Submission ID 118416
| Issue/Objective | The President's Emergency Plan for AIDS Relief (PEPFAR) was launched in 2003 and has been a cornerstone in supporting HIV care globally through provision of antiretroviral therapy (ART), healthcare workforce support, and prevention services. However, the recent hold on PEPFAR funding by the U.S. administration has had significant implications for HIV service delivery, especially in resource-limited settings like Uganda. The objective of this study was to explore the impact of the PEPFAR funding hold on HIV/AIDS programs, service delivery, and affected communities at Mbarara Regional Referral Hospital (MRRH), focusing on service disruptions, client experiences, and staff responses. |
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| Methodology/Approach | A qualitative descriptive approach was used to gather data between January 20 and March 31, 2025. Reports were documented from clients accessing care during this period, supplemented by a qualitative survey conducted among MRRH healthcare workers. In-depth observations and patient voice recordings provided additional insights into the lived experiences of people living with HIV during the funding crisis. |
| Results | MRRH experienced a significant rise in patient volume, with daily attendance reaching up to 200 clients. Forty individuals presented as new testers despite already being diagnosed, while others sought early refills, re-initiation after default, or those transferring from other facilities. Key drivers included lack of staff at their mother sites, unofficial drug charges, and poor patient-provider interactions elsewhere. Staff at MRRH, despite receiving notices to stop work, voluntarily continued services, preserving continuity of care. However, drug shortages, particularly of ABC/3TC and Etravirine, forced rationing. Healthcare workers reported increased anxiety, changes in treatment models, and growing economic stress among both patients and providers. |
| Discussion/Conclusion | The PEPFAR funding hold revealed deep vulnerabilities in HIV service delivery, affecting treatment adherence, client trust, and overall program stability. Despite challenges, the response at MRRH highlighted the critical role of committed healthcare workers and the need for emergency preparedness funding at national level. The experience underscores the importance of predictable, sustained funding in HIV programming and points to the need for further research into the broader effects of such funding disruptions. Strengthening resilience through policy support and contingency planning is vital to sustaining HIV care during fiscal uncertainties. |
| Presenters and affiliations | Robinah Kusemererwa Mbarara Regional Referral Hospital Robinah Kusemererwa Mbarara Regional Referral Hospital Evalyne Asiimwe Mbarara Regional Referral Hospital Peace Atwongyeire Mbarara Regional Referral Hospital Hope Asimire Mbarara Regional Referral Hospital Aminah Nakayenga Mbarara Regional Referral Hospital Winnie Muyindike Mbarara Regional Referral Hospital |
