{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T10:06:39Z","timestamp":1783937199811,"version":"3.55.0"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T00:00:00Z","timestamp":1783900800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>In January 2025, the United States government froze most foreign assistance and issued a 90-day stop-work order affecting many global health, education, and nutrition programs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using a qualitative case study approach, we examined perceptions about experiences around how this abrupt funding disruption affected HIV care in one county in Kenya through in-depth interviews with women and men living with HIV and with healthcare providers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Participants described immediate and severe antiretroviral therapy (ART) rationing and broader, cascading effects across the HIV care continuum, including missed visits, interrupted monitoring, and heightened anxiety about treatment continuity. Respondents also reported that rapid integration of HIV and primary care services\u2014implemented amid the funding shock\u2014undermined confidentiality in clinical settings, intensifying stigma concerns and discouraging care seeking among people living with HIV.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>These findings highlight how sudden financing shocks can destabilize HIV programs in ways that extend beyond medication supply. We translate qualitative evidence into actionable recommendations to support person-centered HIV services during periods of uncertainty, including safeguarding continuous access to affordable\/free ART, reducing access barriers such as transportation costs, and strengthening confidentiality protections as HIV and primary care services integrate.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic review registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/www.who.int\/publications\/i\/item\/9789241549684<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1812962","type":"journal-article","created":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T05:34:58Z","timestamp":1783920898000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["A snapshot of how U.S. funding cuts impacted HIV care in one county of Kenya: a qualitative case study"],"prefix":"10.3389","volume":"14","author":[{"given":"Erica","family":"Sedlander","sequence":"first","affiliation":[{"name":"Institute for Health and Aging, University of California","place":["San Francisco, CA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyla","family":"Lawson","sequence":"additional","affiliation":[{"name":"Independent Consultant","place":["Sydney, NSW, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Njeri","family":"Wairimu","sequence":"additional","affiliation":[{"name":"Kenya Medical Research Institute","place":["Nairobi, Kenya"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kalin","family":"Werner","sequence":"additional","affiliation":[{"name":"Independent Consultant","place":["New York, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharon","family":"Mutai","sequence":"additional","affiliation":[{"name":"Kenya Medical Research Institute","place":["Nairobi, Kenya"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Mwai","sequence":"additional","affiliation":[{"name":"Kenya Medical Research Institute","place":["Nairobi, Kenya"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica","family":"Gandhi","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of California","place":["San Francisco, CA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth","family":"Ngure","sequence":"additional","affiliation":[{"name":"Jomo Kenyatta University of Agriculture and Technology","place":["Nairobi, Kenya"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,13]]},"reference":[{"key":"B1","unstructured":"Reevaluating and Realigning United States Foreign AID\n          \n          2025"},{"key":"B2","unstructured":"Implementing the President's Executive Order on Reevaluating and Realigning United States Foreign AID\n          \n          2025"},{"key":"B3","unstructured":"Foreign AID Freeze & Dissolution of USAID: Timeline of Events\n          \n          2025"},{"key":"B4","unstructured":"Prakash\n              M\n            \n            \n              Custer\n              S\n            \n            \n              Burgess\n              B\n            \n            \n              Mathew\n              D\n            \n            \n              Cheng\n              M\n            \n            \n              Knight\n              R\n            \n          \n          Williamsburg, VA\n          AidData\n          Investing in Kenya's People: Valuing the Benefits of the U.S.-Kenya Relationship\n          \n          2020"},{"key":"B5","unstructured":"\u201cThe System is Folding in on itself\u201d: The Impact of U.S. Global Health Funding Cuts in Kenya\n          \n          \n            \n              Physicians\n              for Human Rights\n            \n          \n          \n          2025"},{"key":"B6","unstructured":"About the Impact of US Funding Cuts on the Global HIV Response"},{"key":"B7","unstructured":"Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection: Recommendations for a Public Health Approach\n          \n          2016"},{"key":"B8","unstructured":"We can't Stop at Almost"},{"key":"B9","doi-asserted-by":"publisher","first-page":"e457","DOI":"10.1016\/S2352-3018(18)30059-6","article-title":"HIV treatment in pregnancy","volume":"5","author":"Bailey","year":"2018","journal-title":"Lancet HIV."},{"key":"B10","first-page":"576","article-title":"2023 updated guidelines on infant feeding and HIV in the United States: what are they and why have recommendations changed?","author":"Pollock","year":"2023","journal-title":"Top Antivir Med."},{"key":"B11","unstructured":"HIV Estim Portal\n          \n          2025"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2025.5180","article-title":"Long-acting HIV treatment in low- and middle-income countries: addressing the public health need","author":"Ehrenkranz","year":"2025","journal-title":"JAMA."},{"key":"B13","unstructured":"Brangham\n              W\n            \n            \n              Raskin\n              MK\n            \n          \n          How USAID Cuts are Impacting The Fight Against HIV in Kenya\n          \n          2025"},{"key":"B14","unstructured":"Impact of US Funding Cuts on Global AIDS Response\n          \n          2025"},{"key":"B15","unstructured":"Impact of US Funding Cuts on HIV Programmes in East and Southern Africa\n          \n          2025"},{"key":"B16","unstructured":"Service-level effects of HIV funding cuts in Southern Africa: findings from a community-led early warning system\n          \n          94\n          \n            \n              Oberth\n              G\n            \n            \n              Bozinovski\n              J\n            \n            \n              Lauer\n              K\n            \n            \n              Rafif\n              N\n            \n            \n              Sithole\n              S\n            \n            \n              Mwanza\n              H\n            \n          \n          2\n          2025"},{"key":"B17","doi-asserted-by":"publisher","first-page":"368","DOI":"10.1186\/s12913-026-14165-2","article-title":"Early impacts of PEPFAR funding freeze on HIV service delivery in mid-Western Uganda","volume":"26","author":"Zakumumpa","year":"2026","journal-title":"BMC Health Serv Res."},{"key":"B18","unstructured":"Thika Municipality"},{"key":"B19","volume-title":"Applied Thematic Analysis","author":"Guest","year":"2011"},{"key":"B20","doi-asserted-by":"publisher","first-page":"e0232076","DOI":"10.1371\/journal.pone.0232076","article-title":"simple method to assess and report thematic saturation in qualitative research","volume":"15","author":"Guest","year":"2020","journal-title":"PLoS One."},{"key":"B21","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1177\/1744987107081254","article-title":"Memoing in qualitative research: probing data and processes","volume":"13","author":"Birks","year":"2008","journal-title":"J Res Nurs."},{"key":"B22","doi-asserted-by":"publisher","first-page":"883","DOI":"10.1097\/AOG.0000000000004967","article-title":"Long-acting reversible contraception","volume":"140","author":"Baker","year":"2022","journal-title":"Obstet Gynecol."},{"key":"B23","unstructured":"Y+\n              Kenya\n            \n          \n          Impact of USAID Funding Freeze on Young People Living with and Affected by HIV in Kenya\n          \n          2025"},{"key":"B24","unstructured":"Release of the America First Global Health Strategy\n          \n          2025"},{"key":"B25","first-page":"1","article-title":"Infectious diseases and its global epidemiology","volume-title":"Nanostructured Drug Delivery Systems in Infectious Disease Treatment","author":"Beg","year":"2024"},{"key":"B26","doi-asserted-by":"publisher","first-page":"e143","DOI":"10.1016\/S2214-109X(25)00408-5","article-title":"Future directions: ending HIV in Africa\u2014a call to action for sustainable and nationally led prevention","volume":"14","author":"Chola","year":"2026","journal-title":"Lancet Glob Health."},{"key":"B27","doi-asserted-by":"publisher","first-page":"1612902","DOI":"10.3389\/frph.2025.1612902","article-title":"Breaking barriers, changing paradigms: Africa's radical agenda for HIV sustainability","volume":"7","author":"Chola","year":"2025","journal-title":"Front Reprod Health."},{"key":"B28","unstructured":"United States and Kenya Sign Five-Year, $2.5 Billion Health Cooperation Framework\n          \n          2025"},{"key":"B29","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1186\/s12916-019-1271-3","article-title":"The health stigma and discrimination framework: a global, crosscutting framework to inform research, intervention development, and policy on health-related stigmas","volume":"17","author":"Stangl","year":"2019","journal-title":"BMC Med."},{"key":"B30","doi-asserted-by":"publisher","first-page":"e0004871","DOI":"10.1371\/journal.pgph.0004871","article-title":"Achieving universal coverage of childhood cancers in Ghana via the national health insurance scheme: a stakeholder analysis","volume":"5","author":"Owusu","year":"2025","journal-title":"PLOS Glob Public Health."},{"key":"B31","doi-asserted-by":"publisher","first-page":"6","DOI":"10.25259\/JRHM_4_2023","article-title":"Modeling one-stop-shop integration of family planning and HIV services in Zimbabwe","volume":"4","author":"Mugauri","year":"2023","journal-title":"J Reprod Healthc Med."}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1812962\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T09:10:58Z","timestamp":1783933858000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1812962\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,13]]},"references-count":31,"alternative-id":["10.3389\/fpubh.2026.1812962"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1812962","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,13]]},"article-number":"1812962"}}