{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,8,8]],"date-time":"2026-08-08T11:44:13Z","timestamp":1786189453361,"version":"build-2736575974"},"posted":{"date-parts":[[2026,8,6]]},"group-title":"HIV\/AIDS","reference-count":48,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T00:00:00Z","timestamp":1785974400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"crossref","award":["U01AI096299"],"award-info":[{"award-number":["U01AI096299"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"crossref","award":["U01AI069923"],"award-info":[{"award-number":["U01AI069923"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"crossref","award":["R24AI124872"],"award-info":[{"award-number":["R24AI124872"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,8,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>After U.S. foreign assistance was frozen in January 2025, empirical data on the status of the HIV response has been limited. To better understand the ongoing impacts of changes in U.S. foreign assistance, we launched an open survey to assess disruptions in HIV-related care among clinics and programs in low- and middle-income countries (LMICs).<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Conducted from August to December 2025, the survey explored U.S. foreign assistance-related disruptions in HIV service delivery, medication availability, laboratory services and clinic operations; whether disruptions were fully resolved at the survey timepoint; and the introduction of clinic mitigation strategies. Data on other impacts of U.S. funding changes were explored through an open-ended question. A convergent mixed-methods design, involving parallel quantitative and qualitative analyses and merging of findings from each, was used to examine the impacts of U.S. funding freezes on HIV-related care.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>We received 158 responses from 38 LMICs, including 30 countries supported by the U.S. President\u2019s Emergency Fund for AIDS Relief (PEPFAR) at the beginning of 2025 (n=123 responses) and eight non-PEPFAR countries (n=35 responses). Respondents represented health centers (25%), hospitals (31%), dedicated HIV clinics and drop-in centers (39%), and multi-site programs (4%), with a majority (59%) in the non-governmental\/private sector. Overall, 81% reported disruptions in at least one HIV-related service since January 2025 because of changes in U.S. foreign assistance, with most also reporting disruptions in medication availability, laboratory services, and clinic operations. The largest reported disruptions were in the areas of pre-exposure prophylaxis (67%) and HIV testing (63%), along with patient tracing (67%), adherence support (63%) and services to key populations (64%). Disruptions were more prevalent in PEPFAR-supported countries and were more likely to be \u201cnot fully resolved\u201d by time of survey completion. Qualitative data highlighted the impact of U.S. foreign assistance disruptions on the erosion of client trust in the health system and strains on staff morale.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Substantial and sustained disruptions in HIV prevention and care reported by diverse clinics in LMICs reinforce concerns that recent funding shifts could reverse progress in ending the HIV epidemic, particularly for vulnerable and key populations.<\/jats:p>\n                <\/jats:sec>","DOI":"10.64898\/2026.08.04.26359701","type":"posted-content","created":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T20:35:12Z","timestamp":1786048512000},"source":"Crossref","is-referenced-by-count":0,"title":["Service disruptions and stockouts: Ongoing impacts of U.S. funding freezes on HIV care across clinics in 38 low- and middle-income countries in late 2025"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8514-1958","authenticated-orcid":false,"given":"Ellen","family":"Brazier","sequence":"first","affiliation":[{"name":"Institute for Implementation Science in Population Health, City University of New York, Graduate School of Public Health and Health Policy, New York, NY, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maabo","family":"Kludze","sequence":"additional","affiliation":[{"name":"City University of New York, Graduate School of Public Health and Health Policy, New York, NY, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernanda","family":"Maruri","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annabelle","family":"Niyongabo","sequence":"additional","affiliation":[{"name":"Association Nationale de Soutien aux S\u00e9ropositifs et malades du sida-Sant\u00e9 PLUS (ANSS-Sant\u00e9 PLUS), Bujumbura, Burundi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip","family":"Kreniske","sequence":"additional","affiliation":[{"name":"Institute for Implementation Science in Population Health, City University of New York, Graduate School of Public Health and Health Policy, New York, NY, United States"},{"name":"City University of New York, Graduate School of Public Health and Health Policy, New York, NY, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephany N.","family":"Duda","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States"},{"name":"Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denis","family":"Nash","sequence":"additional","affiliation":[{"name":"Institute for Implementation Science in Population Health, City University of New York, Graduate School of Public Health and Health Policy, New York, NY, United States"},{"name":"City University of New York, Graduate School of Public Health and Health Policy, New York, NY, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"54368","reference":[{"key":"2026080804200621000_2026.08.04.26359701v1.1","unstructured":"Kates J , Michaud J , Moss K , Dawson L , Rouw A . 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