BACKGROUND:UNAIDS estimates global HIV investment needs in low- and middle-income countries (LMICs) at 26billionperyearin2020.YetinternationalfinancingforHIVprogramshasstagnatedamidstdespitetheincreasingnumberofpeoplerequiringandaccessingtreatment.DespiteincreasedefficienciesinHIVservicedelivery,evaluatingprogramsforgreaterefficienciesremainsnecessary.WhileHIVbudgetshavebeenunderscrutinyinrecentyears,indirectcostshavenotbeenquantifiedforanymajorglobalHIVprogram,butmayconstituteanadditionalavenuetoidentifyprogramefficiencies.ThisanalysispresentsamethodforestimatingindirectcostsinthePresident′sEmergencyPlanforAIDSRelief(PEPFAR).METHODS:UtilizingPEPFARcountryoperationalplan(COP)fundingdatafrom2007to2016forinternationalorganizations(IOs)anduniversitiesandstandardregulatorycostbases,wecalculatedmodifiedtotaldirectcostsonwhichindirectcostratesmaybeappliedbypartnerandfundingagency.Wethenapplyaseriesofplausibleindirectcostrates(1037.01 billion in total COP funding between 2007 and 2016, 22.24billion(60.0817.95B) and universities (4.29B).Afterexcludingfundingforsub−awards(1.92B) and other expenses (3.89B)towhichindirectratescannotbeapplied,16.44B remained in combined direct and indirect costs. From this, we estimate that between 1.85B(8.304.34B (19.51%) has been spent on indirect costs from 2007-2016, including 157−369 million in 2016. INTERPRETATION:To our knowledge, this is the first analysis to quantify the indirect costs of major implementing partners of a global HIV funder. However, lack of transparency in the indirect cost rates of non-University international partners creates an opaque layer of programmatic costs. Given the current funding environment and evolution of HIV programming in PEPFAR countries, the findings motivate a re-examination of the current policies and the return on investment in indirect cost recovery across the PEPFAR program
The purpose of this study was to ascertain COVID-19 transmission dynamics among Latino communities nationally.
We compared predictors of COVID-19 cases and deaths between disproportionally Latino counties (≥17.8% Latino population) and all other counties through May 11, 2020. Adjusted rate ratios (aRRs) were estimated using COVID-19 cases and deaths via zero-inflated binomial regression models.
COVID-19 diagnoses rates were greater in Latino counties nationally (90.9 vs. 82.0 per 100,000). In multivariable analysis, COVID-19 cases were greater in Northeastern and Midwestern Latino counties (aRR: 1.42, 95% CI: 1.11–1.84, and aRR: 1.70, 95% CI: 1.57–1.85, respectively). COVID-19 deaths were greater in Midwestern Latino counties (aRR: 1.17, 95% CI: 1.04–1.34). COVID-19 diagnoses were associated with counties with greater monolingual Spanish speakers, employment rates, heart disease deaths, less social distancing, and days since the first reported case. COVID-19 deaths were associated with household occupancy density, air pollution, employment, days since the first reported case, and age (fewer <35 yo).
COVID-19 risks and deaths among Latino populations differ by region. Structural factors place Latino populations and particularly monolingual Spanish speakers at elevated risk for COVID-19 acquisition