The researchers found that in the years leading up the program, death rates rose in all of the countries studied. As PEPFAR funding became available, the death toll declined by more than 10 percent in the focus countries, compared to the control countries, with more than 1 million lives saved, the researchers estimated. The difference in death rates was most pronounced between 2005 and 2006, during PEPFAR's third year of operation.
The researchers calculated that for every life saved, PEPFAR spent roughly $2,450 on treatment. "This is not a trivial cost, and PEPFAR will need to make the available resources go a long way to continue changing the course of the epidemic," Bendavid said.
As more people survived with antiretroviral treatment, the number of those living with HIV rose more rapidly in the PEPFAR countries, compared with the control countries. But there was no significant difference in adult prevalence of HIV between the focus countries and the control countries, either before or after the program was launched. "For prevalence, the trends remain perfectly parallel, regardless of when PEPFAR came in," Bendavid said.
It is difficult to know exactly why those trends remained parallel, but understanding the epidemiology of new infections would help solve that question, he said. Even today, for every two people who start antiretroviral treatment, there are five others who become newly infected with the virus.
"Reducing the number of infections has to be a crucial part of any major program," Bendavid said.
As the program enters a new phase under the Obama administration, Bendavid said it's important that it continually be monitored and evaluated to ensure these vast taxpayer funds are efficiently spent.
"It is working," he said of the program. "It's reducing the death toll from HIV. People who are not dying may be able to work and support their families and their local economy." But he noted, "evaluating how the money is being spent, and which aspects of the program work best, could help it improve."