ArticleAnnals of internal medicine2025
Potential Clinical and Economic Impacts of Cutbacks in the President's Emergency Plan for AIDS Relief Program in South Africa : A Modeling Analysis.
Article in Annals of internal medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers.
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Who cites it
27 citing papers in PubMed.
- The second Trump presidency: Health care themes, policies, and impacts in his first year back in office.Health policy (Amsterdam, Netherlands) · 2026Article
- Estimated HIV cases and costs in South Africa due to global warming from 2000 to 2050: a modeling study.Scientific reports · 2026Article
- The Delivery Disconnect: Why We Could Not Model the Impact of Foreign Aid Reductions on Vertical HIV Transmission and What Remains Evident About Strategic Priorities.Journal of the International AIDS Society · 2026Article
- Demanding solidarity, not salvation: sex work and global health.BMJ global health · 2026Review
- Implications of year 1 Trump Administration policies for Americans' lung health.American journal of respiratory and critical care medicine · 2026Article
- Sustaining policy promise: rhetorics of disease elimination and sustainable development.Medical humanities · 2026Article
- Sustaining Rwanda's HIV response after elimination of PEPFAR funding: a modelling analysis of HIV epidemic and care continuum outcomes.Journal of the International AIDS Society · 2026Article
- Article
- A qualitative exploration of psychosocial determinants influencing viral load suppression among adolescents living with HIV: Application of social action theory.Health SA = SA Gesondheid · 2026Article
- The impact of US Government Stop Work Order on HIV epidemic trajectory in Zimbabwe.PLOS global public health · 2026Article
- Measuring health financing vulnerability due to reductions in official development assistance: A conceptual framework with empirical application across 47 African countries.PLOS global public health · 2026Article
- A roadmap to scale up person-centred care in the HIV response: recommendations from a global consensus-building process.Journal of the International AIDS Society · 2025Article
- Case study of PEPFAR funding cuts on HIV infections and deaths: reversing hard-won gains.AIDS (London, England) · 2025Article
- Silence=Death Redux: Infectious Diseases, Public Health, and the Imperative to Resist.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2025Article
- The impact of cuts in the US President's Emergency Plan for AIDS Relief funding for HIV pre-exposure prophylaxis in sub-Saharan Africa: a modelling study.The lancet. HIV · 2025Article
- At a crossroads: confronting setbacks and advancing the 95-95-95 HIV targets in sub-Saharan Africa.AIDS research and therapy · 2025Review
- Article
- Impacts of US Bilateral Aid Disruptions on HIV Resurgence in Zambia: A Mathematical Modeling Study.Open forum infectious diseases · 2025Article
- The great mismatch: unfulfilled promise of biomedical HIV prevention.AIDS (London, England) · 2025Article
- The impact of the PEPFAR funding freeze on HIV deaths and infections: a mathematical modelling study of seven countries in sub-Saharan Africa.EClinicalMedicine · 2025Article
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Authors and funding
8 authors.
Funding
Abstract
backgroundFuture U.S. congressional funding for the President's Emergency Plan for AIDS Relief (PEPFAR) program is uncertain.
objectiveTo evaluate the clinical and economic impacts of abruptly scaling back PEPFAR funding ($460 million) from South Africa's total HIV budget ($2.56 billion) in 2024.
designModel-based analysis of 100%, 50%, and 0% PEPFAR funding with proportional decreases in HIV diagnosis rates (26.0, 24.3, 22.6 per 100 person-years [PY]), 1-year treatment engagement (people with HIV [PWH] receiving/initiating antiretroviral therapy: 92.2%/80.4%, 87.1%/76.0%, 82.0%/71.5%), and primary prevention (4.0%, 2.2%, 0.5% reduction in incidence with no programming [1.24 per 100 PY]). DATA SOURCES: Published HIV care continuum; PEPFAR funding estimates. TARGET POPULATION: South African adults (HIV prevalence, 16.2%; incidence, 0.32 per 100 PY). TIME HORIZON: Lifetime. PERSPECTIVE: Health care sector.
interventionPEPFAR funded 100% (PEPFAR_100%), 50% (PEPFAR_50%), or 0% (PEPFAR_0%). OUTCOME MEASURES: HIV infections, life expectancy, and lifetime costs (2023 U.S. dollars). RESULTS OF BASE-CASE ANALYSIS: With current HIV programming (PEPFAR_100%), 1 190 000 new infections are projected over 10 years; life expectancy would be 61.42 years for PWH, with lifetime costs of $11 180 per PWH. Reduced PEPFAR funding (PEPFAR_50% and PEPFAR_0%) would add 286 000 and 565 000 new infections, respectively. PWH would lose 2.02 and 3.71 life-years with nominal lifetime cost reductions of $620 per PWH and $1140 per PWH that would be offset at the population level by more PWH requiring treatment for infection. RESULTS OF SENSITIVITY ANALYSIS: Countries with similar HIV prevalence and greater reliance on PEPFAR funding could experience disproportionately higher incremental infections and survival losses. LIMITATION: Budget fungibility and exact programmatic implications of reducing PEPFAR funding are unknown.
conclusionAbrupt PEPFAR cutbacks would have immediate and long-term detrimental effects on epidemiologic and clinical HIV outcomes in South Africa. PRIMARY FUNDING SOURCE: National Institutes of Health.
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