{"doi":"10.7326/annals-24-01104","title":"Potential Clinical and Economic Impacts of Cutbacks in the President’s Emergency Plan for AIDS Relief Program in South Africa","abstract":"BACKGROUND: Future U.S. congressional funding for the President's Emergency Plan for AIDS Relief (PEPFAR) program is uncertain. OBJECTIVE: To evaluate the clinical and economic impacts of abruptly scaling back PEPFAR funding ($460 million) from South Africa's total HIV budget ($2.56 billion) in 2024. DESIGN: Model-based analysis of 100%, 50%, and 0% PEPFAR funding with proportional decreases in HIV diagnosis rates (26.0, 24.3, 22.6 per 100 person-years [PY]), 1-year treatment engagement (people with HIV [PWH] receiving/initiating antiretroviral therapy: 92.2%/80.4%, 87.1%/76.0%, 82.0%/71.5%), and primary prevention (4.0%, 2.2%, 0.5% reduction in incidence with no programming [1.24 per 100 PY]). DATA SOURCES: Published HIV care continuum; PEPFAR funding estimates. TARGET POPULATION: South African adults (HIV prevalence, 16.2%; incidence, 0.32 per 100 PY). TIME HORIZON: Lifetime. PERSPECTIVE: Health care sector. INTERVENTION: PEPFAR funded 100% (PEPFAR_100%), 50% (PEPFAR_50%), or 0% (PEPFAR_0%). OUTCOME MEASURES: HIV infections, life expectancy, and lifetime costs (2023 U.S. dollars). RESULTS OF BASE-CASE ANALYSIS: With current HIV programming (PEPFAR_100%), 1 190 000 new infections are projected over 10 years; life expectancy would be 61.42 years for PWH, with lifetime costs of $11 180 per PWH. Reduced PEPFAR funding (PEPFAR_50% and PEPFAR_0%) would add 286 000 and 565 000 new infections, respectively. PWH would lose 2.02 and 3.71 life-years with nominal lifetime cost reductions of $620 per PWH and $1140 per PWH that would be offset at the population level by more PWH requiring treatment for infection. RESULTS OF SENSITIVITY ANALYSIS: Countries with similar HIV prevalence and greater reliance on PEPFAR funding could experience disproportionately higher incremental infections and survival losses. LIMITATION: Budget fungibility and exact programmatic implications of reducing PEPFAR funding are unknown. CONCLUSION: Abrupt PEPFAR cutbacks would have immediate and long-term detrimental effects on epidemiologic and clinical HIV outcomes in South Africa. PRIMARY FUNDING SOURCE: National Institutes of Health.","journal":"Annals of Internal Medicine","year":2025,"id":509167,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":43,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9381,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":273592,"name":"Linda‐Gail Bekker","orcid":"0000-0002-0755-4386","position":1,"is_corresponding":false},{"id":226455,"name":"A. David Paltiel","orcid":"0000-0002-4861-3290","position":2,"is_corresponding":false},{"id":273590,"name":"Emily P. Hyle","orcid":"0000-0001-8721-106X","position":3,"is_corresponding":false},{"id":273593,"name":"Andrea Ciaranello","orcid":"0000-0002-4268-3263","position":4,"is_corresponding":false},{"id":771505,"name":"Yogan Pillay","orcid":"0000-0003-2700-6181","position":5,"is_corresponding":false},{"id":273595,"name":"Kenneth A. Freedberg","orcid":"0000-0001-6471-7930","position":6,"is_corresponding":false},{"id":273591,"name":"Anne M. Neilan","orcid":"0000-0001-7915-4974","position":7,"is_corresponding":false},{"id":441607,"name":"Aditya R Gandhi","orcid":"0000-0002-2095-9767","position":0,"is_corresponding":true}],"reference_count":49,"raw_metadata":null,"created_at":"2026-07-19T02:47:00.188082Z","pmid":"39932732","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}