HIV patient testing falls in South Africa after US aid cuts, data shows

Testing and monitoring of HIV patients across SA have fallen since the US cut aid that funded health workers and clinics, with pregnant women, infants and youth the most affected, previously unpublished government data shows.

SA has the world's highest burden of HIV, with about 8-million people, or one in five adults, living with the virus. The US was funding 17% of the country's HIV budget until President Donald Trump slashed aid earlier this year.

Data from the National Health Laboratory Service, a government entity, showed viral load testing fell by up to 21% among key groups in the past two months, which four HIV experts said appeared to be due to the loss of US funding.

Viral load testing measures how much virus is in the blood of people living with HIV who are on antiretroviral treatment. It is normally done at least once a year.

It checks whether the treatment is working and whether the virus is sufficiently suppressed to prevent it spreading to others.

With less testing, fewer people who may transmit the virus will be identified. Missing a test can also indicate a patient has dropped out of the system and may be missing treatment.

It is specially important for pregnant women who may be at risk of transmitting HIV through childbirth, and for infants who need to be diagnosed and treated early to survive.

Trump froze many foreign aid programmes early in his presidency, before reinstating some lifesaving assistance, including parts of the US President's Emergency Plan for Aids Relief (Pepfar), its global HIV initiative. But SA was also specifically targeted, with an executive order cutting all funding to the country in February.

SA did not rely on US funding for its HIV drugs, but about 15,000 health workers' salaries were paid by Pepfar, which previously gave SA more than $400m (R7.2bn) a year. Most of the funding has been withdrawn, though it is unclear exactly how much.

The health workers did HIV testing and counselling in districts with a high prevalence of HIV, and followed up when patients missed a check-up or dropped off treatment, which is common.

The Pepfar funding also supported NGO-run clinics which have closed. The government has urged HIV patients who did check-ups at the clinics to go to public health centres instead, but public health centres often have long lines and staff can be unwelcoming to certain groups such as sex workers and gay men.

According to the data seen by Reuters, the number of viral load tests conducted for people aged 15 to 24 fell by 17.2% in April compared to April last year, after dropping 7.8% year-on-year in March. Total population testing was down 11.4% in April.

Maternal viral load testing was down 21.3% in April after falling by 9.1% in March, and early infant diagnostic testing was down 19.9% in April after falling by 12.4% in March, the same data showed.

The percentage of people who were virally suppressed among those tested also fell nationwide by 3.4% in March and 0.2% in April, with steeper declines for young adults, a further sign patients may have had their treatment interrupted, the data showed.

The data has not been made public.

“These are shocking figures, with profound implications for maternal and child health across the country,” said Francois Venter, executive director of the Ezintsha Research Centre in Johannesburg.

Given a summary of the data, Foster Mohale, a spokesperson for the department of health, said more analysis was needed and SA had challenges with patient retention and viral load testing before the aid cuts.

HIV experts have said for months the health ministry was downplaying the impact of the funding loss, and a drop in testing figures might be an early warning sign, followed by a rise in new cases and deaths.

The US state department did not immediately respond to a request for comment.

“This data demonstrates what previous models have shown regarding the impact of Pepfar/USAID cuts on pregnant women and their infants,” said Dvora Joseph Davey, an epidemiologist working on maternal and infant HIV at the University of Cape Town.

She said the impact was clear at five public health clinics where she works in Cape Town, which since the US aid cuts have been under-staffed, with fewer nurses to draw blood needed for viral load tests.

HIV experts said diagnostic testing was also likely affected by the funding cuts, though that data was not available.

The counsellors who used to do rapid diagnostic HIV tests are also gone, and pregnant women are no longer being put on preventive HIV drugs (PrEP) because the counsellors are the ones who used to offer that, Davey said.

In the Johannesburg township of Diepsloot, HIV activist and community leader Sophy Moatshe said it was hard to get HIV patients to seek care because of the stigma, and without health workers reaching out when they miss an appointment, many fall through the cracks.

“These people, they don't want to go to the clinic,” she said outside a community centre.

“If there is nobody to check them, they're going to die.”

The long-term future of HIV-related US assistance remains uncertain in SA and globally, as Trump pursues cuts to the international aid budget in line with his “America First” agenda.

The cuts have also hit research, including HIV vaccine trials.

Mohale said the government was speaking to prospective local and international donors about covering funding gaps, but declined to give details.

Davey said the data on testing in April, however, was “a good indication of what's going to happen in the future”.

Reuters