Hontelez Jan A C, Goymann Hannah, Berhane Yemane, Bhattacharjee Parinita, Bor Jacob, Chabata Sungai T, Cowan Frances, Kimani Joshua, Knox Justin, Lora Wezzie S, Lungu Cynthia, Manne-Goehler Jennifer, Mauti Joy, Moshabela Mosa, Mpembeni Rose M, Wa Mwanza Mwanza, Ndung'u Thumbi, Omondi Evans, Phiri Sam, Siedner Mark, Tanser Frank C, de Vlas Sake J, Bärnighausen Till W
Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
Heidelberg Institute of Global Health (HIGH), Medical Faculty and University Hospital, Heidelberg University, Germany.
EClinicalMedicine. 2025 Apr 25;83:103233. doi: 10.1016/j.eclinm.2025.103233. eCollection 2025 May.
On January 24, 2025, the United States government issued an executive order to freeze all foreign aid programs, including The President's Emergency Plan for AIDS Relief (PEPFAR), for 90 days. A limited waiver option became available, but its implementation remains incomplete. We estimated the impact of these policy changes on HIV deaths and new infections in seven sub-Saharan African (SSA) countries-Ethiopia, Kenya, Malawi, South Africa, Tanzania, Zambia, and Zimbabwe -, which together account for about half of all people living with HIV in SSA.
We used STDSIM, an established individual-based simulation model, and previously published quantifications for the seven countries. We predicted changes in HIV deaths and new infections over the period 2025-2030 for four scenarios: (1) -, where treatment disruption was proportional to the country-specific PEPFAR's share of total HIV funding; (2) -, assuming near-total system collapse due to program dependencies; and (3-4) scenarios where treatment was resumed after 4 or after 8 weeks. Resumptions of programs accounted for delays due to organizational and logistical challenges.
A 90-day funding freeze would result in 60 thousand [95% UI: 49-71 thousand] excess HIV deaths for the - scenario. This number would increase to 74 thousand excess HIV deaths [95% UI: 63-89 thousand] for the - scenario. Under a 4-week and 8-week waiver scenario, projected excess HIV deaths ranged between 21 thousand [95% UI: 15-28 thousand] and 28 thousand [95% UI: 22-36 thousand] respectively. Excess new infections ranged between 35 and 103 thousand for the different scenarios.
The sudden cessation of PEPFAR funding likely results in tens of thousands of HIV deaths and new infections. These losses of life and health should compel the United States government to rapidly and fully re-instate one of the most successful health programs in history.
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2025年1月24日，美国政府发布行政命令，冻结所有对外援助项目，包括总统防治艾滋病紧急救援计划（PEPFAR），为期90天。有一个有限的豁免选项，但该选项的实施仍未完成。我们估计了这些政策变化对撒哈拉以南非洲（SSA）七个国家（埃塞俄比亚、肯尼亚、马拉维、南非、坦桑尼亚、赞比亚和津巴布韦）的艾滋病毒死亡和新感染情况的影响，这七个国家的艾滋病毒感染者约占撒哈拉以南非洲地区的一半。
我们使用了STDSIM，这是一个既定的基于个体的模拟模型，以及之前发表的这七个国家的量化数据。我们预测了2025 - 2030年期间四种情景下艾滋病毒死亡和新感染情况的变化：（1），治疗中断与特定国家PEPFAR在艾滋病毒总资金中所占份额成正比；（2），假设由于项目依赖性导致近乎全面的系统崩溃；以及（3 - 4）在4周或8周后恢复治疗的情景。项目恢复考虑了组织和后勤挑战导致的延误。
对于第一种情景，90天的资金冻结将导致6万例[95%不确定区间：4.9 - 7.1万例]额外的艾滋病毒死亡。对于第二种情景，这个数字将增至7.4万例额外的艾滋病毒死亡[95%不确定区间：6.3 - 8.9万例]。在4周和8周豁免情景下，预计额外的艾滋病毒死亡分别在2.1万例[95%不确定区间：1.5 - 2.8万例]和2.8万例[95%不确定区间：2.2 - 3.6万例]之间。不同情景下额外的新感染病例在3.5万至10.3万例之间。
PEPFAR资金的突然停止可能导致数万人死于艾滋病毒并出现新感染病例。这些生命和健康的损失应促使美国政府迅速全面恢复历史上最成功的卫生项目之一。
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