The impact of USAID and CDC funding cuts on HIV incidence and mortality in KwaZulu Natal, South Africa

ABSTRACT Background Abrupt cessation of USAID and CDC resources to KwaZulu Natal province in South Africa, threatens the progress over decades to address HIV. Methods We used a previously developed validated HIV transmission model with input from the KZN Department of Health and local stakeholders to estimate impact of funding cuts on HIV incidence and mortality at 12-months and through 2030. We applied the model to estimate the impact of restoring funds on HIV incidence and mortality. Results HIV incidence increased at 12 months and through 2030 by 3.4% and 22.8%, leading to 35,300 and 116,100 additional infections, and 12,800 and 42,300 additional deaths, respectively. Restoring funding after a 12-month pause, reallocated to focus on long-acting PrEP, would avert 12,600 new infections. Conclusion This model application demonstrates that the sudden cessation of USAID and CDC commitments in the largest HIV epidemic in the world leads to increased incidence and mortality and threatens decades of progress in KZN, South Africa. Restoring funding within 12 months and increasing efficiency of HIV interventions can reestablish KwaZulu Natal province, South Africa’s trajectory toward EHE goals.