Saito Suzue, Farahani Mansoor, Kunda Salaza, Maluantesa Lievain, Guambe Agnaldo, Worku Habtamu Ayalneh, Poirot Eugenie, Mahachi Nyikadzino, Bonaventure Lucille, Koblavi Stéphania, Dzinamarira Tafadzwa, El-Sadr Wafaa M
ICAP at Columbia University, New York, New York, USA.
ICAP at Columbia University, Lusaka, Zambia.
J Int AIDS Soc. 2025 Sep;28(9):e70034. doi: 10.1002/jia2.70034.
Beginning in late January 2025, Stop-Work 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.
Weekly aggregate HIV services data from a convenience sample of 165 Center for Disease Control and Prevention (CDC)-funded, ICAP-supported facilities-22 in Angola, 75 in the Democratic Republic of the Congo (DRC), 20 in South Sudan and 48 in Zambia-were analysed. We compared data from pre-Stop-Work (7 October 2024-23 January 2025), Stop-Work (24 January 2025-11 February 2025) and post-resumption (12 February 2025-31 March 2025) phases. We examined the number of individuals: (1) who tested for HIV; (2) receiving index testing; (3) had HIV-positive results/yield; (4) initiated antiretroviral therapy (ART); as well as (5) number of pregnant women with known HIV status; and (6) number of HIV-exposed infants who received early infant diagnosis (EID) testing. We used phase-specific weekly averages, relative percentage changes across phases and linear trend tests to measure the magnitude of disruptions and recovery.
In Angola, DRC and Zambia, significant declines in number of HIV-positive tests (-58%, -34%, -17%) and ART initiations (-16%, -32%, -17%) 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 (-33%, -35%), including index testing (-37%, -72%), significantly declined; additionally, HIV testing of pregnant women significantly declined (-28%) in DRC. In Angola and Zambia, EID testing declined (-12%, -18%) with limited recovery. In Angola, HIV testing (2476→2205→2519), including testing for pregnant women (280→ 233→ 287), rebounded in the post-resumption phase; in DRC, EID (6.5→6.3→7.9) rebounded. There were increases in HIV testing yield in Zambia (2.8%→3.1%→4.0%) and index testing (20→24→36) in Angola. No reductions were observed in South Sudan.
Stop-Work orders and award terminations have resulted in substantial short-term reductions in the delivery of HIV testing and treatment services. Long-term funding disruptions necessitate careful planning, realistic timelines and investment in cost-effective service models to sustain the gains and maintain the momentum in the global HIV response.
从2025年1月下旬开始，停工令和合同取消扰乱了由总统艾滋病紧急救援计划（PEPFAR）支持的艾滋病项目。我们评估了这对四个非洲国家艾滋病服务提供的影响。
分析了来自165个由美国疾病控制与预防中心（CDC）资助、由ICAP支持的机构的便利样本的每周艾滋病服务汇总数据，这些机构分别位于安哥拉22个、刚果民主共和国（DRC）75个、南苏丹20个和赞比亚48个。我们比较了停工前（2024年10月7日至2025年1月23日）、停工期间（2025年1月24日至2025年2月11日）和恢复后（2025年2月12日至2025年3月31日）三个阶段的数据。我们检查了以下各类人员的数量：（1）进行艾滋病检测的；（2）接受初次检测的；（3）检测结果呈艾滋病阳性/检测阳性率的；（4）开始接受抗逆转录病毒治疗（ART）的；以及（5）已知艾滋病感染状况的孕妇数量；和（6）接受早期婴儿诊断（EID）检测的艾滋病暴露婴儿数量。我们使用各阶段的每周平均数据、各阶段之间的相对百分比变化以及线性趋势检验来衡量干扰和恢复的程度。
在安哥拉、刚果民主共和国和赞比亚，三个阶段中艾滋病检测阳性数量（分别下降58%、34%、17%）和开始接受抗逆转录病毒治疗的人数（分别下降16%、32%、17%）均显著下降，赞比亚的检测阳性数量和安哥拉的开始接受抗逆转录病毒治疗的人数恢复有限。在刚果民主共和国和赞比亚，艾滋病检测（分别下降33%、35%），包括初次检测（分别下降37%、72%）显著下降；此外，刚果民主共和国孕妇的艾滋病检测也显著下降（下降28%）。在安哥拉和赞比亚，早期婴儿诊断检测下降（分别下降12%、18%），恢复有限。在安哥拉，艾滋病检测（从2476例降至2205例再升至2519例），包括孕妇检测（从280例降至233例再升至287例）在恢复后阶段有所反弹；在刚果民主共和国，早期婴儿诊断检测数量（从6.5例降至6.3例再升至7.9例）有所反弹。赞比亚的艾滋病检测阳性率（从2.8%升至3.1%再升至4.0%）和安哥拉的初次检测数量（从20例升至24例再升至36例）有所增加。南苏丹未观察到下降情况。
停工令和授标终止导致艾滋病检测和治疗服务的提供在短期内大幅减少。长期的资金中断需要精心规划、现实的时间表以及对具有成本效益的服务模式进行投资，以维持所取得的成果并保持全球艾滋病应对的势头。
