Author Affiliation: Bureau for Global Health, US Agency for International Development, Washington, DC (email@example.com).
To the Editor: The analysis by Dr Bendavid and colleagues1 may have overestimated the association of the President's Emergency Plan for AIDS Relief (PEPFAR) with adult mortality. Nigeria and Ethiopia together represent 60% of the population among the 9 PEPFAR focus countries, yet their prevalence of human immunodeficiency virus (HIV) is much lower than the other focus countries (3.6% for Nigeria, 1.4% for Ethiopia vs an average of 8.5% for the other 7 countries).2,3 Where HIV prevalence is lower, one would expect the effect on overall adult mortality to be lower. The numbers of people in Nigeria and Ethiopia receiving antiretroviral therapy under PEPFAR are similar to the average of the other smaller 7 focus countries. However, in eTable 3 of the article,1 the authors projected essentially the same 15% reduction in mortality for both Nigeria and Ethiopia as the overall estimate across all 9 countries. The overall projected estimate should have been better weighted based on prevalence and population size.
Shelton JD. PEPFAR and Adult Mortality. JAMA. 2012;308(10):972-973. doi:10.1001/jama.2012.9243