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From vertical to domestic: transition readiness of National HIV responses in 14 countries in Africa
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BACKGROUND: Following the halt of U.S. government funding in January 2025, the HIV Leadership Forum'comprising Director Generals of 40 national AIDS commissions'conducted a rapid transition readiness survey across 24 sub-Saharan African countries to gauge service continuity, systems resilience and available transition assets. Fourteen countries(58%) responded by mid-April, via a 46-indicator Microsoft-Forms assessment, analyzed descriptively in Excel.
DESCRIPTION: Service-delivery: All countries reported operational public-health facilities and governments quickly integrated antiretroviral (ART) dispensing into OPD departments. PMTCT services remained functional in 83% of nations. However, 75% of NGO/community sites closed, disrupting 90% of prevention programs.
Systems: All countries reported data interruptions in facility and national health information tied to NGO-managed servers or licenses. ART client transfers occasionally occurred without records. Laboratory networks faced similar vulnerabilities.
Commodities: While 65% of countries had nine-month ARV and testing commodity stocks, half held <6-months of prevention-specific ARVs or condoms. Supply chain disruptions varied, though 8 countries indicated internal distribution breakdowns.
Human Resources: Donor-funded staff attrition totaled 123,668 across 12 countries, including 60% frontline clinical workers (nurses, doctors, lab staff) and 44,502 community volunteers. Contractual complexities hindered retention efforts.
Governance: Governments issued service-continuity directives, repurposing HIV clinics and initiating domestic funding. Countries with partial control over procurement, logistics, and data systems experienced milder disruptions.
Transition assets identified: embedding HIV services in universal health coverage schemes, leveraging private/faith facilities for co-payment models, expanding data interoperability, aligning community-social services, and strengthening AIDS commissions stewardship.
LESSONS LEARNED: Decades of significant HIV systems investments collapsed, underscoring the fragility of donor-dependent structures and the protective role of integrated national platforms. Public facilities struggle with sudden ART client influxes amid system disruptions. The attrition of 60% frontline health workers risks care quality, while prevention collapses demand urgent cross-sector models targeting at-risk populations. Reported commodity stocks are residual from pre-January shipments, thus, urgent domestic investments are needed.
CONCLUSIONS: Governments demonstrated rapid adaptation and now transition stewardship is required. Immediate priorities include: ecosystem audits to resolve client data gaps; revised commodity forecasts reflecting new client distributions; redesigned, cross-sector prevention models; partnerships with PLHIV networks and private sector; workable HR retention solutions; and sustained political advocacy for domestic resources
DESCRIPTION: Service-delivery: All countries reported operational public-health facilities and governments quickly integrated antiretroviral (ART) dispensing into OPD departments. PMTCT services remained functional in 83% of nations. However, 75% of NGO/community sites closed, disrupting 90% of prevention programs.
Systems: All countries reported data interruptions in facility and national health information tied to NGO-managed servers or licenses. ART client transfers occasionally occurred without records. Laboratory networks faced similar vulnerabilities.
Commodities: While 65% of countries had nine-month ARV and testing commodity stocks, half held <6-months of prevention-specific ARVs or condoms. Supply chain disruptions varied, though 8 countries indicated internal distribution breakdowns.
Human Resources: Donor-funded staff attrition totaled 123,668 across 12 countries, including 60% frontline clinical workers (nurses, doctors, lab staff) and 44,502 community volunteers. Contractual complexities hindered retention efforts.
Governance: Governments issued service-continuity directives, repurposing HIV clinics and initiating domestic funding. Countries with partial control over procurement, logistics, and data systems experienced milder disruptions.
Transition assets identified: embedding HIV services in universal health coverage schemes, leveraging private/faith facilities for co-payment models, expanding data interoperability, aligning community-social services, and strengthening AIDS commissions stewardship.
LESSONS LEARNED: Decades of significant HIV systems investments collapsed, underscoring the fragility of donor-dependent structures and the protective role of integrated national platforms. Public facilities struggle with sudden ART client influxes amid system disruptions. The attrition of 60% frontline health workers risks care quality, while prevention collapses demand urgent cross-sector models targeting at-risk populations. Reported commodity stocks are residual from pre-January shipments, thus, urgent domestic investments are needed.
CONCLUSIONS: Governments demonstrated rapid adaptation and now transition stewardship is required. Immediate priorities include: ecosystem audits to resolve client data gaps; revised commodity forecasts reflecting new client distributions; redesigned, cross-sector prevention models; partnerships with PLHIV networks and private sector; workable HR retention solutions; and sustained political advocacy for domestic resources