Impact of PEPFAR Funding Freezes on HIV Treatment Access and Projected Outcomes, January–June 2025
1
International Association of Providers of AIDS Care, Washington, DC, United States
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
INTRODUCTION:
The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) has been pivotal in expanding global access to antiretroviral therapy (ART). In early 2025, funding freezes disrupted ART supply chains and service delivery, raising concerns about continuity of care, workforce stability, and public health outcomes. This study analyzes the impact of these freezes on HIV treatment access, with projections for new infections, morbidity, and mortality.
METHODS:
A comparative analysis of service delivery data from PEPFAR-supported sites across 12 countries was conducted, comparing January–June 2025 against the baseline period of July–December 2024. Metrics included ART initiation and refill rates, viral load monitoring, and retention in care. Interrupted time series analysis assessed changes in service delivery. Projections of new infections and health outcomes were estimated using a transmission model incorporating the effects of treatment interruptions on viral rebound and onward transmission. Qualitative interviews with health workers and program managers provided context on systemic disruptions.
RESULTS:
ART refill rates declined by an average of 18%, with the steepest drops in sub-Saharan Africa. Viral load monitoring decreased by 22%, limiting early detection of treatment failure. Funding freezes altered the HIV care delivery ecosystem, leading to health worker layoffs, clinic closures, and reduced capacity of community-based organizations. Modeling suggests that treatment gaps and viral rebound could result in up to 145,000 additional new HIV infections and 65,000 excess AIDS-related deaths globally in 2025 if freezes persist. Providers reported widespread patient disengagement, stigma, and declining trust in health systems.
CONCLUSIONS:
PEPFAR funding freezes disrupted ART access and destabilized HIV care delivery ecosystems, threatening progress toward epidemic control. Projections indicate substantial increases in new infections, morbidity, and mortality due to disrupted treatment-as-prevention benefits. Safeguarding continuity of funding, protecting the health workforce, and ensuring emergency buffers for ART supply are critical to sustain global HIV gains.
The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) has been pivotal in expanding global access to antiretroviral therapy (ART). In early 2025, funding freezes disrupted ART supply chains and service delivery, raising concerns about continuity of care, workforce stability, and public health outcomes. This study analyzes the impact of these freezes on HIV treatment access, with projections for new infections, morbidity, and mortality.
METHODS:
A comparative analysis of service delivery data from PEPFAR-supported sites across 12 countries was conducted, comparing January–June 2025 against the baseline period of July–December 2024. Metrics included ART initiation and refill rates, viral load monitoring, and retention in care. Interrupted time series analysis assessed changes in service delivery. Projections of new infections and health outcomes were estimated using a transmission model incorporating the effects of treatment interruptions on viral rebound and onward transmission. Qualitative interviews with health workers and program managers provided context on systemic disruptions.
RESULTS:
ART refill rates declined by an average of 18%, with the steepest drops in sub-Saharan Africa. Viral load monitoring decreased by 22%, limiting early detection of treatment failure. Funding freezes altered the HIV care delivery ecosystem, leading to health worker layoffs, clinic closures, and reduced capacity of community-based organizations. Modeling suggests that treatment gaps and viral rebound could result in up to 145,000 additional new HIV infections and 65,000 excess AIDS-related deaths globally in 2025 if freezes persist. Providers reported widespread patient disengagement, stigma, and declining trust in health systems.
CONCLUSIONS:
PEPFAR funding freezes disrupted ART access and destabilized HIV care delivery ecosystems, threatening progress toward epidemic control. Projections indicate substantial increases in new infections, morbidity, and mortality due to disrupted treatment-as-prevention benefits. Safeguarding continuity of funding, protecting the health workforce, and ensuring emergency buffers for ART supply are critical to sustain global HIV gains.
| eISSN: | 2654-1459 |
We process personal data collected when visiting the website. The function of obtaining information about users and their behavior is carried out by voluntarily entered information in forms and saving cookies in end devices. Data, including cookies, are used to provide services, improve the user experience and to analyze the traffic in accordance with the Privacy policy. Data are also collected and processed by Google Analytics tool (more).
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
