of Health. National HIV Seroprevalence Sentinel Survey Among pregnant women attending antenatal clinics in Nigeria. Technical report, 2010. http://www.naca.gov.ng/ (Accessed April 22, 2011).
WHO/UNAIDS/UNICEF. Towards universal access: ews/newsitem.aspx?RecordID=03302007. Accessed scaling up priority HIV/AIDS interventions in the January 6, 2011.
health sector. Progress report. http://www.who. 29. Eyakuze C, Jones D, Starrs A, Sorkin N. From PMTCT int/hiv/pub/tuapr_2009_en.pdf (Accessed December to a more comprehensive aids response for women:
, 2010). A much-needed shift. Developing World Bioethics,
National Agency for the Control of AIDS. Fact Sheet: 2008; 8 (1): 33–42.
PMTCT in Nigeria 2011. http://naca.gov.ng/ 30. PEPFAR. Appendix 3 - Description of Budget Codes by content/view/399/lang,en/ (Accessed July 25, 2011). Program Area. n.d, http://www.pepfar.gov
National Agency for the Control of AIDS. National /about/2010/150655.htm (Accessed February 22,
HIV/AIDS Response Review 2005-09. 2011).
www.naca.gov.ng (Accessed December 18, 2010). 31. National Population Commission (NPC) [Nigeria] and
FGON/FMOH/NACA. Nigeria HIV/AIDS Service ICF Macro. (2009). Nigeria Demographic and Provision Assessment 2008, www.naca Health Survey 2008. Abuja, Nigeria: National
.gov.ng (Accessed December 18, 2010).
World Health Organization. Nigeria Country profile, n.d, http://www.who.int/making_pregnancy_safer/count ries/nig.pdf (Accessed December 20, 2010).
Joint United Nations Programme on HIV/AIDS. Financing and Resources needed to prevent MTCT in Africa. African Parliamentary meeting, 2010. http://www.who.int/pmnch/events/2010/unaids_pres entation.pdf (Accessed December 7, 2010).
The Henry J. Kaiser Family Foundation. The U.S. Government’s Global Health Policy Architecture: Structure, Programs, and Funding, 2009. http://www.kff.org/globalhealth/upload/7881.pdf (Accessed December 15, 2010).
PEPFAR. Celebrating life: 2009 Annual Report to Congress-Highlights; January 2009.
The Henry J. Kaiser Family Foundation. US Global health policy-The US President’s Emergency Plan for AIDS Relief (PEPFAR)-Fact sheet, 2010. http://www.kff.org/globalhealth/upload/8002-02.pdf (Accessed December 15, 2010).
PEPFAR. Implementing agencies, n.d, http://www.
pepfar.gov/agencies/index.htm (Accessed Dec 20, 2010).
Oomman N, Bernstein M, Rosenzweig S. Following the Funding for HIV/AIDS: A Comparative Analysis of the Funding Practices of PEPFAR, the Global Fund and World Bank MAP in Mozambique, Uganda and Zambia. Centre for Global Development: Washington D.C, 2007.
PEPFAR. Implementing partners .n.d, http://nigeria. usembassy.gov/pepfar_nigeria_implementing_partn ers.html (Accessed December 27, 2010)
PEPFAR. Fact sheet. n.d, http://nigeria.usem bassy.gov/pepfar.html (Accessed December 26, 2010).
PEPFAR. Partnership to Fight HIV/AIDS in Nigeria. n.
d, http://www.pepfar.gov/countries/nigeria/index .htm. (Accessed December 22, 2010).
PEPFAR. Nigeria 2009 Country Operational Plan, 2009.
http://www.pepfar.gov/documents/organization/140 413.pdf (Accessed January 16, 2011).
Sepulveda J. PEPFAR Implementation: Progress and Promise. Institute of Medicine. National Research
Council. Washington, DC: National Academies, 2007). http://www8.nationalacademies.org/onpin Population Commission and ICF Macro.
De Waal A. AIDS and Power: Why there is no political crisis yet. New York: Zed books, 2006.
Peters A., Scharf M, Van Driel F, Jansen W. Where does public funding for HIV prevention go to? The case of condoms versus microbicides and vaccines. Globalization and Health, 2010; 6(23):1-10.
World Health Organisation. Ottawa charter for health promotion. Geneva: WHO, 1986. http://www.who. int/healhpromotion/conferences/previous/ottawa/en/ (Accessed April 22, 2011).
Chabikuli N, Awi D, Chukwujekwu O, Abubakar Z, Gwarzo U, Ibrahim M, Merrigan M, Hamelmann C. The use of routine monitoring and evaluation systems to assess a referral model of family planning and HIV service integration in Nigeria. AIDS, 2009; 23 (suppl 1): S97–S103.
Ricca J, Negroustoueva S. Development of a Monitoring Framework for Referral within a Network of HIV/AIDS Service Providers: Final Report Based on Four Case Studies, 2009. http://www. phishare.org/files/8970_sr_09_58a.pdf (Accessed April 2, 2011).
Lawrence O, Gostin J. Meeting the Survival Needs of the World’s Least Healthy People A Proposed Model for Global Health Governance. Journal of American Medical Association, 2007; 298 (2): 225-228.
Aigbokhan B. Growth, Inequality and Poverty in Nigeria. Prepared for United Nations Economic Commission for Africa (UNECA). Addis Ababa, Ethiopia, 2008.
Charurat M, Oyegunle M, Benjamin R, Habib A, Eze E, Ele P, Ibanga I, Ajayi S, Eng M, Mondal P, Gebi
U, Iwu E, Etiebet M, Abimiku A, Dakum P, Farley
J, Blattner W. Patient Retention and Adherence to Antiretrovirals in a Large Antiretroviral Therapy Program in Nigeria: A Longitudinal Analysis for Risk Factors. PLoS ONE (Electronic source), 2010 5(5): e10584. doi:10.1371/journal.pone.0010584.
Geng E, Nash D, Kambugu A, Zhang Y, Braitstein P, Christopoulos K, Muyindike W, Bwana M,
Yiannoutsos C, Petersen M, Martin J. Retention in
Care among HIV-Infected Patients in ResourceLimited Settings: Emerging Insights and New Directions. Current HIV/AIDS Report, 2010; 7 (4): 234–244.
National Agency for the Control of AIDS. HIV/AIDS national strategic framework for action (2005- 2009),2005.http://siteresources.worldbank.org/INT
HIVAIDS/Resources/3757981151090631807/2693 180-1151090665111/2693181155742859198/Nigeri anNationalStrategicFrameworkonHIVAIDS.pdf (Accessed July 25, 2011).
Peoples Health Movement, Medact, and Global Equity Gauge Alliance. Global Health Watch 2: An alternative World health Report. New York: Zed Books, 2008.
Kippax S, Stephenson N. Infectious Disease and Globalisation. In B. Turner (Ed.) Handbook of Globalisation Studies. London: Taylor & Francis (pp. 205-226), 2010.
Sridhar D, Batniji R. Misfinancing global health: a case for transparency in disbursements and decision making. The Lancet, 2008; 372: 1185–91.
Sridhar D, Khagram S, Pang T. Are existing governance structures equipped to deal with today’s global health challenges- Towards systematic coherence in scaling up. Global Health Governance, 2008; 2 (2): 1-25.
World Health Organization. Everybody business: Strengthening health systems to improve health outcomes: WHO’s framework for action, 2007. http://www.who.int/healthsystems/round9_2.pdf (Accessed April 27, 2011)
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