Mitchell Warren on HIV service integration amid cuts | AIDS 2026

Mitchell Warren, executive director of AVAC, a U.S.-funded organization that advocates for HIV prevention, said HIV programs adapting to steep funding cuts are drawing on service delivery innovations that were already underway before the cuts hit, not because of them.

“I don’t think crisis has been the mother of invention. I would say these were [already] happening,” Warren said in an interview with Managed Healthcare Executive prior to AIDS 2026, the 26th International AIDS Conference, held this week in Rio de Janeiro and concluding today.

Integration of HIV services into other healthcare services was one of the themes of the research presented at the meeting, which was attended by 7,000 researchers, policymakers, activists and patients.

Among the many research reports presented at the meeting about service integration were two from Kenya. Researchers reported that the Fahari ya Jamii program “faced significant challenges in sustaining HIV services” after U.S. funding was cut off. The program’s website describes it as a five-year project that was funded by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through the US Agency for International Development (USAID) and managed by the University of Nairobi. According to the abstract presented at the meeting, after combining HIV care with mental health and tuberculosis services across facilities in Nairobi and Kajiado counties, the program saw a 20% increase in retention, a 35% increase in HIV testing rates and a 28% increase in PrEP uptake.

A separate national baseline assessment by Kenya’s Ministry of Health found that 78% of surveyed facilities had adopted some form of service integration. In Uganda, St. Francis Health Care Services in Jinja, a city in the eastern part of the country, reported screening more than 87% of outpatients for tuberculosis and sexual and reproductive health needs, alongside HIV testing, at a single visit after integrating services in 2025.

Warren described seeing a community-based program during a visit to Zambia several weeks earlier that was organized around the delivery of lenacapavir, the long-acting injectable approved for HIV pre-exposure prophylaxis. Peer educators, a low-cost workforce without formal nursing or technical training, set up tents in communities to talk with residents about sex, HIV and family planning, and to connect them to a nurse on-site for HIV testing and lenacapavir. Warren said he was impressed by the efficiency and convenience of combining services. If young women “went into the tent, they could get their Depo Provera right there,” Warren said, “saving them a 40-minute walk to the clinic.”

Warren cautioned against seeing the integration adaptations as some kind of silver lining to the pullback and disruption of funding for the global HIV response.

“The success stories right now are not the responses to the destruction of what had been. They are representing the kinds of programmatic iterations that, frankly, you could actually do even faster and better if we hadn't broken the system,” Warren said.