Today is the deadline for NGOs working in 26 health districts to submit their plans for the closure or alternative funding of their projects to the Department of Health and US government officials. The US President's Emergency Plan for Aids Relief, which uses money from US taxpayers, will stop funding local NGOs working in areas in which only 6% or less of South Africa's HIV cases live.The districts include Gauteng's West Rand, Mangaung, in Free State, Nelson Mandela, in Eastern Cape, and Vhembe, in Limpopo.The Department of Health has clinics in these areas and is expected to take over full responsibility for HIV treatment there.The US fund has flat-lined since 2010 and, to maximise the effectiveness of its resources, it is to refocus its support on groups with the highest HIV prevalence, such as sex workers.This strategy is based on the "investment case" for HIV, in which economists and doctors have worked out the most cost-effective and effective way to curb infections.The US government is shifting more resources and technical expertise to the 27 districts in South Africa with the most HIV cases - more than 5million people.The US government and Department of Health have had frequent meetings about changing the strategy.US lawyer and fund analyst Brian Honermann said: "By targeting resources in the high-burden locations, the ability to prevent the greatest number of infections is enhanced."This is the same strategy now being identified and implemented in the US."The US and South African governments agreed in 2012 that America would reduce funding for the HIV response from $484-million (about R6.7-billion) to $250-million by 2017.The Health Department has committed to increasing its funding from 80% of all HIV projects to 88% by 2017.Centres for Disease Control director in South Africa Dr Nancy Knight said the shift in resources to areas with the highest incidences of HIV was essential to reduce infections."This is a such a critical time. There is so much information that we have now about what needs to be done to help South Africa get its epidemic under control ... if we don't make the right change ..."If you look at what the models predict, South Africa will have an HIV epidemic that we will not be able to afford . it will become worse .... Now is the time to make changes."Honermann said: “I don't in any way doubt the sincerity of the concern the affected NGOs may be expressing regarding their cutbacks for programs and the patients who receive services through them.“The public health system at present isn't a great place to be referred to given the levels of stock-outs and over-crowding. It is admittedly a scary and challenging time and there are many questions that should be asked of PEPFAR We do need to nail the execution.”..