The impact of US Government Stop Work Order on HIV epidemic trajectory in Zimbabwe

Zimbabwe is highly dependent on United States Government (USG) funding for the HIV Response, where 42% of the HIV expenditures in 2020 were financed by the USG and in 2023, PEPFAR invested more than $200 million to support HIV programmes. In late January 2025, the USG issued a "Stop Work Order," suspending funding for international aid and development during a 90-day review period and this was expected to have a significant negative impact on the Zimbabwean healthcare system therefore an epidemiological assessment was conducted to assess the impact of the stop work order. To assess the impact on incidence and mortality, an epidemiological assessment using the Avenir Health Goals model simulated five scenarios ranging from temporary pauses to the indefinite withdrawal of PEPFAR and 11% reduction in the Global Fund funding support. The stopping funding specified in the waiver plus 11% reduction in the Global Fund funding results in 74% (11,000) additional new HIV infections. The 90-day stop-work order will result in 35% (6,000) additional new HIV infections in 2025. The stopping of PEPFAR direct funding will result in additional 7,000 new HIV infections in 2025. Stopping all PEPFAR direct funding will add 35,000, 90-days pause will add 31,000, while stopping support to HIV prevention programs will add 22,000 additional new HIV infections through 2030. Stopping all PEPFAR direct funding will result in more than 13% increase in AIDS-related deaths with additional 107,000 deaths through 2030. The 90 days pause will reduce adult treatment coverage by 10% from 95% to 85% in 2025, while stopping direct PEPFAR funding will result in a reduction in adult ART coverage by 40% to 55% in 2025. These disruptions pose a significant threat to Zimbabwe's ability to achieve epidemic control and reach the 2030 target of ending AIDS as a public health threat.