July 23, 2025
How the Global Fund and PEPFAR work together to make each other stronger
American investments are saving millions of lives by reducing new HIV infections and AIDS-related deaths, while also spurring contributions from other donors and partner countries. The unique model — combining bilateral with multilateral investments through the President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) — has yielded dramatic lifesaving results. PEPFAR and the Global Fund work in close synergy, leveraging each program’s comparative strengths. With U.S. support and collaboration, the Global Fund helps extend the reach of U.S. bilateral programs while also encouraging the transition to greater country ownership. In addition to U.S. support, the Global Fund mobilizes financial resources from impacted countries receiving grants, corporations and foundations, and through its pooled procurement mechanism, reduces treatment costs, advancing U.S. goals to end infectious diseases and strengthen global health security.
Nigeria Case Study
Nigeria is both a donor to the Global Fund and an implementer of Global Fund-supported programs. Nigeria represents the Global Fund’s largest investment portfolio, with over $4.8 billion invested in the country since 2002. Nigeria has contributed a total of $38.79 million to the Global Fund to date and pledged $13.2 million for the funding cycle covering 2023-2025—a 10% increase over the last cycle.
As of 2023, PEPFAR had disbursed over $7.8 billion, expanding programs that seek to ensure that all Nigerians living with HIV have comprehensive access to quality HIV prevention, care and treatment services. This investment provides close to 2 million Nigerians with access to antiretroviral treatment (ART).
The Global Fund/Andrew Esiebo/Panos: Health volunteer Oyinlola conducts HIV testing at Ikorodu General Hospital, Nigeria
Between 2012 and 2024, HIV infections in Nigeria declined by 63%. By the end of 2024, 84% of people living with HIV in the country knew their status. Among those diagnosed as HIV positive, over 98% were on treatment, and 95% of those on treatment achieved viral suppression.
Leveraging each partner’s strengths to save money and cover more ground
An alignment agreement between PEPFAR, the Global Fund and the government of Nigeria means that all three parties are committed to seeking synergies, reducing duplication, optimizing resources and building on comparative advantages to achieve common goals.
The Global Fund’s unique pooled procurement mechanism enables bulk purchasing of medication and other commodities at lower prices. PEPFAR has a network of in-country staff who supervise local programming. Given these respective advantages, the Global Fund can focus more on the cost-effective procurement of commodities in Nigeria while PEPFAR focuses on superior service delivery – saving money and creating a highly efficient operation for both organizations.
Harmonized service delivery
A single health products pool means there are no artificial barriers to service for patients. A patient can walk into any HIV clinic across Nigeria and receive care – it doesn’t matter if the clinic is specifically funded by PEPFAR or the Global Fund. Aligned service delivery means that facilities have the products they need and that the focus is on the client.
Working together to scale innovative new tools
GeneXpert Testing Machine
The GeneXpert machine, which is the size of a small printer and usually diagnoses TB, does exceptionally fast testing in the HIV space as well, including on Early Infant Diagnosis (EID) and viral load testing. In the past, EID and viral load testing for HIV were primarily done in bigger labs, posing a challenge in a country with a population of over 220 million and less than 20 large labs.
The Global Fund: A lab assistant uses a GeneXpert machine to test for TB on a mobile clinic and laboratory
Both PEPFAR and the Global Fund wanted to find a way to increase access to EID and viral load testing while reducing turnaround time. PEPFAR used its resources to pilot alternative TB testing tools that could work offline and not require a power connection. After an initial trial period, the Global Fund was able to bring these innovative new products to scale. As a result, GeneXpert machines that were solely used for TB testing have now been multiplexed to conduct EID and viral load testing for HIV as well. This partnership exemplifies how PEPFAR and the Global Fund work together to introduce, optimize and scale up innovative diagnostic tools and solutions – improving outcomes and saving lives.