A coalition of eight former directors of the Centers for Disease Control and Prevention (CDC) is warning that a proposed restructuring of the President's Emergency Plan for AIDS Relief (PEPFAR) could undermine HIV testing, surveillance, and treatment programs that have operated for more than two decades.
In an opinion piece published by STAT News, the former CDC leaders criticized a State Department plan that would significantly reduce CDC involvement in PEPFAR operations and shift many responsibilities to host countries and new bilateral agreements. According to the authors, the proposal could affect CDC-supported programs that currently help provide HIV treatment to millions of people worldwide.
For clinical laboratory professionals, the concerns extend beyond treatment programs. HIV testing networks, disease surveillance systems, laboratory quality initiatives, and workforce training programs have long been supported through CDC-led technical assistance under PEPFAR.
The proposal emerges as the federal government continues broader efforts to restructure foreign assistance programs. Since 2025, PEPFAR has experienced funding reviews, operational changes, and a transition toward country-led agreements intended to reduce long-term dependence on US support. Supporters of the approach argue it promotes sustainability and greater national ownership of HIV programs. Critics contend the transition is occurring too quickly and without sufficient safeguards.
Concerns about testing and surveillance capacity
Recent analyses of PEPFAR data have shown that while the number of patients receiving HIV treatment has remained relatively stable, several key prevention and monitoring indicators have declined. Independent reviews found reductions in HIV testing activity, pre-exposure prophylaxis (PrEP) enrollment, and healthcare workforce capacity following disruptions to program operations. Experts have cautioned that decreases in testing today could translate into delayed diagnoses and reduced visibility into emerging outbreaks in the future.
Those trends may be particularly relevant for laboratories. HIV testing volumes, viral load monitoring, epidemiologic surveillance, specimen referral networks, and laboratory workforce development have historically been core components of PEPFAR-supported public health infrastructure.
The former CDC directors also warned that proposed reductions in CDC's overseas presence could weaken the disease surveillance systems that have supported responses to HIV as well as other infectious disease threats.
Notably, there have been no significant official updates, reversals, or finalized implementation announcements since the STAT News report was published on May 26. The State Department has disputed claims that PEPFAR or CDC global health operations are being dismantled and has maintained that future bilateral agreements could preserve or even expand certain CDC-supported activities. However, details regarding the final structure of the program remain unclear.
For now, laboratory leaders involved in global health, infectious disease testing, or public health partnerships may be watching closely to determine whether proposed organizational changes ultimately affect HIV testing capacity, laboratory funding streams, and disease surveillance efforts in countries that have historically relied on PEPFAR support.
This article was created with the assistance of Generative AI and has undergone editorial review before publishing.
