{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T08:26:29Z","timestamp":1792657589524,"version":"4.5.0"},"reference-count":7,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T00:00:00Z","timestamp":1756944000000},"content-version":"vor","delay-in-days":3,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Int AIDS Soc."],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Beginning in late January\u00a02025, Stop\u2010Work orders and contract cancellations have disrupted HIV programmes supported by the President's Emergency Plan for AIDS Relief (PEPFAR). We assessed the effects on HIV service delivery in four African countries.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Weekly aggregate HIV services data from a convenience sample of 165\u00a0Center for Disease Control and Prevention (CDC)\u2010funded, ICAP\u2010supported facilities\u201422\u00a0in Angola, 75\u00a0in the Democratic Republic of the Congo (DRC), 20\u00a0in South\u00a0Sudan and 48\u00a0in Zambia\u2014were analysed. We compared data from pre\u2010Stop\u2010Work (7 October 2024\u201323 January\u00a02025), Stop\u2010Work (24 January 2025\u201311 February 2025) and post\u2010resumption (12 February 2025\u201331 March 2025) phases. We examined the number of individuals: (1) who tested for HIV; (2) receiving index testing; (3) had HIV\u2010positive results\/yield; (4) initiated antiretroviral therapy (ART); as well as (5) number of pregnant women with known HIV status; and (6) number of HIV\u2010exposed infants who received early infant diagnosis (EID) testing. We used phase\u2010specific weekly averages, relative percentage changes across phases and linear trend tests to measure the magnitude of disruptions and recovery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In Angola, DRC and Zambia, significant declines in number of HIV\u2010positive tests (\u221258%, \u221234%, \u221217%) and ART initiations (\u221216%, \u221232%, \u221217%) were observed across the three phases with limited recovery in number of positive tests in Zambia and ART initiations in Angola. In DRC and Zambia, HIV testing (\u221233%, \u221235%), including index testing (\u221237%, \u221272%), significantly declined; additionally, HIV testing of pregnant women significantly declined (\u221228%) in DRC. In Angola and Zambia, EID testing declined (\u221212%, \u221218%) with limited recovery. In Angola, HIV testing (2476\u21922205\u21922519), including testing for pregnant women (280\u2192 233\u2192 287), rebounded in the post\u2010resumption phase; in DRC, EID (6.5\u21926.3\u21927.9) rebounded. There were increases in HIV testing yield in Zambia (2.8%\u21923.1%\u21924.0%) and index testing (20\u219224\u219236) in Angola. No reductions were observed in South Sudan.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Stop\u2010Work orders and award terminations have resulted in substantial short\u2010term reductions in the delivery of HIV testing and treatment services. Long\u2010term funding disruptions necessitate careful planning, realistic timelines and investment in cost\u2010effective service models to sustain the gains and maintain the momentum in the global HIV response.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jia2.70034","type":"journal-article","created":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T08:05:27Z","timestamp":1756973127000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Effects of Stop\u2010Work orders on HIV testing, treatment and programmes for prevention of vertical transmission in four sub\u2010Saharan African countries"],"prefix":"10.1002","volume":"28","author":[{"given":"Suzue","family":"Saito","sequence":"first","affiliation":[{"name":"ICAP at Columbia University  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8968-9822","authenticated-orcid":false,"given":"Mansoor","family":"Farahani","sequence":"additional","affiliation":[{"name":"ICAP at Columbia University  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salaza","family":"Kunda","sequence":"additional","affiliation":[{"name":"ICAP at Columbia University  Lusaka Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lievain","family":"Maluantesa","sequence":"additional","affiliation":[{"name":"ICAP at Columbia University  Kinshasa Democratic Republic of the Congo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agnaldo","family":"Guambe","sequence":"additional","affiliation":[{"name":"ICAP at Columbia University  Luanda Angola"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Habtamu Ayalneh","family":"Worku","sequence":"additional","affiliation":[{"name":"ICAP at Columbia University  Juba South Sudan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eugenie","family":"Poirot","sequence":"additional","affiliation":[{"name":"ICAP at Columbia University  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nyikadzino","family":"Mahachi","sequence":"additional","affiliation":[{"name":"ICAP at Columbia University  Juba South Sudan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucille","family":"Bonaventure","sequence":"additional","affiliation":[{"name":"ICAP at Columbia University  Luanda Angola"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"St\u00e9phania","family":"Koblavi","sequence":"additional","affiliation":[{"name":"ICAP at Columbia University  Kinshasa Democratic Republic of the Congo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9929-5739","authenticated-orcid":false,"given":"Tafadzwa","family":"Dzinamarira","sequence":"additional","affiliation":[{"name":"ICAP at Columbia University  Lusaka Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wafaa M.","family":"El\u2010Sadr","sequence":"additional","affiliation":[{"name":"ICAP at Columbia University  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,9,4]]},"reference":[{"key":"e_1_2_11_2_1","unstructured":"The White House.Re\u2010evaluating and re\u2010aligning United States foreign aid. 2025 January 20 [cited 2025 April 19].https:\/\/www.whitehouse.gov\/presidential\u2010actions\/2025\/01\/reevaluating\u2010and\u2010realigning\u2010united\u2010states\u2010foreign\u2010aid\/."},{"key":"e_1_2_11_3_1","unstructured":"EligonJ.Trump's foreign aid freeze causes fear of H.I.V. resurgence in Africa.https:\/\/www.nytimes.com\/2025\/01\/30\/world\/africa\/africa\u2010trump\u2010hiv\u2010pepfar\u2010aid.html?searchResultPosition=3[Internet]. 2025 January 30 [cited 2025 April 19]; Available from:https:\/\/www.nytimes.com\/2025\/01\/30\/world\/africa\/africa\u2010trump\u2010hiv\u2010pepfar\u2010aid.html?searchResultPosition=3"},{"key":"e_1_2_11_4_1","unstructured":"KristofN.Musk said no one has died since aid was cut. That isn't true.https:\/\/www.nytimes.com\/interactive\/2025\/03\/15\/opinion\/foreign\u2010aid\u2010cuts\u2010impact.html?searchResultPosition=6[Internet]. 2025 March 15 [cited 2025 April 19]; Available from:https:\/\/www.nytimes.com\/interactive\/2025\/03\/15\/opinion\/foreign\u2010aid\u2010cuts\u2010impact.html?searchResultPosition=6"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352\u20103018(25)00074\u20108"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(25)00401\u20105"},{"key":"e_1_2_11_7_1","unstructured":"amfAR.Impact of Stop Work orders for PEPFAR programs [Internet]. 2025 Feb [cited 2025 July 17]. Available from:https:\/\/www.amfar.org\/wp\u2010content\/uploads\/2025\/01\/Impact\u2010of\u2010Stop\u2010Work\u2010Orders\u2010for\u2010PEPFAR\u2010Programs\u20102.pdf"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.26423"}],"container-title":["Journal of the International AIDS Society"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jia2.70034","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T01:38:30Z","timestamp":1760405910000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jia2.70034"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9]]},"references-count":7,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2025,9]]}},"alternative-id":["10.1002\/jia2.70034"],"URL":"https:\/\/doi.org\/10.1002\/jia2.70034","archive":["Portico"],"relation":{},"ISSN":["1758-2652","1758-2652"],"issn-type":[{"value":"1758-2652","type":"print"},{"value":"1758-2652","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9]]},"assertion":[{"value":"2025-05-10","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-08-20","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-09-04","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70034"}}