Abstract
IntroductionLeadership is a key factor in the success of HIV prevention and treatment. Positive HIV-related outcomes are also affected by funding levels for HIV, health sector resources, disease burden and the socio-economic environment. Leadership on HIV as well as these other factors are affected by the quality of political governance of the country, which may be an overarching factor that influences the making of effective responses to the HIV epidemic.AimThe aim of the study was to investigate the association between quality of political governance, on one hand, and coverage of antiretroviral therapy (ART) and prevention of mother-to-child transmission (PMTCT), on the other, in low- to middle-income countries.MethodsThis investigation was carried out through a global review, online data sourcing and statistical analyses. We collected data on health burden and resources, the socio-economic environment, HIV prevalence, ART and PMTCT coverage and indicators of political governance. Outcome variables were coverage of ART (from 2004) and PMTCT (from 2007) to 2009 as a percentage of persons needing it. Potential predictors of treatment coverage were fitted with a baseline multilevel model for univariable and multivariable analyses.ResultsCountries with higher levels of political voice and accountability, more political stability and better control of corruption have higher levels of ART coverage but not PMTCT coverage. Control of corruption (in standard deviation units) had a strong association with ART (AOR=1.82, p=0.002) and PMTCT (AOR=1.97, p=0.01) coverage. Indicators of economic development were not significant when control of corruption was included in the multivariable regression model. Many countries in all income groups had high ART but not PMTCT coverage (e.g. Mexico, Brazil and Romania in the upper-middle-income group; Papua New Guinea and Philippines in the lower-middle-income group; and Cambodia, Laos and Comoros in the low-income group). Very few low-income countries (notably, Haiti and Kenya) had high PMTCT coverage.ConclusionsOur research found a significant relationship between quality of political governance and treatment coverage. Measures and policies for improving the quality of political governance should be considered as a part of HIV programme implementation to more effectively improve the welfare of people living with HIV, particularly mothers living with HIV and their babies.
Highlights
Leadership is a key factor in the success of HIV prevention and treatment
Outcomes: antiretroviral therapy (ART) and prevention of mother-to-child transmission (PMTCT) coverage The outcome variables chosen for analyses were: 1) ART coverage from 2004 to 2009, as a percentage of the number of persons living with HIV and needing ART, as estimated by United Nations Programme on HIV and AIDS (UNAIDS): The need for ART is defined by the criteria of having clinical signs of severe immune suppression and/or a CD4 cell count B200 cells per microliter [18]
Estimates of PMTCT coverage were less complete in earlier years, with fewer than 50 countries having estimates of PMTCT within each year before 2008; this increased to 74 countries in 2008 and 108 countries in 2009
Summary
Leadership is a key factor in the success of HIV prevention and treatment. Positive HIV-related outcomes are affected by funding levels for HIV, health sector resources, disease burden and the socio-economic environment. We collected data on health burden and resources, the socio-economic environment, HIV prevalence, ART and PMTCT coverage and indicators of political governance. As Piot and Seck [4] state, a central component in changing the epidemic’s course is the willingness of leaders, at both national and provincial levels, to make a political commitment to respond to the epidemic, to acknowledge the AIDS crisis and to swiftly implement interventions even in the face of opposition This political commitment is the extent to which leaders support HIV as a priority on the national, provincial or local agenda as evidenced through actions that include legislative, financial and programmatic components. Others have shown that there is a relationship between HIV-related health coverage and funding levels, health sector resources, disease burden and socio-economic development [6Á9] Both political leadership on HIV and other factors affecting HIV-related
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