CHAI reports impact of cuts in HIV, CD4 and viral load testing, reduced PrEP: children fare worst

Simon Collins, HIV i-Base

The withdrawal of US funding for HIV treatment and prevention programmes across 14 countries in African and Asia continues to have a devastating impact according to the latest market report published in June by CHAI. [1]

This latest analysis – based on national data rather than just from PEPFAR-funded clinics – shows that decades of progress are steadily being drawn backwards. [1]

Summary results comparing 2024 to 2025

Top-line reports include the following combined changes from 2024 to 2025 in key metrics among countries providing data.

HIV testing dropped 12% (8 countries).
New ART initiations fell by 9% (8 countries).
New PrEP initiations fell by 42% (10 countries).
CD4 testing in advanced care dropped by 35% (6 countries).
Viral load testing dropped by 21% (10 countries).
The number of children on ART fell by 11% (9 countries).
Overall, new HIV diagnoses dropped 28%.

Continued US funding has also changed from multinational programmes to bilateral agreements called Memoranda of Understanding (MoUs) that generally steeply reduce support by 2030 and tie funding to trade agreements favouring US commercial interests.

Global Fund allocations for the next round of funding across 13 African countries also drop over the same time by between 8% to 34%.

The report also covers reductions in international donor funding and the impact this could have on procurement and supply chains that have been critical for affordable healthcare in many countries.

Reduced funding for PrEP is highlighted by the 42% drop in people starting oral PrEP.

Injectable lenacapavir PrEP in South Africa

However, there is also positive news that the 6-monthly injectable lenacapavir PrEP programme has just started in South Africa. [2]

Lenacapavir has so far reached only 20,000 people in low income countries with plans for generic access in early 2027 projected at a fixed US $40 per person per year for 3 million people (against an estimated need for 20 million people).

The report also flags the importance of planning now for wide generic access to alimatrevir (MK-8527), the once-monthly oral PrEP being developed by Merck/MSD and currently in phase 3 studies.

References

Clinton Health Access Initiative (CHAI). HIV Market Impact Memo. June 2026.
https://www.clintonhealthaccess.org/wp-content/uploads/2026/06/HIV-Market-Impact-Memo-June2026.pdf
Bhekisisa. How to use the anti-HIV jab — and where to find it. (5 June 2026).
https://bhekisisa.org/health-news-south-africa/2026-06-05-how-to-use-the-anti-hiv-jab-and-where-to-find-it/