Releasing an "America First" strategy on public health, the State Department said the United States should also promote health pacts with sub-Saharan Africa to compete with China, whose billions of dollars in spending on the continent traditionally focuses on building physical infrastructure and comes through loans.

The United States will aim to complete bilateral agreements with countries that receive health funding by the end of this year and they would go into effect in April 2026, according to this strategy.

"We must keep what is good about our health foreign assistance programs while rapidly fixing what is broken," Secretary of State Marco Rubio said in a statement to introduce the strategy.

On PEPFAR, the mammoth HIV/AIDS initiative once broadly supported in Washington that is credited with saving 26 million lives since 2003, the strategy said the United States would preserve funding only for "frontline support" such as purchasing drugs and directly supporting clinics.

The United States will no longer back "wrap-around" activities -- which it described as accounting for $3.1 billion of the existing $4.7 billion PEPFAR overseas budget -- such as training and program management.

The United States would keep covering 100 percent of frontline PEPFAR costs in the fiscal year starting in October but then will lower that amount as other countries agree to take greater responsibility, it said.

The Trump administration has vowed to cut off many non-governmental organizations, which worked closely with the US Agency for International Development, the world's largest humanitarian aid agency until Trump shuttered it.

"The number one thing that we're vetting NGOs for is, do they actually deliver real value?" a senior Trump administration official told reporters on condition of anonymity.

He said the United States would not support groups that provide "psychosocial support, LGBTQ education, a bunch of stuff like that, that has gone really far away from PEPFAR and these global health programs' core life-saving disease treatment and prevention mission."

Many aid groups say that such broader efforts are critical, with governments in countries where homosexuality is highly stigmatized unlikely to involve at-risk LGBTQ people.

The Trump administration has already stopped funding PrEP, a medication that significantly reduces the rate of HIV sexual transmission.

UNAIDS in April warned that a permanent discontinuation of PEPFAR would lead to more than six million new infections and an additional 4.2 million AIDS-related deaths in the next four years.