The impact of the PEPFAR funding freeze on HIV deaths and infections: a mathematical modelling study of seven countries in sub-Saharan Africa.

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dc.contributor.authorHontelez JAC
dc.contributor.authorGoymann H
dc.contributor.authorBerhane Y
dc.contributor.authorBhattacharjee P
dc.contributor.authorBor J
dc.contributor.authorChabata ST
dc.contributor.authorCowan F
dc.contributor.authorKimani J
dc.contributor.authorKnox J
dc.contributor.authorLora WS
dc.contributor.authorLungu C
dc.contributor.authorManne-Goehler J
dc.contributor.authorMauti J
dc.contributor.authorMoshabela M
dc.contributor.authorMpembeni RM
dc.contributor.authorWa Mwanza M
dc.contributor.authorNdung'u T
dc.contributor.authorOmondi E
dc.contributor.authorPhiri S
dc.contributor.authorSiedner M
dc.contributor.authorTanser FC
dc.contributor.authorde Vlas SJ
dc.contributor.authorBärnighausen TW
dc.date.accessioned2025-09-17T10:25:39Z
dc.date.issued2025-May
dc.description.abstractBACKGROUND: On January 24, 2025, the United States government issued an executive order to freeze all foreign aid programs, including The President's Emergency Plan for AIDS Relief (PEPFAR), for 90 days. A limited waiver option became available, but its implementation remains incomplete. We estimated the impact of these policy changes on HIV deaths and new infections in seven sub-Saharan African (SSA) countries-Ethiopia, Kenya, Malawi, South Africa, Tanzania, Zambia, and Zimbabwe -, which together account for about half of all people living with HIV in SSA. METHODS: We used STDSIM, an established individual-based simulation model, and previously published quantifications for the seven countries. We predicted changes in HIV deaths and new infections over the period 2025-2030 for four scenarios: (1) FINDINGS: A 90-day funding freeze would result in 60 thousand [95% UI: 49-71 thousand] excess HIV deaths for the INTERPRETATION: The sudden cessation of PEPFAR funding likely results in tens of thousands of HIV deaths and new infections. These losses of life and health should compel the United States government to rapidly and fully re-instate one of the most successful health programs in history. FUNDING: None.
dc.identifier.doi10.1016/j.eclinm.2025.103233
dc.identifier.urihttps://pubs.cidrz.org/handle/123456789/11871
dc.identifier.uri.pubmedhttps://pubmed.ncbi.nlm.nih.gov/40626258/
dc.relation.affiliationDepartment of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
dc.relation.affiliationHeidelberg Institute of Global Health (HIGH), Medical Faculty and University Hospital, Heidelberg University, Germany.
dc.relation.affiliationHeidelberg Institute of Global Health (HIGH), Medical Faculty and University Hospital, Heidelberg University, Germany.
dc.relation.affiliationDepartment of Epidemiology and Biostatistics, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia.
dc.relation.affiliationInstitute of Global Public Health, University of Manitoba, Winnipeg, Manitoba, Canada.
dc.relation.affiliationPartners for Health and Development in Africa, Nairobi, Kenya.
dc.relation.affiliationDepartment of Global Health and Epidemiology, School of Public Health, Boston University, Boston, MA, USA.
dc.relation.affiliationCentre for Sexual Health and HIV AIDS Research (CeSHHAR) Zimbabwe, Harare, Zimbabwe.
dc.relation.affiliationDepartment of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK.
dc.relation.affiliationCentre for Sexual Health and HIV AIDS Research (CeSHHAR) Zimbabwe, Harare, Zimbabwe.
dc.relation.affiliationDepartment of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK.
dc.relation.affiliationInstitute of Global Public Health, University of Manitoba, Winnipeg, Manitoba, Canada.
dc.relation.affiliationPartners for Health and Development in Africa, Nairobi, Kenya.
dc.relation.affiliationDepartment of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA.
dc.relation.affiliationHIV Center for Clinical and Behavioral Studies, NewYork State Psychiatric Institute and Columbia University, New York, New York, USA.
dc.relation.affiliationDepartment of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York, USA.
dc.relation.affiliationPublic Health Group, Malawi Liverpool Wellcome Trust-Clinical Research Programme, Lilongwe, Malawi.
dc.relation.affiliationCentre for Infectious Disease Research in Zambia (CIDRZ)
dc.relation.affiliationDepartment of Pathology, Erasmus University Medical Center, Rotterdam, the Netherlands.
dc.relation.affiliationDivision of Infectious Diseases, Brigham and Women's Hospital, Medical Practice Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
dc.relation.affiliationHeidelberg Institute of Global Health (HIGH), Medical Faculty and University Hospital, Heidelberg University, Germany.
dc.relation.affiliationUniversity of Cape Town, Cape Town, South Africa.
dc.relation.affiliationMuhimbili University of Health and Allied Sciences, School of Public Health and Social Sciences, Dar es Salaam, Tanzania.
dc.relation.affiliationCentre for Infectious Disease Research in Zambia (CIDRZ)
dc.relation.affiliationAfrica Health Research Institute (AHRI), Somkhele and Durban, South Africa.
dc.relation.affiliationHIV Pathogenesis Programme, The Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa.
dc.relation.affiliationRagon Institute of Mass General Brigham, Massachusetts Institute of Technology and Harvard University, Cambridge, Massachusetts, USA.
dc.relation.affiliationDivision of Infection and Immunity, University College London, London, UK.
dc.relation.affiliationAfrican Population and Health Research Center (APHRC), Nairobi, Kenya.
dc.relation.affiliationInstitute of Mathematical Sciences, Strathmore University, Nairobi, Kenya.
dc.relation.affiliationPartners in Hope, Lilongwe, Malawi.
dc.relation.affiliationSchool of Global and Public Health, Kamuzu University of Health Sciences, Lilongwe, Malawi.
dc.relation.affiliationAfrica Health Research Institute (AHRI), Somkhele and Durban, South Africa.
dc.relation.affiliationDepartment of Medicine, Harvard Medical School, Boston, MA, USA.
dc.relation.affiliationAfrica Health Research Institute (AHRI), Somkhele and Durban, South Africa.
dc.relation.affiliationSouth African Centre for Epidemiological Modelling and Analysis, Centre for Epidemic Response and Innovation, School for Data Science and Computational Thinking, Stellenbosch University, Stellenbosch, South Africa.
dc.relation.affiliationDepartment of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
dc.relation.affiliationHeidelberg Institute of Global Health (HIGH), Medical Faculty and University Hospital, Heidelberg University, Germany.
dc.relation.affiliationAfrica Health Research Institute (AHRI), Somkhele and Durban, South Africa.
dc.relation.affiliationDepartment of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA.
dc.sourceEClinicalMedicine
dc.titleThe impact of the PEPFAR funding freeze on HIV deaths and infections: a mathematical modelling study of seven countries in sub-Saharan Africa.

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