ArticlePloS one2019
Effect of PEPFAR funding policy change on HIV service delivery in a large HIV care and treatment network in Nigeria.
Article in PloS one, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 1 of them a synthesis that pooled it.
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Who cites it
23 citing papers in PubMed, 1 synthesis or guideline pooled it, 45 citations in OpenAlex.
- Barriers to and enablers of adherence to the treatment of active drug-sensitive tuberculosis in people living with HIV: a mixed method systematic review.BMC public health · 2025Pooled it
- Laboratory test availability and user fees in routine HIV care: a global analysis in 42 countries.Health affairs scholar · 2026Article
- Early impacts of PEPFAR funding freeze on HIV service delivery in mid-Western Uganda.BMC health services research · 2026Article
- Limited user fees for adult HIV diagnosis and routine laboratory monitoring in the global IeDEA consortium: analysis in 42 countries.medRxiv : the preprint server for health sciences · 2025Article
- Shaping sustainable paths for HIV/AIDS funding: a review and reminder.Annals of medicine and surgery (2012) · 2025Review
- Intergovernmental Learning Exchange to Advance Data-Driven Decision Making: Experiences from Nigeria.F1000Research · 2025Article
- Feasibility and Impact of Community Pharmacy and Novel Pick-up Points for Antiretroviral Therapy Pre-exposure Prophylaxis Initiation and Continuation in Low and Middle-income Countries.Current HIV/AIDS reports · 2024Review
- A Mixed-Methods Evaluation of Mainstreaming Mass Drug Administration for Schistosomiasis and Soil-Transmitted Helminthiasis in Four Districts of Nigeria.The American journal of tropical medicine and hygiene · 2024Article
- The impact of shifts in PEPFAR funding policy on HIV services in Eastern Uganda (2015-21).Health policy and planning · 2024Article
- Stakeholders' Perspectives on the Financial Sustainability of the HIV Response in Nigeria: A Qualitative Study.Global health, science and practice · 2023Article
- Potential risk factors for cardiovascular diseases and associated sociodemographic characteristics: A cross-sectional evaluation of a large cohort of women living with HIV in north-central Nigeria.PLOS global public health · 2023Article
- A multicenter survey of asymptomatic cryptococcal antigenemia among patients with advanced HIV disease in Nigeria.PLOS global public health · 2023Article
- Whose rights are being violated when receiving HIV and sexual and reproductive health services in Nigeria?BMC health services research · 2022Article
- Analyses of Kaposi Sarcoma trends among adults establishing initial outpatient HIV care in Nigeria: 2006-2017.Infectious agents and cancer · 2022Article
- Evaluation of the Nigeria national HIV rapid testing algorithm.PLOS global public health · 2022Article
- Emerging Use of Public-Private Partnerships in Public Radiotherapy Facilities in Nigeria.JCO global oncology · 2021Article
- Exploring perceived effects from loss of PEPFAR support for outreach in Kenya and Uganda.Globalization and health · 2021Article
- The impact of loss of PEPFAR support on HIV services at health facilities in low-burden districts in Uganda.BMC health services research · 2021Article
- Program sustainability post PEPFAR direct service support in the Western Cape, South Africa.PloS one · 2021Article
- Collective insights of public-private partnership impacts and sustainability: A qualitative analysis.PloS one · 2021Article
Corrections and comments
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Authors and funding
10 authors at 4 institutions in 2 countries.
Funding
Abstract
The transition to PEPFAR 2.0 with its focus on country ownership was accompanied by substantial funding cuts. We describe the impact of this transition on HIV care in a large network of HIV clinics in Nigeria. We surveyed 30 comprehensive HIV treatment clinics to assess services supported before (October 2013-September 2014) and after (October 2014-September 2015) the PEPFAR funding policy change, the impact of these policy changes on service delivery areas, and response of clinics to the change. We compared differences in support for staffing, laboratory services, and clinical operations pre- and post-policy change using paired t-tests. We used framework analysis to assess answers to open ended questions describing responses to the policy change. Most sites (83%, n = 25) completed the survey. The majority were public (60%, n = 15) and secondary (68%, n = 17) facilities. Clinics had a median of 989 patients in care (IQR: 543-3326). All clinics continued to receive support for first and second line antiretrovirals and CD4 testing after the policy change, while no clinics received support for other routine drug monitoring labs. We found statistically significant reductions in support for viral load testing, staff employment, defaulter tracking, and prevention services (92% vs. 64%, p = 0.02; 80% vs. 20%, 100% vs. 44%, 84% vs. 16%, respectively, p<0.01 for all) after the policy change. Service delivery was hampered by interrupted laboratory services and reduced wages and staff positions leading to reduced provider morale, and compromised quality of care. Almost all sites (96%) introduced user fees to address funding shortages. Clinics in Nigeria are experiencing major challenges in providing routine HIV services as a result of PEPFAR's policy changes. Funding cutbacks have been associated with compromised quality of care, staff shortages, and reliance on fee-based care for historically free services. Sustainable HIV services funding models are urgently needed.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.