The Impact of Donor Funding Disruptions Across the Paediatric HIV Care Cascade in Sub-Saharan Africa (2005–2025): A Scoping Review

Abstract Paediatric HIV outcomes in sub-Saharan Africa (SSA) have significantly improved over the past two decades, largely due to donor-funded programmes that promote early infant diagnosis (EID), antiretroviral therapy (ART), and community-based service delivery. Despite these achievements, many countries in the region remain highly dependent on external donor financing, raising concerns about the sustainability of paediatric HIV services during periods of funding uncertainty. This scoping review examined how donor funding disruptions impact paediatric HIV service continuity in SSA and their system-level consequences for children. This review included studies published between January 2005 and November 2025. Following the PRISMA-ScR guidelines, studies were analysed using descriptive statistics and narrative synthesis with findings organised across the paediatric HIV care cascade. Across nine studies, donor transitions, especially those related to PEPFAR, were linked to workforce reductions, supply chain disruptions, and the elimination of community-based outreach programmes. These changes contributed to delays in EID, weakened linkage to care, disruptions in ART initiation, and decline in retention. These effects occurred through interconnected health-system pathways rather than isolated programme failures. Overall, the results show that paediatric HIV services remain highly dependent on donor-supported systems, with limited transition preparedness. Transition frameworks should prioritise paediatric service continuity, strengthen health-system resilience, and align financing responsibilities between donors and governments to reduce preventable child morbidity and mortality.