PEPFAR Spending Types and Reduction in HIV Infection Rates

Abstract Since 2004, PEPFAR has invested over $100 billion in fighting HIV, primarily targeting sub-Saharan Africa. This study examines the effectiveness of spending types as defined by the program. In this study, I take the spending data published by PEPFAR that was categorized into key focus areas that include (1) Care & Treatment, (2) Testing, (3) Prevention, (4) Socioeconomic, and (5) Above-site, Program Management and Other, and estimate the effectiveness of these categories on a key outcome variable: new HIV infections. I also estimate the same regressions for the period prior to and post PEPFAR 2.0 that was implemented in 2014. Data was collected from public sources including PEPFAR, the GHO, and the World Bank and a total of $61.5 billion in spending was identified from 2005-2021 covering 54 target countries. Main Outcome(s) and Measure(s)The marginal dollar spent on prevention activities experienced the highest incremental effect of reducing new HIV infections in targeted countries from 2005-2021. The coefficient on Prevention spending was -0.715 (t-stat of -2.83), which was highly significant at the 1 percent level. However, much of this effect was driven by pre-2014 spending before PEPFAR 2.0 was implemented. Post 2014, socioeconomic programs were measured to have the greatest marginal effect. Overall effectiveness of spending increased post PEPFAR 2.0.