CROI 2015 Program and Abstracts

Abstract Listing

Oral Abstracts

Conclusions: Our results do not support the claim that ART program scale-up lead to reduced access to care for other diseases. In contrast, the ART program has freed up secondary care capacity and has likely improved both the effectiveness and efficiency of the public-sector health system by channelling utilization from secondary to primary care in this setting. Future health systems interventions should build on these trends to improve the performance of chronic disease management in public-sector primary care. 160 The Impact of PEPFAR Abstinence and Faithfulness Funding Upon HIV Risk Behaviors in Sub-Saharan Africa Nathan C. Lo ; Anita Lowe; Eran Bendavid Stanford University School of Medicine, Stanford, CA, US Background: The United States President’s Emergency Plan for AIDS Relief (PEPFAR) supports more abstinence and faithfulness programs in sub-Saharan Africa than any other funder. We assess the relationship between PEPFAR’s support for these programs and changes in high-risk sexual behavior. Evaluating the outcomes of foreign aid for HIV is important for optimizing HIV treatment and prevention portfolios. Methods: Using individual-level nationally-representative survey data from the Demographic and Health Surveys for 22 sub-Saharan African countries, we employed a difference-in-differences analysis to assess the relationship of PEPFAR abstinence and faithfulness funding to changes in three outcomes indicative of high-risk sexual behaviors: the number of sexual partners, age of first sexual intercourse, and teenage pregnancies. We compare trends in these outcomes among persons living in PEPFAR funded and non- PEPFAR countries from 1998 to 2013. Results: We analyzed 252,251 men and 591,714 women using 54 surveys in 14 PEPFAR funded and 8 non-PEPFAR funded countries. In comparison with non-PEPFAR countries, survey respondents living in PEPFAR countries exhibited no relative change in the number of sexual partners among men (0.02 more partners; 95% CI (-0.04, 0.08); p=0.48), number of sexual partners among women (0.02 fewer partners; 95% CI (-0.05, 0.01); p=0.15), age of first sex among men (0.10 years earlier; 95% CI (-0.91, 0.70); p=0.79), age of first sex among women (0.19 years earlier; 95% CI (-0.76, 0.37); p=0.49), or in rates of teenage pregnancy (2% relative decline in prevalence; 95% CI (-7, 2%); p=0.34).

Oral Abstracts

Conclusions: We find no evidence to suggest that PEPFAR funding of abstinence and faithfulness programs results in reduced high-risk sexual behavior. These results suggest the importance of examining alternative funding priorities for PEPFAR to improve HIV prevention in sub-Saharan Africa.

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CROI 2015