Potential Clinical and Economic Impacts of Cutbacks in the President’s Emergency Plan for AIDS Relief Program in South Africa: A Modeling Analysis, Gandhi AR et al, Ann Intern Med, Online ahead of print, Feb 2025

This modelling study simulates HIV programming in South Africa with different levels of cutbacks (0%; 50%; 100%) in PEPFAR funding to determine the clinical and economic consequences. The authors find that abruptly scaling back PEPFAR in South Africa would reverse progress and lead to over half a million additional HIV acquisitions by 2034 and 1.2 life-years lost per person. HIV-related costs would increase within one year relative to current spending, with an excess of USD 1.70 billion by 2034.

Early impacts of the PEPFAR stop-work order: a rapid assessment, Lankiewicz E et al, J Int AIDS Soc, Feb 2025

Following the announcement of the 90-day foreign aid freeze, this rapid assessment documents the disruption to PEPFAR-supported programmes. The surveyed PEPFAR funding recipients reported widespread disruption of HIV services and staff layoffs, most commonly of community-based staff. Nearly one-third of surveyed respondents reported that their organizations had closed either temporarily or permanently. The authors call for an immediate end to the funding freeze and urge the development of rapid waiver-related workplans and budget approvals to mitigate disruptions.

Securing our HIV response: The PEPFAR crisis in South Africa, Grimsrud A et al, S Afr Med J, March 2025

This editorial article describes the significant role of PEPFAR in the HIV response in South Africa over the past 22 years. Recent US policy shifts and the foreign aid freeze have led to immense vulnerability in the country’s HIV programmes. Sustaining the gains made and achieving the global HIV targets by 2030 will be particularly challenging in this new landscape. To mitigate the impact of the sudden loss of USAID-funded PEPFAR support, the authors propose a list of urgent actions. They conclude that this crisis poses an opportunity for the South African government, in partnership with civil society, to reassess urgent health system demands while securing the HIV and TB response and identify strategies to enhance healthcare delivery for long-term sustainability.

Africa’s defining moment: the time to lead the HIV response is now, Chola M et al, The Lancet Glob Health, online first, March 2025

This comment article warns that the HIV response on the African continent is at risk due to a sense of complacency and impact of the recent US policy shifts. In combination with domestic financial instabilities and the risk of disease outbreaks in a context of climate change, these factors have revealed the fragility of the continent’s health systems and revealed an over-reliance on external support and weak supply chains. The authors call for African leadership in global health to foster sustainability, relevance and health sovereignty and outline a vision for Africa’s HIV response that is centred around six crucial pillars.

A turning point for global health: challenge or opportunity? Goosby Eric and Reid MJA, The Lancet, March 2025

This comment article describes the “Enshittoscene” – the current phase of global health decline that is driven by political indifference, economic retrenchment and shifting geopolitical priorities. The authors call for a new strategic approach to global health financing that reflects current economic and political realities and prioritizes locally led, self-sustaining health programmes and a transition to country ownership. During the transition period, financing models should foster co-financing models through development finance institutions, private sector investment and increasing partner government contributions.

Acceptability of six-monthly PrEP dispensing supported with interim HIV self-testing to simplify PrEP delivery in Kenya: findings from qualitative research, Thuo N, BMC Health Serv Res, Oct 2024

Conducted within a randomized control trial, this qualitative study explored the acceptability of six-monthly PrEP dispensing with interim HIVST versus quarterly PrEP dispensing with clinic-based HIV testing. Overall, participants found the novel PrEP/HIVST delivery model highly acceptable and were confident in their ability to participate in the intervention. Confidence in at-home HIVST and PrEP continuation increased following each semi-annual clinic visit. The authors conclude that more comprehensive pre-intervention counselling and training on HIVST may help alleviate clients’ concerns, which were often resolved over time with intervention experience.

Integrated multi-month dispensing for HIV and hypertension in South Africa: A model of epidemiological impact and cost-effectiveness, Jo Y, J Int AIDS Soc, Feb 2025

This modelling study examined the cost effectiveness of integrated multi-month dispensing (MMD) for people living with HIV and hypertension (HTN) over a 10-year period. The integrated scenario assumed that clients received both HIV and HTN drugs at the same facility on the same day every six months (6MMD). This was compared with conventional care, defined as 3MMD and quarterly clinic visits. Results indicate that scale up of 6MMD strategies may be more effective or cost saving when combined with strategies to address multiple conditions and integration. Integrated 6MMD is expected to improve care-seeking and control among clients already in care, reducing loss to follow up and deaths of all clients in care due to improved provider capacity.