U.S. Funding Cuts Threaten 39 Research Sites in South Africa Putting Scientific Advancements and Hard Won Progress Against TB and HIV at Risk

TAG and MSF urge donors to act now to protect ongoing research and ensure continuity of care for people with HIV and TB

Contact: Shailly Gupta, Médecins Sans Frontières, shailly.gupta@geneva.msf.org
Dorrit Walsh, Treatment Action Group, dorrit.walsh@treatmentactiongroup.org

Johannesburg/New York, 15 May 2025 – Lifesaving scientific research on prevention, testing, treatment and care for people living with HIV and tuberculosis (TB) in South Africa is under serious threat due to funding suspensions and grant terminations from the United States (US) government. A recent joint analysis by Treatment Action Group (TAG) and Médecins Sans Frontières/Doctors Without Borders (MSF) revealed that 39 TB and HIV clinical research sites in South Africa are under threat due to potential funding cuts by the U.S. government, placing at least 27 HIV trials and 20 TB trials at risk. This is the first time an analysis has been done to map specific trials and clinical research sites related to HIV and TB that are at risk due to the US funding cuts. TAG and MSF call on donor agencies, governments, and philanthropic organizations to urgently intervene to:

Ensure continuity of care and follow-up for research participants in South Africa already enrolled in impacted HIV and TB clinical research sites by providing emergency support.
Address urgent research gaps by funding vital HIV and TB trials that were planned or paused just before launch.
Make sustained investments to secure South Africa’s unique and internationally recognized research infrastructure.

“Public funding from the US government to South Africa is the scaffold on which pharmaceutical companies, philanthropies, and other governments invest in transformative TB and HIV science,” said Lindsay McKenna, TB project co-director of Treatment Action Group. “These ongoing funding disruptions by the US government don’t just affect US-funded research projects, they put in peril a much wider ecosystem of global research. Donors must act swiftly to preserve scientific advances, prevent the collapse of medical research infrastructure in South Africa, and ensure continuity of care for people living with HIV and TB that have volunteered to participate in research.”

As per TAG and MSF’s analysis, TB trials that are at risk include new drugs and shorter, safer regimens for treatment and prevention, an optimized regimen for TB meningitis, and therapeutic and preventive vaccines. Cutting support to sites in South Africa that are part of international clinical trial networks including ACTG, HVTN and IMPAACT[1], could derail up to 30 percent of global TB trial enrollment and between 50-90 percent for studies focused on pediatric and pregnant populations. For HIV, trials at risk include cure-related protocols involving broadly neutralizing antibodies (bNAbs) and analytical interruptions of antiretroviral therapy in both adults and infants, studies to promote treatment adherence for youth, and trials of innovative preventive vaccine modalities designed to induce bNab production.

The analysis was primarily focused on NIH-funded DAIDS[2] HIV Clinical Trials Network studies and research infrastructure, but this is just the tip of the iceberg. The US funding cuts impacting critical research being funded through other NIH mechanisms, US university grants, US Centers for Disease Control and Prevention (CDC) and the US President’s Emergency Plan for AIDS Relief (PEPFAR) are expected to disrupt a much wider array of TB and HIV research projects.

“For years, South Africa has spearheaded the research and development of critical innovative medical tools for the prevention, diagnosis, treatment and care of HIV and TB which have saved lives not just within South Africa’s borders, but also in communities worldwide,” said Dr. Tom Ellman, director of the Southern Africa Medical Unit (SAMU) of MSF. “If the research work of tackling these two infectious diseases – including for the most vulnerable – is stalled, we risk losing hard-won progress. These cuts are especially devastating since they come on top of existing reductions to TB and HIV programming. We call on all potential donors to step up, as without sustained investment, we will never end these deadly epidemics.”

Research conducted in South Africa — much of it led by South African scientists and supported with funding from the NIH, and, to a lesser extent, the CDC and the US Agency for International Development (USAID) — has helped to bring forward most of the innovations introduced globally in the last two decades and shaped global health policies that have revolutionized TB and HIV prevention, diagnosis, treatment and care, benefiting both people locally and communities worldwide. Without urgent action by donors, there is a potential risk of TB and HIV research capacity in South Africa collapsing, which would have direct implications for people living with HIV and TB in South Africa, and globally.

“Future breakthroughs in HIV and TB research, particularly in the areas of vaccine development and long-acting treatments, is likely to rely on settings with high incidence rates and vulnerable populations, such as those in South Africa. Importantly, these advances will benefit people globally, including in high-income countries like the United States,” said Ellman.

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Read the briefing document, South Africa’s TB and HIV Research At Risk: A Call to Catalyze Urgent Action by Funders, for more details on the HIV and TB trials that are impacted by US funding cuts and their ripple effects. The annex provides a detailed overview of trials and South African research sites in the DAIDS HIV/AIDS Clinical Trials Networks and the extent of disruptions caused by actual and potential US government funding terminations.

[1] ACTG = Advancing Clinical Therapeutics Globally for HIV/AIDS and Other Infections; HVTN = HIV Vaccine Trials Network; and IMPAACT = International Maternal, Pediatric, Adolescent AIDS Clinical Trials Network.

[2] DAIDS stands for the Division of AIDS within the National Institute of Allergy and Infectious Diseases (NIAID), which is part of the U.S. National Institutes of Health (NIH).

South Africa’s TB and HIV Research At Risk: A Call to Catalyze Urgent Action by Funders