Sustainability of Donor Funded HIV Prevention, Care, and Treatment Programs for Key Populations in Nigeria

Overseas development assistance (ODA) for HIV from bilateral donors other then the US has fallen 57% in the last decade. HIV responses in low- and middle-income countries is $8 billion short for 2025. Donors want national governments to gradually take over HIV responses to maintain program gains and investments. Programs with greater sustainability capacity can maintain positive outcomes and benefits over time. We examine Nigeria's donor funded KP HIV program for sustainability. A mixed-methods approach using Washington University Program Sustainability Assessment Tool (PSAT) to survey perspectives of key informants from HIV stakeholders. Overall and domain mean scores and standard deviation determined, and quantitative analysis conducted using IBM Statistical Package for the Social Sciences (SPSS) version 28. Thematic analysis was applied to open-ended questions from key informant interviews. A total of 24 consenting respondents participated. Overall mean sustainability score was 4.72. Highest mean scoring domains were program adaptation (5.6) and program evaluation (5.59), lowest means scores were partnerships (3.17) and funding stability (3.56). Sociocultural and political contexts hinder strategic behavioral change communication to promote KP and quality services. Suboptimal political support, funding insecurity, limited partnerships, and donor-driven strategic planning cycles threaten the program's sustainability. Keywords: HIV, Key Populations, Program Sustainability.