The National Institutes of Health (NIH) instructed leaders of its four HIV clinical trials networks to temporarily pause launching new studies that have not yet begun enrolling participants and would extend beyond November 30, 2027 (when funding expires). As The New York Times reports, this comes amid continued delays in releasing Notices of Funding Opportunities (NOFOs) to renew the networks and the Centers for AIDS Research (CFARs) for the next seven years, threatening research infrastructure built over decades and potentially disrupting clinical trials and services for participants. In response, AVAC, along with allies PrEP4All, HIVMA, TAG, and AIDS Action Baltimore as part of the Save HIV Funding Campaign are inviting sign-ons to a letter to Congress demanding that the US Department of Health and Human Services (HHS) authorize the long overdue funding announcements. Organizations can sign-on by October 15. 

IMPLICATIONS: The affected clinical trial networks include the Advancing Clinical Therapeutics Globally for HIV (ACTG), HIV Prevention Trials Network (HPTN), HIV Vaccine Trials Network (HVTN), and the International Maternal Pediatric Adolescent AIDS Clinical Trial Network (IMPAACT). The delayed renewal of the networks and the directive to hold off on launching new studies create uncertainty for the research pipeline, potentially delaying scientific advances, disrupting services for trial participants and weakening infrastructure built over decades. These networks have yielded critical advancements for HIV treatment and prevention and are important catalysts for tuberculosis treatment and prevention research, and for other emerging infectious diseases. Simultaneously, the proposed NIAID reorganization raises questions about the future of centralized clinical research oversight and support. As AVAC shared with the NIAID Council and the AIDS Research Advisory Committee (ARAC) at their meeting September 27, “Collectively, these programs have saved millions of lives over the last several decades and advanced some of the most important scientific discoveries and implementation science advances. Delays in the release of the NOFOs are forcing clinical trial sites to prepare for lapses in funding that could harm study participants, halt promising clinical trials, and erode the scientific workforce and infrastructure that has taken decades to develop.” In sum, the continued attacks on the HIV research infrastructure could reshape the trajectory of research for years to come.

READ:  

• H.I.V. Research Networks Face Uncertain Future Amid Funding Delays—New York Times 
• ‘The anti-Fauci’? Lab-leak proponent listed in NIH directory but denies being hired—Science  
• NIH rolling out streamlined website to help public find information more easily—STAT  
• Lame-duck effort brewing to protect NIH grantmaking—Rollcall  

The US Department of State was said to begin implementing its America First Global Health Strategy across 35+ partner countries on October 1, the start of the US fiscal year. But this is all evolving differently across countries. In Zimbabwe, US bilateral health assistance ended September 30 after the two countries failed to reach an agreement. Health GAP details the disagreements, which include sharing health data and biological specimens, but more importantly, major reductions in US funding and co-financing requirements that would have required Zimbabwe to increase its contributions by 290% in the first year. It proposes several next steps to avert the crisis. Health Policy Watch reports that “researchers project that there could be over 75,000 new HIV infections in Zimbabwe within a year ‘as a consequence of full PEPFAR withdrawal and no additional government or international support’.” 

In contrast, the US and Zambia signed a five-year, $2.49 billion health agreement yesterday, following months of negotiations. Zambia reports that requirements to share patient-level health data and biological specimens were removed, while negotiations over critical minerals were separated from the health agreement. Meanwhile, South Africa is preparing for the phaseout of PEPFAR support by March 2027, raising concerns about the future of community-based HIV prevention and treatment services. 

IMPLICATIONS: The withdrawal of US health assistance in Zimbabwe could dismantle decades of progress against HIV, TB and malaria, with consequences beyond the immediate term. Health GAP warns that the crisis could disrupt Zimbabwe's introduction of injectable lenacapavir for HIV PrEP, jeopardizing access to one of the most important recent advances in HIV prevention. The implications are particularly alarming because these are interconnected programs: disruptions to community health workers, laboratories, supply chains and service delivery can undermine responses to all three diseases simultaneously. 

READ: 

• Zim sustains HIV response gains as NAC raises US$76 million—The Herald  
• US aid cuts drove sharp HIV service drops in Africa, study finds—Bloomberg 
• HIV service delivery after the PEPFAR and USAID HIV funding withdrawal in Uganda and Zimbabwe: an interrupted time-series study—Lancet Global Health 
• Trump is conditioning foreign aid on deals—Politico Pro 
• Zambia and US reach health financing deal after monthslong stalemate—Devex  
• Health Crisis Looms for Zimbabwe Following US Withdrawal of Aid—Health Policy Watch 

The US 2026 fiscal year ended on September 30, and the picture is becoming slightly clearer on how billions of dollars of Congressionally-appropriated global health funding was actually spent. According to Devex and in court filings, the US Department of State committed more than $4 billion in foreign assistance funding just before the end of the fiscal year, preventing much of that money from expiring. A new filing in the Global Health Council and AVAC court cases shows that only $18,919 in Global Health Programs funding for which the State Department was responsible expired without being committed. However, the filing also identifies funds committed to covering the costs of closing out USAID, rather than supporting health and development programs as Congress had intended.  

IMPLICATIONS: This adds to concerns raised last week about the transfer of $2.5 billion originally intended for global health and development assistance into an alternative or ‘miscellaneous’ account. While the government appears to have met much of the deadline for committing funds, questions remain about where the money is going, whether it is being used as Congress intended and when it will actually reach programs and communities. As AVAC’s Mitchell Warren summarized last week, “the issue extends beyond foreign assistance or the HIV response; it is fundamentally about Congress’s constitutional power of the purse.” 

READ: 

• The State Dept. obligates billions, just in the nick of time—Devex  
• Trump to tout innovation ‘Golden Age’ amid funding cuts, researcher exodus—Washington Post  
• The State Department is Dumping Billions of Global Health Dollars Into Sole Source Awards—Health Security Policy Academy 
• Watchdog finds holes in the US foreign aid review story—Devex  
• NIH awarded all its grant funding, but delayed and opaque decisions stymied researchers—STAT  

Last week, leadership candidates for the Global Fund to Fight AIDS, Tuberculosis and Malaria, and WHO were announced. This week, China confirmed its nomination for WHO Director-General, expanding the known candidates to seven and raising questions about geopolitical influence as the US withdraws from the organization. On his Global Health Insights Substack, former WHO Adviser Peter Singer published a scorecard examining how specifically candidates have articulated plans to deliver measurable results and protect WHO's scientific independence. And in Lights. Camera. Equity!, former Global Fund Board member Jirair Ratevosian called for greater public engagement in the Global Fund's selection process. He reported that the Fund confirmed it has no plans for a public candidate forum, with engagement instead taking place through Board constituencies. 

IMPLICATIONS: These developments raise questions about transparency and accountability in choosing the next generation of global health leadership. These new leaders will face immediate decisions that will shape how these institutions define their roles in an evolving architecture. WHO is already reducing its staff significantly after the US refused to support it, and the Global Fund is facing difficult decisions about where and how to invest its smaller Grant Cycle 8 budget. 

READ:

• WHO Director-General Election Scorecard—Global Health Insights Substack 
• The top 10 causes of death-World Health Organization—Lights. Camera. Equity! Substack 
• Global Fund Leadership Shortlist Unveiled Amid Donor Friction and Push for Reform—Health Policy Watch  
• China Confirms Song Li’s WHO Leadership Bid, Reshuffling Race Amidst Fraught Multilateral Landscape—Health Policy Watch  

Ahead of the October 26 UNAIDS Programme Coordinating Board (PCB) meeting, more than 225 civil society organizations signed an open letter urging members of the PCB to protect the Joint Programme from being dismantled through proposed funding, staffing and operational cuts. Advocates warn that proposals to reduce UNAIDS to a $30 million budget and just 34 staff could undermine its ability to coordinate the global HIV response, defend human rights and ensure meaningful community leadership and accountability. 

IMPLICATIONS: The upcoming UNAIDS PCB meeting will be a defining moment in determining the Joint Programme’s essential functions and whether and how reform can preserve UNAIDS’ leadership, accountability and community engagement. 

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• Open Letter to Members of the UNAIDS Programme Coordinating Board (PCB)