PEPFAR Impact Tracker

The impact counters have been redefined in light of continuous peer review, now reflecting the total number of deaths that have occurred to date, rather than the anticipated lifetime impact of a disruption. Detailed information regarding the current methodology is provided below.

Number of adult deaths to date

For the current estimation, we utilized existing modeling research that assessed the impact of a six-month cessation of HIV services in sub-Saharan Africa, which resulted in an average of 679,000 deaths within one year [1]. To adjust these estimates for a three-month pause, we halved the reported number of deaths, resulting in 339,000 deaths (while taking half of the number of deaths may be an overestimate in the short term, this assumption takes into account that a significant proportion of people who interrupt treatment will likely face some delay in restarting and therefore be off ART for three months or more). In this analysis, we assumed a complete disruption over a three-month period and averaged the results across five mathematical models. Given that PEPFAR funds approximately 47% of HIV programs in PEPFAR countries in sub-Saharan Africa, [2], we estimated that 47% of the deaths would be attributable to a complete suspension of PEPFAR funding, leading to a total of 159,000 deaths over one year if the disruption results in an average 3 month interruption of ART. It is important to note that these results pertain solely to sub-Saharan Africa and do not include PEPFAR investments made outside this region.

Why does pausing treatment services result in deaths?

The recovery of the immune system among individuals living with HIV through antiretroviral therapy can take several years. However, this recovery is quickly compromised when the virus begins to replicate in the absence of treatment [1],[3],[4].

What was not included?

In addition to adult deaths to date from the sudden cessation of life-saving medication, HIV treatment also stops HIV transmission. Without antiretroviral therapy, individuals are more likely to transmit the virus, leading to new infections. These new cases have a multiplicative effect, driving further HIV transmission and resulting in additional future HIV infections and deaths.

Number of additional infants/children infected with HIV

In countries receiving PEPFAR support, UNAIDS estimates that approximately 920,000 women are utilizing prevention of mother-to-child transmission (PMTCT) services [5]. The transmission rate of HIV to infants/children from untreated pregnant or breastfeeding women is approximately 40% [6]. Conversely, when antiretroviral treatment is administered, the transmission rate significantly decreases to about 1% [7]. The projected number of new infections without PEPFAR support over three months would be calculated as follows: 920,000 multiplied by the difference between 40% and 1%, divided by four, resulting in 90,000 infant/child infections if all were supported by PEPFAR. Assuming PEPFAR accounts for 47% of HIV-related expenditures in these countries [2], we multiply the estimated infant/child infections by 47%, yielding a total of 42,300 infections attributable to the cessation of PEPFAR funding. This estimate is conservative, as it is likely that PEPFAR finances more than 47% of PMTCT services.

Number of infant/child deaths to date

We further assumed that infants/children who were vertically infected with HIV and do not receive treatment, 20% are expected to die within three months [8]. For this calculation, assuming the midpoint of the three-month period, we estimate that 10% of infants/children infected during this 90-day interval will die due to lack of access to PEPFAR-procured antiretroviral treatment. This results in an estimate of 4,230 deaths over the three-month period.

How will this tracker change in the future?

As services resume following clarification of the waiver, these impacts will be reassessed, and the counters will be adjusted to reflect the restoration of services.

The calculations on this website have been endorsed by several independent modellers working as part of the HIV Modelling Consortium (http://hivmodeling.org/) (Andrew Phillips, Rowan Martin-Hughes, Paul Revill, John Stover, Edinah Mudimu)

Much of the underlying data to this model would not be possible without the UNAIDS compiled and produced data.

The PEPFAR Impact Counter is operated with support from Boston University's Center on Emerging Infectious Diseases

Have questions about our methodology?

Ask a Question

How are infant, child, and adult deaths estimated?