A new report has found that staff shortages following the withdrawal of funding from The President’s Emergency Plan for AIDS Relief have negatively affected HIV testing services.
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The withdrawal of funding from the President’s Emergency Plan for AIDS Relief (PEPFAR) has disrupted HIV testing, antiretroviral therapy (ART) collection, and access to contraceptives in former focus priority districts in KwaZulu-Natal.
This is according to a Stop Stockouts Project report, released on Wednesday, which shows there has been an increase in one-month ART refills replacing longer three-month supplies, amid concerns about potential treatment shortages.
The report also found that key populations, particularly adolescent girls and young women, were among the first to experience reduced access as health systems came under strain, with a decline in access to preferred contraceptive methods.
The study focused on the eThekwini, King Cetshwayo, and uMgungundlovu districts.
The PEPFAR programme established in 2003 in response to the global HIV/AIDS epidemic was suspended last year by the US.
It focused on 50 countries with high-burden HIV positive populations, notably in Asia, sub-Saharan Africa, and the Caribbean.
According to the report, HIV testing has been affected by staff shortages following the withdrawal of PEPFAR funding.
“The overall offer rates were low across all three districts, indicating missed opportunities for provider-initiated testing during routine facility visits. The pattern is consistent with the staffing shortages reported by facility managers, particularly in uMgungundlovu and King Cetshwayo, where reduced human resources likely limited the ability to offer testing opportunistically,” the report read.
In King Cetshwayo, a significant proportion of public healthcare users reported longer ART collection times.
“While in-facility and external pick-up points for antiretroviral drugs and treatment (ART) are widely used and appreciated for their time-saving potential, there has been a notable reassignment of facility staff to support pick-up points due to the absence of PEPFAR-funded staff,” the report noted.
It said the most significant impact had been on ART refill length.
"While each of the districts had been achieving higher levels of patients receiving two- or three-month refills before the PEPFAR disruptions, these gains were reversed afterwards.”
Despite Department of Health staff stepping in to fill gaps left by PEPFAR-funded programmes, the report notes continued challenges in service delivery adaptation.
Staffing constraints remained the main issue, with 20% of facilities in eThekwini, 35% in uMgungundlovu, and 10% in King Cetshwayo reporting fewer staff available to provide HIV testing.
“The data do not indicate that people living with HIV were turned away from receiving their medication after PEPFAR-funded programmes were closed. Instead, health service users were redirected to Department of Health-operated facilities, and shorter refills were issued to accommodate additional demand.”
Although there were no reported shortages of HIV test kits, 25–45% of facilities reported reduced staffing for HIV testing, resulting in missed opportunities for diagnosis.
Patient data shows that only 37% of patients in uMgungundlovu and 28% in King Cetshwayo were offered an HIV test during facility visits.
The report notes that adolescent girls and young women among others, were the first to experience reduced access as health systems prioritised treatment continuity over prevention and sexual and reproductive health services.
This is reflected in early service disruptions, including declining HIV testing and emerging barriers to contraceptive access in the months following the funding withdrawal.
“In April–June 2025, the number of patients unable to access their preferred contraceptive method increased sharply across all three districts. Prior to the PEPFAR disruptions, users across the districts were generally able to access their contraceptive of choice. However, between April and June 2025, this changed, with 5% of users in King Cetshwayo reporting that they were unable to do so.”
Cape Times