Immediate risks and disruptions

1. Access to Kenya electronic medical records system: There are media reports indicating that aggregate health data are not accessible through the Kenya health information system (DHIS2).
2. Commodity availability: Short-term commodity availability has improved, with HIV commodities now being available at facilities. However, human resources for health remains impacted.
3. Service impact: Services for HIV, TB, malaria, immunization, nutrition, and family planning programmes are still affected. HIV prevention programmes have been paused or scaled down.  

Politically relevant updates

1. Impact of US Government funding cuts: The Kenyan Government released a comprehensive report on 24 March detailing the impact of the US Government funding cuts. Key recommendations include:
   • Immediate actions:
     • Establish an emergency health contingency fund.
     • Mobilize domestic resources and reallocate the national budget.
     • Begin high-level diplomatic negotiations with the United States.
   • Medium-to-long-term actions:
     • Strengthen public-private partnerships.
     • Expand universal health coverage and implement health insurance reforms.
     • Develop local pharmaceutical manufacturing.
     • Set up a donor coordination platform with real-time monitoring and mapping.
     • Create a structured contractual and legal framework to ensure resilience.
2. Government convening and mitigation measures: The National AIDS & STI Control Programme and the National Syndemic Diseases Control Council are planning to take an in-depth account of the situation at the county level on HIV treatment for adults and children.

Impact highlights

1. Civil society impact: Kenyan civil societies, led by the Kenya Legal and Ethical Issues Network, have demanded clarification from the Office of Data Protection Commission on measures taken to safeguard health data and ensure compliance with relevant data protection laws.
2. Community-led initiatives: ISHTAR, a key populations-led organization, received funding from other donors to continue with community-led monitoring work until the end of March.
3. UN response: The UNAIDS country office, in partnership with the National AIDS & STI Control Programme and the National Syndemic Diseases Control Council is developing a proposal to mobilize resources from the China International Development Cooperation Agency for HIV and other sexually transmitted infections prevention activities.

Documented impact on services

All facilities/service points providing antiretroviral treatment are working at a reduced capacity. The UNAIDS country office has received reports from the field that HIV commodities are now available at the facilities. The country has currently adequate HIV commodities and those that were running low at health facility level were flagged on 14 March 2025 by the Cabinet Secretary Ministry of Health for distribution by the US supported procurement agency. No stockouts are foreseen in the next 3-6 months. However, human resources for health remains impacted. 

Immediate risks and disruptions 

1. Documented impact on services:

• Reduced availability of PrEP; suspension of HIV prevention education and awareness campaigns, and decreased access to HIV testing and counselling services for key populations.
• Disruption of the distribution of condoms, lubricating gel, antiretroviral drugs.
• All programmes on stigma and discrimination funded by the US Government have stopped. 

2. Disruption of HIV data collection:

• Cessation of data entry at PEPFAR sites, leading to a disruption in HIV data collection.

3. Decrease in viral load testing:

• Viral load testing has decreased due to the slowdown in services at PEPFAR-funded sites.

4. Stock concerns:

• Concerns about stock-out of HIV test kits within 3-6 months.
• Condom stocks are sufficient for 1-3 months; but there is a need for 800,000 condoms per month, with funding for procurement being a concern.

5. International NGO-run services:

• All services run by international NGOs funded by US Government/PEPFAR have stopped. 

Politically relevant updates 

1. Government actions:

• The National Programme for the Fight against HIV/AIDS and Sexually Transmitted Infections has conducted an analysis of service provision, commodity availability, and human resources.
• The National Council for the Fight against AIDS sent an information note to the President and the Ministry of Health.
• Advocacy efforts with other technical and financial partners to mobilize resources to fill gaps.
• Integration of HIV services into other health services is being worked on by the government.
• The government is funding 55 operational sites and 142 mediators.

2. Civil society impact:

• Civil society has assessed financial, programmatic, and human resources gaps.
• Consultation meetings with the National Program for the Fight against HIV/AIDS and Sexually Transmitted Infections and implementation of a roadmap. 

Impact 

1. Impact of USAID funding suspension:

• 11,000 people living with HIV will lose access to antiretroviral treatment.
• 24,769 people living with HIV will no longer have access to viral load testing.
• 10,000 individuals, including pregnant women and their children, will miss out on testing.
• 203 project staff are facing technical unemployment since January 2025.

2. Current financial gaps:

• Togo faces a financial gap of 2.1 billion FCFA (West African CFA franc) for 2025, with 1.6 billion FCFA needed for antiretroviral medications and reagents.

3. Proposed solutions:

• Increase the state budget line for health from 2.5 billion FCFA to 5 billion FCFA.
• Include HIV as a chronic disease in the universal health insurance mechanism to ensure sustainable domestic funding. 

UN response 

• The UNAIDS Country Office is meeting with networks of people living with HIV and key populations, and a country-level task team is in place, including representatives from people living with HIV and key population networks. 

Immediate Risks and Disruptions 

• Funding Gap: An immediate input gap of 6,436,448 USD has been identified; these funds are required to cover the purchase of antiretroviral therapy (ARVs), tuberculosis (TB) prevention products, essential drugs for opportunistic infections (OIs), rapid tests, and transport costs. 
• Service Disruptions: The US funding cuts have disrupted services provided by ICAP, a major implementing partner financed by the US, and its two main civil society organization sub-recipients, affecting approximately 10,290 people living with HIV (PLHIV), including 528 pregnant/breastfeeding women, and 5,512 people most at risk of exposure to HIV. 
• Impact on Key Services: An evaluation carried out by the stakeholders estimated the impact of the US funding cuts as follows: Services impacted by more than 25% include: pre-exposure prophylaxis (PrEP), distribution of condoms and lubricants, health promotion and prevention services, services for key vulnerable populations (KVPs), prevention and management of sexual and gender-based violence (SGBV), community-led monitoring (CLM), and data management and health information systems. 

Politically Relevant Updates 

• Suspension of US Government Funding: the 90-freeze of US foreign assistance has put on hold at least 6,872,000 USD, representing support for more than 50% of the HIV activities needed to ensure continuity of service for people living with HIV. 
• Impact on Data Management: The cuts have compromised data production and management, with over 711,500 USD needed to support the management of electronic medical record systems and the strengthening of the national health information system. 
• Civil Society Impact: Community organizations involved into Community Led Monitoring (CLM) are heavily impacted, with three implementing partners (CAPES+, BUNERELA, CBF+) reporting a funding impact of 230,574 USD on their operating budget and on their human resources. Additionally, more than 167 staff from service provider organizations have had their contracts affected, and 30 peer educators working with 200 infected injecting drug users have had their contracts terminated. 

The US funding cuts have had a profound impact on HIV programmes in Burundi. For example, ICAP, an implementing partner financed by the US, provided comprehensive coverage of prevention, treatment, and care as well as HIV viral load monitoring to around 61,000 PLHIV (out of an estimate of 81 000 PLHIV in the country) through the Baho Mbeho project in 349 health facilities across 18 provinces. The disruption of these services has left thousands of individuals without essential support, highlighting the critical need for sustained funding and international cooperation to ensure the continuity of HIV programmes. 

Recommendations and mitigation measures resulting from consultations and an impact workshop include: 

• Organize a joint field impact assessment mission under the lead of the Ministry of Health (MOH). 
• Set up a crisis management group and a mitigation plan. 
• Map US-funded interventions/projects. 
• Set up a team to leverage the UNAIDS Rapid AIDS Financing Tool (RAFT). 
• Model impact according to various scenarios and reprogram/reprioritize interventions. 
• Meet with development partners to discuss funding and support. 
• Include HIV in primary health care, universal health coverage (UHC), and social protection. 

These measures aim to address the immediate risks and disruptions, ensuring that HIV programmes can continue to provide vital services to those in need.