{"id":"https://openalex.org/W7214790802","doi":"https://doi.org/10.64898/2026.09.27.26364124","title":"Facility-level variation in HIV service delivery volumes before and after the 2025 PEPFAR funding cuts: a retrospective analysis of District Health Information System data in Zambia","display_name":"Facility-level variation in HIV service delivery volumes before and after the 2025 PEPFAR funding cuts: a retrospective analysis of District Health Information System data in Zambia","publication_year":2026,"publication_date":"2026-09-29","ids":{"openalex":"https://openalex.org/W7214790802","doi":"https://doi.org/10.64898/2026.09.27.26364124"},"language":"en","primary_location":{"id":"doi:10.64898/2026.09.27.26364124","doi":"https://doi.org/10.64898/2026.09.27.26364124","is_oa":true,"landing_page_url":"https://doi.org/10.64898/2026.09.27.26364124","pdf_url":"https://www.medrxiv.org/content/medrxiv/early/2026/09/29/2026.09.27.26364124.full.pdf","source":{"id":"https://openalex.org/S3005729997","display_name":"medRxiv","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core"],"host_organization":null,"host_organization_name":null,"host_organization_lineage":["https://openalex.org/P4310315909"],"host_organization_lineage_names":["Cold Spring Harbor Laboratory Press"],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"acceptedVersion","is_accepted":true,"is_published":false,"raw_source_name":"medRxiv","raw_type":"posted-content"},"volume":null,"type":"preprint","indexed_in":["crossref"],"open_access":{"is_oa":true,"oa_status":"green","oa_url":"https://www.medrxiv.org/content/medrxiv/early/2026/09/29/2026.09.27.26364124.full.pdf","any_repository_has_fulltext":true},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5013497904","display_name":"Mike Mwale","orcid":"https://orcid.org/0009-0004-6622-2340","observed_orcids":["https://orcid.org/0009-0004-6622-2340"]},"institutions":[{"id":"https://openalex.org/I4210099038","display_name":"Clinton Health Access Initiative","ror":"https://ror.org/013mr5k03","country_code":"US","type":"nonprofit","lineage":["https://openalex.org/I4210099038"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Mike Mwale","raw_affiliation_strings":["Clinton Health Access Initiative-Zambia, Lusaka, Zambia"],"raw_orcid":"https://orcid.org/0009-0004-6622-2340","affiliations":[{"raw_affiliation_string":"Clinton Health Access Initiative-Zambia, Lusaka, Zambia","institution_ids":["https://openalex.org/I4210099038"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5066253506","display_name":"Sydney B. Rosen","orcid":"https://orcid.org/0000-0002-6560-2964","observed_orcids":["https://orcid.org/0000-0002-6560-2964"]},"institutions":[{"id":"https://openalex.org/I111088046","display_name":"Boston University","ror":"https://ror.org/05qwgg493","country_code":"US","type":"education","lineage":["https://openalex.org/I111088046"]},{"id":"https://openalex.org/I192619145","display_name":"University of the Witwatersrand","ror":"https://ror.org/03rp50x72","country_code":"ZA","type":"education","lineage":["https://openalex.org/I192619145"]}],"countries":["US","ZA"],"is_corresponding":true,"raw_author_name":"Sydney Rosen","raw_affiliation_strings":["Boston University School of Public Health, Boston, MA, USA","Health Economics and Epidemiology Research Office, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa"],"raw_orcid":"https://orcid.org/0000-0002-6560-2964","affiliations":[{"raw_affiliation_string":"Boston University School of Public Health, Boston, MA, USA","institution_ids":["https://openalex.org/I111088046"]},{"raw_affiliation_string":"Health Economics and Epidemiology Research Office, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa","institution_ids":["https://openalex.org/I192619145"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5041502382","display_name":"Thandiwe Ngoma","orcid":"https://orcid.org/0000-0003-2643-5021","observed_orcids":["https://orcid.org/0000-0003-2643-5021"]},"institutions":[{"id":"https://openalex.org/I4210099038","display_name":"Clinton Health Access Initiative","ror":"https://ror.org/013mr5k03","country_code":"US","type":"nonprofit","lineage":["https://openalex.org/I4210099038"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Thandiwe Ngoma","raw_affiliation_strings":["Clinton Health Access Initiative-Zambia, Lusaka, Zambia"],"raw_orcid":"https://orcid.org/0000-0003-2643-5021","affiliations":[{"raw_affiliation_string":"Clinton Health Access Initiative-Zambia, Lusaka, Zambia","institution_ids":["https://openalex.org/I4210099038"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5110851644","display_name":"Suilanji Sivile","orcid":"https://orcid.org/0009-0005-3072-475X","observed_orcids":["https://orcid.org/0009-0005-3072-475X"]},"institutions":[{"id":"https://openalex.org/I1336862989","display_name":"Ministry of Health","ror":"https://ror.org/00hpqmv06","country_code":"ZM","type":"government","lineage":["https://openalex.org/I1336862989"]}],"countries":["ZM"],"is_corresponding":false,"raw_author_name":"Suilanji Sivile","raw_affiliation_strings":["Zambia Ministry of Health, Lusaka, Zambia"],"raw_orcid":"https://orcid.org/0009-0005-3072-475X","affiliations":[{"raw_affiliation_string":"Zambia Ministry of Health, Lusaka, Zambia","institution_ids":["https://openalex.org/I1336862989"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5153452664","display_name":"Chimuka Sianyinda","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I1336862989","display_name":"Ministry of Health","ror":"https://ror.org/00hpqmv06","country_code":"ZM","type":"government","lineage":["https://openalex.org/I1336862989"]}],"countries":["ZM"],"is_corresponding":false,"raw_author_name":"Chimuka Sianyinda","raw_affiliation_strings":["Zambia Ministry of Health, Lusaka, Zambia"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Zambia Ministry of Health, Lusaka, Zambia","institution_ids":["https://openalex.org/I1336862989"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5133756527","display_name":"Sydney Rosen","orcid":"https://orcid.org/0009-0001-9567-3640","observed_orcids":["https://orcid.org/0009-0001-9567-3640"]},"institutions":[{"id":"https://openalex.org/I4210099038","display_name":"Clinton Health Access Initiative","ror":"https://ror.org/013mr5k03","country_code":"US","type":"nonprofit","lineage":["https://openalex.org/I4210099038"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Prudence Haimbe","raw_affiliation_strings":["Clinton Health Access Initiative-Zambia, Lusaka, Zambia"],"raw_orcid":"https://orcid.org/0009-0001-9567-3640","affiliations":[{"raw_affiliation_string":"Clinton Health Access Initiative-Zambia, Lusaka, Zambia","institution_ids":["https://openalex.org/I4210099038"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5066448720","display_name":"Hilda Shakwelele","orcid":"https://orcid.org/0009-0006-7818-9159","observed_orcids":["https://orcid.org/0009-0006-7818-9159"]},"institutions":[{"id":"https://openalex.org/I4210099038","display_name":"Clinton Health Access Initiative","ror":"https://ror.org/013mr5k03","country_code":"US","type":"nonprofit","lineage":["https://openalex.org/I4210099038"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Hilda Shakwelele","raw_affiliation_strings":["Clinton Health Access Initiative-Zambia, Lusaka, Zambia"],"raw_orcid":"https://orcid.org/0009-0006-7818-9159","affiliations":[{"raw_affiliation_string":"Clinton Health Access Initiative-Zambia, Lusaka, Zambia","institution_ids":["https://openalex.org/I4210099038"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5043068256","display_name":"Mariet Benade","orcid":"https://orcid.org/0000-0001-9498-3199","observed_orcids":["https://orcid.org/0000-0001-9498-3199"]},"institutions":[{"id":"https://openalex.org/I111088046","display_name":"Boston University","ror":"https://ror.org/05qwgg493","country_code":"US","type":"education","lineage":["https://openalex.org/I111088046"]},{"id":"https://openalex.org/I192619145","display_name":"University of the Witwatersrand","ror":"https://ror.org/03rp50x72","country_code":"ZA","type":"education","lineage":["https://openalex.org/I192619145"]}],"countries":["US","ZA"],"is_corresponding":false,"raw_author_name":"Mariet Benade","raw_affiliation_strings":["Boston University School of Public Health, Boston, MA, USA","Health Economics and Epidemiology Research Office, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa"],"raw_orcid":"https://orcid.org/0000-0001-9498-3199","affiliations":[{"raw_affiliation_string":"Boston University School of Public Health, Boston, MA, USA","institution_ids":["https://openalex.org/I111088046"]},{"raw_affiliation_string":"Health Economics and Epidemiology Research Office, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa","institution_ids":["https://openalex.org/I192619145"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5019705197","display_name":"Allison Morgan","orcid":"https://orcid.org/0000-0001-8877-5107","observed_orcids":["https://orcid.org/0000-0001-8877-5107"]},"institutions":[{"id":"https://openalex.org/I111088046","display_name":"Boston University","ror":"https://ror.org/05qwgg493","country_code":"US","type":"education","lineage":["https://openalex.org/I111088046"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Allison Morgan","raw_affiliation_strings":["Boston University School of Public Health, Boston, MA, USA"],"raw_orcid":"https://orcid.org/0000-0001-8877-5107","affiliations":[{"raw_affiliation_string":"Boston University School of Public Health, Boston, MA, USA","institution_ids":["https://openalex.org/I111088046"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5156350654","display_name":"Amy Huber","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I192619145","display_name":"University of the Witwatersrand","ror":"https://ror.org/03rp50x72","country_code":"ZA","type":"education","lineage":["https://openalex.org/I192619145"]}],"countries":["ZA"],"is_corresponding":false,"raw_author_name":"Amy Huber","raw_affiliation_strings":["Health Economics and Epidemiology Research Office, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Health Economics and Epidemiology Research Office, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa","institution_ids":["https://openalex.org/I192619145"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5027671762","display_name":"Idah Mokhele","orcid":"https://orcid.org/0000-0002-8054-0116","observed_orcids":["https://orcid.org/0000-0002-8054-0116"]},"institutions":[{"id":"https://openalex.org/I192619145","display_name":"University of the Witwatersrand","ror":"https://ror.org/03rp50x72","country_code":"ZA","type":"education","lineage":["https://openalex.org/I192619145"]}],"countries":["ZA"],"is_corresponding":false,"raw_author_name":"Idah Mokhele","raw_affiliation_strings":["Health Economics and Epidemiology Research Office, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa"],"raw_orcid":"https://orcid.org/0000-0002-8054-0116","affiliations":[{"raw_affiliation_string":"Health Economics and Epidemiology Research Office, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa","institution_ids":["https://openalex.org/I192619145"]}]}],"institutions":[],"countries_distinct_count":3,"institutions_distinct_count":4,"corresponding_author_ids":["https://openalex.org/A5066253506"],"corresponding_institution_ids":["https://openalex.org/I111088046","https://openalex.org/I192619145"],"apc_list":null,"apc_paid":null,"fwci":null,"has_fulltext":true,"cited_by_count":0,"citation_normalized_percentile":null,"cited_by_percentile_year":null,"biblio":{"volume":null,"issue":null,"first_page":null,"last_page":null},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10082","display_name":"HIV/AIDS Research and Interventions","score":0.9833999872207642,"subfield":{"id":"https://openalex.org/subfields/2725","display_name":"Infectious Diseases"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T10082","display_name":"HIV/AIDS Research and Interventions","score":0.9833999872207642,"subfield":{"id":"https://openalex.org/subfields/2725","display_name":"Infectious Diseases"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T14334","display_name":"HIV/AIDS Impact and Responses","score":0.015300000086426735,"subfield":{"id":"https://openalex.org/subfields/2002","display_name":"Economics and Econometrics"},"field":{"id":"https://openalex.org/fields/20","display_name":"Economics, Econometrics and Finance"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}},{"id":"https://openalex.org/T11860","display_name":"HIV, Drug Use, Sexual Risk","score":0.00039999998989515007,"subfield":{"id":"https://openalex.org/subfields/2713","display_name":"Epidemiology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/facility-level-variation","display_name":"facility-level variation","score":0.9449999928474426},{"id":"https://openalex.org/keywords/antiretroviral-therapy-initiation","display_name":"antiretroviral therapy initiation","score":0.8730000257492065},{"id":"https://openalex.org/keywords/aid-dependent-countries","display_name":"aid-dependent countries","score":0.5120000243186951},{"id":"https://openalex.org/keywords/zambia","display_name":"Zambia","score":0.6380000114440918},{"id":"https://openalex.org/keywords/district-level-variation","display_name":"district-level variation","score":0.33899998664855957},{"id":"https://openalex.org/keywords/chongwe-district","display_name":"Chongwe District","score":0.7200000286102295},{"id":"https://openalex.org/keywords/usaid","display_name":"USAID","score":0.3230000138282776},{"id":"https://openalex.org/keywords/cdc","display_name":"CDC","score":0.42100000381469727},{"id":"https://openalex.org/keywords/health-system-resilience","display_name":"health system resilience","score":0.4339999854564667}],"concepts":[{"id":"https://openalex.org/C2778058735","wikidata":"https://www.wikidata.org/wiki/Q4692253","display_name":"Aggregate data","level":2,"score":0.6886000037193298},{"id":"https://openalex.org/C3013748606","wikidata":"https://www.wikidata.org/wiki/Q15787","display_name":"Human immunodeficiency virus (HIV)","level":2,"score":0.6033999919891357},{"id":"https://openalex.org/C68595000","wikidata":"https://www.wikidata.org/wiki/Q2274177","display_name":"Service delivery framework","level":3,"score":0.58160001039505},{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.4934999942779541},{"id":"https://openalex.org/C4679612","wikidata":"https://www.wikidata.org/wiki/Q866298","display_name":"Aggregate (composite)","level":2,"score":0.4715000092983246},{"id":"https://openalex.org/C85079727","wikidata":"https://www.wikidata.org/wiki/Q3560114","display_name":"Quarter (Canadian coin)","level":2,"score":0.4595000147819519},{"id":"https://openalex.org/C2780378061","wikidata":"https://www.wikidata.org/wiki/Q25351891","display_name":"Service (business)","level":2,"score":0.4505999982357025},{"id":"https://openalex.org/C99454951","wikidata":"https://www.wikidata.org/wiki/Q932068","display_name":"Environmental health","level":1,"score":0.43149998784065247},{"id":"https://openalex.org/C144133560","wikidata":"https://www.wikidata.org/wiki/Q4830453","display_name":"Business","level":0,"score":0.3928000032901764},{"id":"https://openalex.org/C2986740045","wikidata":"https://www.wikidata.org/wiki/Q31207","display_name":"Health services","level":3,"score":0.39089998602867126},{"id":"https://openalex.org/C2983812674","wikidata":"https://www.wikidata.org/wiki/Q134808","display_name":"Delivery system","level":2,"score":0.3885999917984009},{"id":"https://openalex.org/C138816342","wikidata":"https://www.wikidata.org/wiki/Q189603","display_name":"Public health","level":2,"score":0.37610000371932983},{"id":"https://openalex.org/C180198813","wikidata":"https://www.wikidata.org/wiki/Q121182","display_name":"Information system","level":2,"score":0.35929998755455017},{"id":"https://openalex.org/C149923435","wikidata":"https://www.wikidata.org/wiki/Q37732","display_name":"Demography","level":1,"score":0.3580000102519989},{"id":"https://openalex.org/C205649164","wikidata":"https://www.wikidata.org/wiki/Q1071","display_name":"Geography","level":0,"score":0.3237000107765198},{"id":"https://openalex.org/C112758219","wikidata":"https://www.wikidata.org/wiki/Q16038819","display_name":"Duration (music)","level":2,"score":0.32010000944137573},{"id":"https://openalex.org/C2982795734","wikidata":"https://www.wikidata.org/wiki/Q870895","display_name":"Health information","level":3,"score":0.30230000615119934},{"id":"https://openalex.org/C2992699665","wikidata":"https://www.wikidata.org/wiki/Q337517","display_name":"Hiv test","level":5,"score":0.2955000102519989},{"id":"https://openalex.org/C2777267654","wikidata":"https://www.wikidata.org/wiki/Q3519023","display_name":"Test (biology)","level":2,"score":0.28610000014305115},{"id":"https://openalex.org/C2778253041","wikidata":"https://www.wikidata.org/wiki/Q699735","display_name":"Annual report","level":2,"score":0.2734000086784363},{"id":"https://openalex.org/C45355965","wikidata":"https://www.wikidata.org/wiki/Q1643441","display_name":"Socioeconomics","level":1,"score":0.2705000042915344},{"id":"https://openalex.org/C15587899","wikidata":"https://www.wikidata.org/wiki/Q7455812","display_name":"Service system","level":3,"score":0.259799987077713},{"id":"https://openalex.org/C2778334786","wikidata":"https://www.wikidata.org/wiki/Q1586270","display_name":"Variation (astronomy)","level":2,"score":0.25429999828338623}],"mesh":[],"locations_count":1,"locations":[{"id":"doi:10.64898/2026.09.27.26364124","doi":"https://doi.org/10.64898/2026.09.27.26364124","is_oa":true,"landing_page_url":"https://doi.org/10.64898/2026.09.27.26364124","pdf_url":"https://www.medrxiv.org/content/medrxiv/early/2026/09/29/2026.09.27.26364124.full.pdf","source":{"id":"https://openalex.org/S3005729997","display_name":"medRxiv","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core"],"host_organization":null,"host_organization_name":null,"host_organization_lineage":["https://openalex.org/P4310315909"],"host_organization_lineage_names":["Cold Spring Harbor Laboratory Press"],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"acceptedVersion","is_accepted":true,"is_published":false,"raw_source_name":"medRxiv","raw_type":"posted-content"}],"best_oa_location":{"id":"doi:10.64898/2026.09.27.26364124","doi":"https://doi.org/10.64898/2026.09.27.26364124","is_oa":true,"landing_page_url":"https://doi.org/10.64898/2026.09.27.26364124","pdf_url":"https://www.medrxiv.org/content/medrxiv/early/2026/09/29/2026.09.27.26364124.full.pdf","source":{"id":"https://openalex.org/S3005729997","display_name":"medRxiv","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core"],"host_organization":null,"host_organization_name":null,"host_organization_lineage":["https://openalex.org/P4310315909"],"host_organization_lineage_names":["Cold Spring Harbor Laboratory Press"],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"acceptedVersion","is_accepted":true,"is_published":false,"raw_source_name":"medRxiv","raw_type":"posted-content"},"sustainable_development_goals":[{"display_name":"Good health and well-being","score":0.9537000060081482,"id":"https://metadata.un.org/sdg/3"}],"study_designs":[],"awards":[{"id":"https://openalex.org/G5982108493","display_name":"Wits Health Consortium (Pty) Ltd - To evaluate the impact of changes in global funding support for HIV service delivery on patient outcomes and health system capacity.","funder_award_id":"INV-088605","funder_id":"https://openalex.org/F4320306137","funder_display_name":"Bill and Melinda Gates Foundation"}],"funders":[{"id":"https://openalex.org/F4320306137","display_name":"Bill and Melinda Gates Foundation","ror":"https://ror.org/0456r8d26"}],"has_content":{"grobid_xml":true,"pdf":true},"content_urls":{"pdf":"https://content.openalex.org/works/W7214790802.pdf","grobid_xml":"https://content.openalex.org/works/W7214790802.grobid-xml"},"referenced_works_count":5,"referenced_works":["https://openalex.org/W4386098099","https://openalex.org/W4409814189","https://openalex.org/W4413756550","https://openalex.org/W4414511548","https://openalex.org/W7137305550"],"related_works":["https://openalex.org/W7137102804","https://openalex.org/W7219850030","https://openalex.org/W2979954049","https://openalex.org/W7171443368","https://openalex.org/W7140173358","https://openalex.org/W2976277847","https://openalex.org/W4391116406","https://openalex.org/W6958242505","https://openalex.org/W3151794574","https://openalex.org/W4413994864"],"abstract_inverted_index":{"Abstract":[0],"Background":[1],"The":[2],"abrupt":[3],"withdrawal":[4],"and":[5,41,52,65,85,110,112,132,155,158,168,214,269,315],"uneven":[6],"restoration":[7],"of":[8,96,152,164,188,202,224,279,288,293,310,317,349],"United":[9],"States":[10],"PEPFAR":[11,341],"support":[12,372],"in":[13,19,26,59,116,120,134,162,179,253,264,273,282],"2025":[14,340],"disrupted":[15],"HIV":[16,27,60,174],"service":[17,28,61,153,351],"delivery":[18,29],"aid-dependent":[20],"countries":[21],"worldwide.":[22],"In":[23],"Zambia,":[24],"decreases":[25],"have":[30,44],"been":[31,46],"documented":[32],"at":[33,265],"a":[34,285,322],"national":[35],"level,":[36],"but":[37,256],"variations":[38],"by":[39,42,48,126,140,251,271,304],"facility":[40],"quarter":[43,268],"largely":[45],"masked":[47],"existing":[49],"aggregate":[50,221,247],"district\u2013":[51],"province-level":[53],"estimates.":[54],"We":[55,71],"examined":[56],"facility-level":[57,367],"variation":[58,211,303],"volumes":[62,154,176,249,352],"delivered":[63],"before":[64],"after":[66],"the":[67,127,291,318,335,339,364],"funding":[68,342],"cuts.":[69],"Methods":[70],"analysed":[72],"monthly":[73],"District":[74,275],"Health":[75],"Information":[76],"System":[77],"(DHIS2)":[78],"data":[79],"covering":[80],"testing":[81,175,248],"volumes,":[82],"ART":[83,88,196,228],"initiations,":[84,167],"numbers":[86,163],"on":[87,170,227],"for":[89,93,366],"January":[90],"2024-December":[91],"2025)":[92],"two":[94,117],"sets":[95],"facilities:":[97],"1)":[98],"24":[99,189,203],"selected":[100],"SENTINEL":[101,180],"network":[102],"facilities":[103,115,181,190,204,217,235,258,320],"across":[104],"four":[105],"provinces":[106],"(Central,":[107],"Copperbelt,":[108],"Lusaka,":[109],"Southern);":[111],"2)":[113],"all":[114],"districts,":[118],"Chongwe":[119,254,283],"Lusaka":[121],"Province,":[122,136],"which":[123,137],"was":[124,138],"supported":[125,139],"U.S.":[128],"CDC":[129],"under":[130,142],"PEPFAR,":[131],"Mpongwe":[133,274,300],"Copperbelt":[135],"USAID":[141],"PEPFAR.":[143],"For":[144,208],"each":[145],"facility,":[146,305],"we":[147],"calculated":[148],"quarterly":[149,157,260],"2025:2024":[150],"ratios":[151],"summarized":[156],"annual":[159,193],"percentage":[160],"changes":[161],"tests,":[165],"treatment":[166],"clients":[169,225,289],"ART.":[171],"Results":[172],"Aggregate":[173,195],"declined":[177,198],"18%":[178],"from":[182,325],"2024":[183,326,359],"to":[184,327,369],"2025,":[185,294],"with":[186,200,232,295,306,344],"17":[187],"showing":[191,236],"net":[192,206,237,286,323],"decreases.":[194,207],"initiations":[197],"16%,":[199],"23":[201],"experiencing":[205,297],"both":[209],"indicators,":[210],"between":[212],"quarters":[213,314],"among":[215],"individual":[216],"matched":[218],"or":[219,357],"exceeded":[220,358],"changes.":[222],"Numbers":[223],"currently":[226],"were":[229],"comparatively":[230],"stable,":[231],"only":[233],"6":[234],"declines":[238,261,309],"exceeding":[239,262],"5%.":[240],"District-level":[241],"analyses":[242],"showed":[243,284],"divergent":[244],"patterns.":[245],"Net":[246],"increased":[250],"7%":[252],"District,":[255],"28/39":[257],"experienced":[259,301],"10%":[263],"least":[266],"one":[267],"fell":[270],"40%":[272],"overall.":[276],"Only":[277],"4":[278],"36":[280],"sites":[281,346],"loss":[287,324],"over":[290],"course":[292],"most":[296,348],"gains,":[298],"while":[299,353],"substantial":[302],"many":[307],"having":[308],">30%":[311],"during":[312],"some":[313,345],"14":[316],"25":[319],"suffering":[321],"2025.":[328],"Conclusions":[329],"Facility-level":[330],"performance":[331],"varied":[332],"substantially":[333],"within":[334],"same":[336],"district":[337],"following":[338],"disruptions,":[343],"losing":[347],"their":[350],"others":[354],"remained":[355],"stable":[356],"levels.":[360],"These":[361],"findings":[362],"emphasize":[363],"need":[365],"monitoring":[368],"target":[370],"recovery":[371],"where":[373],"it":[374],"is":[375],"needed":[376],"most.":[377]},"counts_by_year":[],"updated_date":"2026-11-04T10:54:05.112534","created_date":"2026-09-30T00:00:00"}
