Can at Scale Drug Provision Improve the Health of the Targeted in Sub-Saharan Africa?
The single largest item in the United States foreign aid health budget is antiretroviral therapy (ART) for the treatment of HIV/AIDS. Many supply- and demand-side factors in sub-Saharan Africa could cause smaller than expected epidemiological effects of this at scale drug provision. We provide what appears to be the first quasi-experimental evidence on the effect of at scale drug provision in a poor country, using the phased roll-out of ART in Zambia, a setting where approximately 1 in 6 adults are HIV positive. Combining anthropometric data from national household surveys and a spatially-based triple difference specification, we find that local ART introduction increased the weight of high HIV likelihood adult women. This finding from a clinically difficult setting suggest that the generalized challenges of scalability of ART for adult health in sub-Saharan Africa are surmountable.
We would like to thank Herby Derenoncourt, Albert Mwango, Frank Sloan, Jeffrey Stringer, Harsha Thirumurthy, Jenny Trinitapoli, two anonymous referees, and seminar participants at Harvard University, the International Health Economics Association (iHEA) 11th Annual Congress, Northeastern University, the Northwest Development Workshop, the Population Association of America Annual Meeting, Swarthmore College, and the University of Washington for many excellent comments. Madeleine Watson and Wentao Xiong provided superb research assistance. The NBER Africa Project provided generous financial and institutional support. The NBER Africa Project was not involved in study design, data collection/analysis, manuscript writing, and the decision to submit the manuscript for publication. This research would not be possible without the assistance of the Network of Zambian People Living with HIV/AIDS (NZP+), the Zambia Central Statistical Office, and the Zambia Ministry of Health. All errors are our own. The findings, interpretations, and conclusions expressed in this paper are those of the authors and do not necessarily represent the views of the aforementioned individuals or agencies, nor of the National Bureau of Economic Research.
Adrienne M. Lucas & Nicholas L. Wilson, 2018. "Can At-Scale Drug Provision Improve the Health of the Targeted in Sub-Saharan Africa?," American Journal of Health Economics, vol 4(3), pages 358-382. citation courtesy of