School of Public Health an d Community Medicine

Analysis of political governance as a determinant of ART

coverage using country level data

Man, W.Y.N. 1, Worth, H1. Kelly, A. 2, Wilson, D. 3 & Siba, P. 2,

1 International HIV Research Group, University of New South Wales, Sydney, Australia

2 Papua New Guinea Institute of Medical Research, Papua New Guinea

3 Kirby Institute, University of New South Wales, Australia

Rationale and Method• Considerable interest arisen in the role of governance

or political commitment in determining success or failure of HIV/AIDS policies and programs, including roll-out of ART

• Aim of this project was to investigate governance as a determinant of ART roll-out in PNG (using country-level data) but grew bigger than that

• Collection of (low to middle income) country-level data on:• Health burden and resources; socio-demography;

economy; development; equality• HIV prevalence; ART coverage (from UNAIDS/WHO

databases, UNGASS reports)• Indicators of political governance (World Bank)- political

voice and accountability; political stability; control of corruption; government effectiveness; rule of law; regulatory quality; democracy scores (Polity IV Project)

• Study funded by the PNG AIDS Council

Statistical Model/Analysis/Results• Outcome variables: ART coverage 2009 as % persons

needing it (UNGASS Indicator 4)• Baseline multi-level model for univariate analyses of each

potential predictor of ART coverage. Variables with p<0.10 tested in multivariate multi-level model, and again in final model.

Results show:• Countries with higher levels of voice, accountability, lower

regulatory quality, more political stability, better control of corruption have higher levels of ART coverage

• Control of corruption strongly associated with ART coverage • Indicators of economic development dropped out when

control of corruption was included in multivariate regression model

• Somalia, Myanmar, DR Congo, Chad, PNG,and Angola (with high levels of corruption) had relatively poor ART coverage

• Countries with better control of corruption (e.g. Chile, Uruguay and Botswana) had relatively better ART coverage

Predictors of percentage of ART coverage (logit-transformed; based on UNAIDS estimates; N=678).

a Rescaled so that the plausible range is from 0 to10 (original plausible range was from 0 to 1). b χ2 statistic is estimated from (F statistic)X(numerator degrees of freedom).