{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T11:27:49Z","timestamp":1791199669044,"version":"4.2.0"},"reference-count":26,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T00:00:00Z","timestamp":1785110400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T00:00:00Z","timestamp":1785110400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Int AIDS Soc."],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>On 24 January 2025, the U.S. government issued a stop\u2010work order freezing foreign assistance, including support for the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), although a limited waiver for selected \u201clife\u2010saving\u201d interventions was subsequently granted. PEPFAR's official 2025 monitoring results, released 17 April 2026, included only fourth\u2010quarter data, whereas an earlier inadvertent release contained data for all four quarters of 2025. Using both datasets, we conducted a systematic facility\u2010level assessment of HIV programme performance while accounting for reporting disruptions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Facilities were categorized by reporting between Q1 2024 and Q4 2025 (continuous, intermittent, dropped, new). We assessed changes in HIV treatment, testing, prevention of mother\u2010to\u2010child transmission (PMTCT) and HIV prevention across facility categories. We additionally analyse changes in human resources for health (HRH) reported by PEPFAR.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The dataset included 31,628 facilities and community service sites. Most sites reported continuously (71.5%), while 16.7% reported intermittently, 3.9% stopped reporting, 3.1% were new in 2025 and 2.5% were community service sites. Between Q4 2024 and Q4 2025, the total number of people receiving HIV treatment declined by \u22121%. People on treatment increased 0.3% at continuously reporting facilities but declined \u22126.0% at intermittently reporting facilities. HIV testing declined by \u221218% overall. HIV diagnoses decreased by \u221213% at continuously reporting facilities, \u221232% in intermittently reporting facilities and \u221236% in community services sites. PMTCT infant testing declined by \u22126% at continuously reporting facilities and \u221260% at intermittently reporting facilities, while infant HIV diagnoses declined by \u221212% and \u221231%, respectively. Pre\u2010exposure prophylaxis initiations declined by \u221233%, and the number of direct service delivery healthcare workers declined by \u221262,541 (\u221224%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Although HIV treatment remained relatively stable at continuously reporting facilities, substantial declines were observed in HIV testing, HIV diagnoses, treatment initiation, prevention services and the PEPFAR\u2010supported workforce. These findings suggest that treatment coverage alone is an insufficient indicator of programme resilience. As countries assume greater responsibility for HIV programmes, sustained investment across the entire HIV care cascade coupled with transparent reporting and robust monitoring systems covering the full prevention, testing, treatment and health workforce landscape will be essential to maintain progress towards epidemic control.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jia2.70182","type":"journal-article","created":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T18:49:52Z","timestamp":1785178192000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["The Impact of the United States Foreign Aid Freeze on HIV Service Delivery in PEPFAR\u2010Supported Countries: A Facility\u2010Level Analysis of 2024\u20132025 Programme Data"],"prefix":"10.1002","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4907-0603","authenticated-orcid":false,"given":"Brian","family":"Honermann","sequence":"first","affiliation":[{"name":"amfAR, Andelson Office of Public Policy  Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1199-8377","authenticated-orcid":false,"given":"Anna","family":"Grimsrud","sequence":"additional","affiliation":[{"name":"International AIDS Society  Geneva Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-9642-4495","authenticated-orcid":false,"given":"Elise","family":"Lankiewicz","sequence":"additional","affiliation":[{"name":"amfAR, Andelson Office of Public Policy  Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Sherwood","sequence":"additional","affiliation":[{"name":"amfAR, Andelson Office of Public Policy  Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8682-8850","authenticated-orcid":false,"given":"Greg","family":"Millett","sequence":"additional","affiliation":[{"name":"amfAR, Andelson Office of Public Policy  Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,27]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"U. S. Department of State O of the GAC PEPFAR Program Results Fact Sheet [Internet](2024) https:\/\/www.state.gov\/wp\u2010content\/uploads\/2024\/11\/PEPFAR\u2010Program\u2010Results\u2010Fact\u2010Sheet\u2010December\u20102024.pdf."},{"key":"e_1_2_10_3_1","volume-title":"Impact of Stop Work Orders for PEPFAR Programs [Internet]","author":"Andelson Office of Public Policy amfAR","year":"2025"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352\u20103018(25)00192\u20104"},{"key":"e_1_2_10_5_1","volume-title":"Domestic Funding Contributions to Health: Comparing Changes in Domestic Financing in PEPFAR and Non\u2010PEPFAR Supported Countries [Internet]","author":"amfAR","year":"2025"},{"key":"e_1_2_10_6_1","volume-title":"Reevaluating and Realigning United States Foreign Aid: Executive Order [Internet]","author":"Trump D. J.","year":"2025"},{"key":"e_1_2_10_7_1","volume-title":"Memorandum: Implementing the Executive Order on Reevaluating and Realigning United States Foreign Aid [Internet]","author":"Marocco P.","year":"2025"},{"key":"e_1_2_10_8_1","volume-title":"U.S. Department of State Guidance on HIV Services to be Immediately Resumed Under Waiver [Internet]","author":"UNAIDS","year":"2025"},{"key":"e_1_2_10_9_1","volume-title":"U.S. Foreign Aid Freeze & Dissolution of USAID: Timeline of Events [Internet]","author":"Kates J.","year":"2025"},{"key":"e_1_2_10_10_1","volume-title":"Guidance on Improvement of Service Delivery in Both Central and Local Government Health Facilities [Internet]","author":"Dr. Diana Atwine UM Permanent Secretary","year":"2025"},{"key":"e_1_2_10_11_1","volume-title":"Analysis of USAID's Active and Terminated Awards List: How Many Are Global Health? [Internet]","author":"Kates J.","year":"2025"},{"key":"e_1_2_10_12_1","volume-title":"Analyzing USAID Program Disruptions: Implications for PEPFAR Programming and Beneficiaries [Internet]","author":"Godbole R.","year":"2025"},{"key":"e_1_2_10_13_1","volume-title":"PEPFAR Program Status [Internet]","author":"amfAR","year":"2025"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2025.103233"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352\u20103018(25)00074\u20108"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214\u2010109X(25)00281\u20105"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.26423"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1093\/haschl\/qxag020"},{"key":"e_1_2_10_19_1","volume-title":"Impact of US Funding Cuts on the Global HIV Response [Internet]","author":"UNAIDS","year":"2025"},{"key":"e_1_2_10_20_1","volume-title":"Millions Lost Access to PEPFAR\u2010Supported HIV Drugs During the US Foreign Assistance Pause [Internet]","author":"Kenny C.","year":"2025"},{"key":"e_1_2_10_21_1","volume-title":"Panorama Spotlight [Internet]","author":"PEPFAR","year":"2026"},{"key":"e_1_2_10_22_1","unstructured":"amfAR PEPFAR_impact_2025 [Internet](2026) https:\/\/github.com\/amfAR\u2010PPO\/PEPFAR_Impact_2025\/."},{"key":"e_1_2_10_23_1","unstructured":"amfAR PEPFAR Monitoring Evaluation and Reporting Database [Internet](2026) https:\/\/mer.amfar.org\/location\/South%20Africa\/TX_CURR."},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1038\/s44360\u2010026\u201000159\u20101"},{"key":"e_1_2_10_25_1","unstructured":"PEPFAR FY25 PEPFAR Human Resources for Health Inventory Handbook [Internet](2025) https:\/\/help.datim.org\/hc\/en\u2010us\/article_attachments\/41725340682260."},{"key":"e_1_2_10_26_1","unstructured":"J.Graham U.S. Department of State \"Info Memo for the PEPFAR Implementing Agencies and PEPFAR Country Coordinators \" (2025) https:\/\/docs.google.com\/document\/d\/e\/2PACX\u20101vQgNTpC6F5oaOnkebQokJ_2eYgM_IcQNT7alIL6R3P16Ef4Z0pmQby3Y1eHbJcTxK_yJ8EPVNiibxON\/pub."},{"key":"e_1_2_10_27_1","volume-title":"America First Global Health Strategy [Internet]","author":"U.S. Department of State","year":"2025"}],"container-title":["Journal of the International AIDS Society"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jia2.70182","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/jia2.70182","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jia2.70182","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T06:58:36Z","timestamp":1787641116000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jia2.70182"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,27]]},"references-count":26,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1002\/jia2.70182"],"URL":"https:\/\/doi.org\/10.1002\/jia2.70182","archive":["Portico"],"relation":{},"ISSN":["1758-2652","1758-2652"],"issn-type":[{"value":"1758-2652","type":"print"},{"value":"1758-2652","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,27]]},"assertion":[{"value":"2026-04-28","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-20","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-27","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70182"}}