D. Moiana Uetela1, O. Tiberi2, R. Muleia3, P. Ramgi4, Y. Paulo2, I. Gaspar2, N. Scott5, R. Martin-Hughes5, N.K. Martin6 1Instituto Nacional de Saude, Research Program on Diseases with Major Health Impact, Marracuene, Mozambique, 2Ministry of Health, National STI-HIV/AIDS Control Program, Maputo, Mozambique, 3Instituto Nacional de Saude, Division of Surveys and Health Observation, Marracuence, Mozambique, 4Instituto Nacional de Saude, Health and Wellbeing Research Division, Marracuene, Mozambique, 5Burnet Institute, Melbourne, Australia, 6University of California San Diego, Department of Medicine, Division of Infectious Diseases and Global Public Health, San Diego, United States
BACKGROUND: Mozambique has the 8th highest global HIV prevalence. ART is available in 97% of health facilities and serves approximately 2.1 million of the 2.4 PLHIV. However, the country relies heavily on external funds to ensure HIV service provision, with the U.S. covering approximately 93% of the country’s expenses, mainly through PEPFAR. In January 2025, the U.S. government issued an executive order suspending almost all foreign aid programmes for 90 days. We aimed to assess the impact of this order on HIV service provision and predict the impact of potential fund interruption on the HIV epidemic in Mozambique.
METHODS: To evaluate the impact of the executive order on HIV service provision, we used the country’s district health information system to compare selected health services indicators in February 2024 and February 2025. We analysed the absolute variation and relative change in ART initiation and viral load cascade performance in these time points. To predict the impact on the HIV epidemic, we used a published dynamic HIV transmission and disease progression model (Optima) calibrated to Mozambique data to compare the trend before January 2025 to a counterfactual scenario with funding interruption, assuming a stagnation in the scenario observed in February 2025. We simulated the impact of funding interruption on HIV incidence and HIV-related mortality until 2030.
RESULTS: Comparing February 2024 to 2025, there was a 25% reduction in ART initiation in adults (>=15years), from 22,865 to 17,105. Among those on treatment, there was a 38% reduction (37,010) in viral load tests performed, a 37% reduction (27,656) in test results received, and a 33% reduction (22,043) in viral suppression. In children (<15years), these indicators were 44%, 71%, and 43%, respectively, showing a disproportionate impact on paediatric population. The funding interruption was estimated to cumulatively increase 83,000 (15% more than the status quo) new HIV infections and 14,000 (10%) HIV-related deaths by 2030.
CONCLUSIONS: The findings highlighted the immediate negative impact of the U.S. funding freeze on HIV service outcomes and the potential alarming effect on the HIV epidemic, in case the funding interruption is sustained. Funding is urgently needed to mitigate these negative impacts.