Funding for Key HIV Commodities in PEPFAR Countries

  • In many low- and middle-income countries, PEPFAR and the Global Fund are significant funders of commodities to diagnose, treat, and prevent HIV, along with country governments. But, information on their relative contributions, which is important for assessing the HIV response, is not readily available. We analyzed data from PEPFAR documents on funding for key HIV commodities in 34 PEPFAR countries to better understand the funding landscape.
  • Overall, we find that funding for HIV commodities in these countries was estimated to total more than $3 billion among PEPFAR countries required to submit 2019 Country and Regional Operating Plans. Almost two-thirds was for antiretroviral drugs (ARVs) (64% or $1.95 billion), followed by lab and diagnostic products (26% or $779 million). Funding for each of the other commodity types was 6% or less.
  • While PEPFAR is the largest funder of HIV efforts in the world, it was not the dominant funder overall for HIV commodities in PEPFAR countries. Country governments were the largest funder of HIV commodities (44% or $1.3 billion), followed by the Global Fund (31%), and PEPFAR (24%). Overall, South Africa’s domestic government funding accounted for 56% of all country government commodity support. When commodity funding for South Africa is removed from the analysis, the Global Fund was the top funder and PEPFAR was second.
  • The main funder varied by commodity. For example, PEPFAR accounted for the largest share of funding for voluntary medical male circumcision (VMMC)-related commodities in countries with a VMMC program, and the Global Fund accounted for the largest share of funding for condoms and lubricants. While country governments accounted for the largest overall share of ARV funding, the Global Fund was the top ARV funder when South Africa was removed.
  • The main funder also varied somewhat by country. The Global Fund provided the largest share of commodity funding in most PEPFAR countries (21 of 34), followed by country governments (8 of 34) and PEPFAR (5 of 34).
  • As we find here, PEPFAR is not the dominant funder of HIV commodities in most of the countries where it works, although PEPFAR often funds many of the associated services needed to support the delivery and use of commodities and, as the main donor to the Global Fund, indirectly funds a larger share of commodities in PEPFAR countries. These findings could help to inform assessments of the sustainability of HIV efforts, decision-making about the most effective division of commodity funding between purchasers, and opportunities for better coordination and synergy in the future, particularly given concerns about overall HIV funding in low- and middle-income countries.
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