The SHIFT Project

Recent global funding cuts for HIV, TB, and other health programs, starting in 2025, have significantly affected HIV service delivery across many countries, particularly in sub-Saharan Africa. These cuts place increasing pressure on governments to take greater responsibility for sustaining health services. It remains unclear how countries will manage this transition, however, and what effects it will have on service delivery, patient care, and overall health system functioning. To sustain health improvements achieved by global HIV programs, it is essential to document these changes and assess their impact on health outcomes, system responsiveness, capacity, and efficiency using perspectives from HIV care clients and healthcare providers and utilizing programmatic facility-level data.

SHIFT (Studying the HIV Program Impact of Funding Transitions) is designed to provide evidence on short- and medium-term responses to the global funding cuts, delivering valuable insights for governments, funders, and partners during donor transitions. It focuses on six countries: Kenya, Malawi, Mozambique, South Africa, Zambia, and Zimbabwe. Inputs to SHIFT include national-level, routinely collected medical record (EMR) and facility (DHIS) data; key stakeholder interviews; and detailed, study-generated data from a set of sentinel facilities, including surveys and interviews with providers and clients.