1. Investing In HIV Services While Building Kenya’s Health System: PEPFAR’s Support To Prevent Mother-to-Child HIV Transmission Arin Dutta, PhD Futures Group Authors: Arin Dutta, Nathan Wallace, Peter Savosnick, John Adungosi, Urbanus Mutuku Kioko, Scott Stewart, Mai Hijazi, and Bedan Gichanga Health Affairs suppl. July 2012 Abstract WEPDE0104

2. Research Question What was the trend in PEPFAR expenditures related to the PMTCT program in Kenya during PEPFAR-I and PEPFAR-II across service delivery (SD) and health system strengthening (HSS)? Approach Collected expenditure and output data from 2005 – 2010 on two USAID partners - FHI 360 and the Elizabeth Glaser Pediatric AIDS Foundation Examined changes in expenditures over the period, as disaggregated by SD and HSS, per the following denominators –mothers reached with ARVs –infant HIV infections averted Kenya PMTCT Case Study

3. Number of HIV-Infected Mothers Receiving ARV Drugs at FHI360 and EGPAF Sites PEPFAR I

4. Expenditure per HIV-positive mother provided with ARVs HSS ($567) 12%

5. Expenditure per Infant Infection Averted * Excludes expenditure on commodities & logistics support HSS

6. Conclusions While the HSS proportion of expenditures increased 33%, project outputs increased and expenditures decreased There is no evidence to suggest that investing in HSS impeded the rapid scale-up of PMTCT services How investing in HSS might affect future output and costs is uncertain. However, if implemented effectively, HSS should contribute to greater sustainability.