The potential impact of reduced donor funding for HIV programs on Malawi's disease burden

Objectives: HIV care in Malawi has been primarily funded through overseas development assistance for health, leading to the establishment of vertically-funded supply chains of key HIV medicines and diagnostics. Cuts in this funding could undermine healthcare services and the success of these supply chains. Design: Using the Thanzi La Onse model, we estimate the potential impact of reduced availability of HIV related consumables that could result from reduced external funding. Methods: We consider a shift in HIV consumable availability from the high levels achieved currently (≥93% for adult ART and ≥85% for HIV tests in relevant facility levels) to levels comparable to those observed within government-funded integrated supply chains in other areas of health (44–76% and 44–73%, respectively). We assume that if key medicines/diagnostics are not available, a patient's care is delayed or interrupted. We measure the consequences in terms of disability-adjusted life years (DALYs) and AIDS deaths over the period 2025–2040. Results: A reduction in HIV consumable availability could cause a substantial increase in HIV/AIDS-related DALYs, with projected increases exceeding 144% compared with the status quo. Mortality rises sharply within the first 4–5 years of the simulation, as continuity of care is disrupted for the large cohort of people currently on ART, demonstrating the rapid and severe consequences of reduced access to essential HIV consumables. Conclusions: This study highlights the risks to HIV programs in Malawi from reduced external funding, emphasising the need for governments to sustain current levels of HIV medicines and diagnostics beyond donor funding.