On 24 January 2025 the U.S. government issued a stop-work order that froze foreign assistance, including funding for the U.S. President's Emergency Plan for AIDS Relief (PEPFAR). A limited waiver for selected “life-saving” interventions was later granted. Official PEPFAR 2025 monitoring results released on 17 April 2026 included only fourth-quarter data; an earlier inadvertent release, however, contained data for all four quarters of 2025. The reporting disruptions motivated a systematic, facility-level assessment of HIV programme performance across 2024–2025 that explicitly accounted for changes in reporting.
The authors framed the analysis to evaluate impacts across the HIV care cascade—treatment, testing, prevention of mother-to-child transmission (PMTCT), HIV prevention including pre-exposure prophylaxis (PrEP)—and to quantify changes in the PEPFAR-supported human resources for health (HRH). The study aimed to determine whether treatment coverage alone reflected programme resilience after the foreign aid freeze.
The analysis used facility-level programme data covering Q1 2024 through Q4 2025. Facilities and community service sites were categorized by their reporting patterns during that interval:
The analysis compared service delivery indicators and HRH counts between Q4 2024 and Q4 2025 and described differences across these facility categories. The authors stated they accounted for reporting disruptions when interpreting programme changes.
The dataset included 31,628 facilities and community service sites. Reporting distribution across categories was: 71.5% continuous reporters, 16.7% intermittent reporters, 3.9% that stopped reporting (dropped), 3.1% new in 2025, and 2.5% community service sites. The facility categories contributed variably to country-level counts and to aggregate service volumes.
Between Q4 2024 and Q4 2025, the total number of people receiving HIV treatment declined by 1% overall. This aggregate change concealed heterogeneity by reporting category. Continuously reporting facilities recorded a 0.3% increase in people on treatment, whereas intermittently reporting facilities experienced a 6.0% decline in people on treatment. The report also noted declines in treatment initiation, though specific numeric details for initiation beyond these category patterns were not separately reported in the source abstract.
HIV testing volumes declined sharply, with an 18% reduction overall between Q4 2024 and Q4 2025. Corresponding declines in HIV diagnoses were observed across facility types: a 13% decrease at continuous facilities, a 32% decrease at intermittent facilities, and a 36% decrease at community service sites. These declines in testing and diagnoses suggest reduced case finding during the period examined.
Measured PMTCT outcomes also worsened in many facility categories. Infant HIV testing through PMTCT programmes fell 6% at continuously reporting facilities and 60% at intermittently reporting facilities between Q4 2024 and Q4 2025. Infant HIV diagnoses declined by 12% at continuous sites and by 31% at intermittent sites. These reductions in infant testing and diagnoses indicate disruptions in the early infant diagnosis component of PMTCT services, particularly at sites with interrupted reporting.
Initiations of pre-exposure prophylaxis (PrEP) declined by 33% overall between Q4 2024 and Q4 2025. The abstract did not provide additional stratified numbers for other prevention modalities but highlighted substantial reductions in prevention services broadly.
PEPFAR-reported direct service delivery healthcare worker counts declined significantly between 2024 and 2025. The reported reduction was 62,541 staff, representing a 24% decrease in the PEPFAR-supported workforce. Changes were described by health care worker category and cadre in the full report; the abstract reports the aggregate loss in direct service delivery staff.
The facility-level analysis found that, although people on HIV treatment remained relatively stable at continuously reporting facilities, there were substantial declines across other critical programme domains: HIV testing, diagnoses, treatment initiation, PMTCT infant testing and diagnoses, PrEP initiations, and the PEPFAR-supported workforce. The authors emphasize that maintaining treatment coverage alone is an insufficient indicator of programme resilience when other elements of the HIV care cascade deteriorate.
The findings underscore the importance of sustained, comprehensive investment across the entire HIV care cascade—prevention, testing, treatment, PMTCT—and in the health workforce. The authors call for transparent reporting and robust monitoring systems that cover the full prevention-to-treatment spectrum and the workforce, particularly as countries take on greater responsibility for financing and managing HIV programmes. Such systems will be critical to preserving progress toward epidemic control.
Note: The abstract describes primary results and key aggregate figures; detailed country-level breakdowns, full cadre-specific HRH changes, and additional methodological specifics are available in the full article but are not reported in the abstract.