INTERNATIONAL JOURNAL OF LATEST TECHNOLOGY IN ENGINEERING,  
MANAGEMENT & APPLIED SCIENCE (IJLTEMAS)  
ISSN 2278-2540 | DOI: 10.51583/IJLTEMAS | Volume XV, Issue I, January 2026  
Donor-Funded HIV Programs in Nigeria: Progress, Systemic Gaps,  
and Sustainability Pathways from a Health Systems and Financing  
Perspective (2018–2025)  
Lukman Ademola Adepoju1 3*, Oyetunji Oyewale2 3, Odekunle Bola Odegbemi3 4, Ifeoluwa Abraham  
Adeagbo3 and Elizabeth Oladipo3  
1Department of Medical Laboratory, University of Lagos, Lagos Nigeria  
2Patient First Bowie, 15459 Annapolis Rd, Bowie, Maryland, USA  
3Department of Medical Laboratory Science, Ladoke Akintola University of Technology, Ogbomosho,  
Nigeria.  
4Medical Laboratory Science Department, Edo State University, Uzairue, Edo State, Nigeria.  
*Corresponding author: Lukman Ademola Adepoju  
DOI : https://doi.org/10.51583/IJLTEMAS.2026.150100021  
Received: 07 January 2026; Accepted: 12 January 2026; Published: 27 January 2026  
ABSTRACT  
Over 40 years after the identification of human immunodeficiency virus (HIV), Nigeria remain one of the highest  
burdens of HIV infections in the world, accounting for almost 10% of new infections in sub-Saharan Africa.  
Despite significant investments and technical supports from different foreign donors including the United States  
President’s Emergency Plan for AIDS Relief (PEPFAR), the Global Fund, and bilateral partners. The persistent  
structural, financial, and programmatic gaps continue to hamper the country’s HIV response. This assessment of  
HIV-related interventions in Nigeria examines what has been achieved, what still need to be done, and how to  
establish a sustainable and domestically owned HIV care. The review summarizes evidence from peer-reviewed  
literature (2018–2025) and major institutional reports (UNAIDS, NACA, WHO, PEPFAR) to assess five key  
domains: coverage and access, funding and sustainability, health system strengthening, monitoring and  
evaluation, and sociocultural barriers. Evidence shows that while substantial progress has been achieved in  
testing, antiretroviral therapy (ART) coverage, and community-based care, the HIV response remains heavily  
donor-dependent, urban-centered, and fragmented across vertical program streams. The review concludes that  
to achieve long-term epidemic control (EC) and universal health coverage (UHC) in Nigeria’s HIV care and  
programming with there is a need for domestic financing, health system integration, decentralized service  
delivery, and data-driven accountability frameworks.  
Keywords: HIV, Nigeria, donor funding, PEPFAR, Global Fund, sustainability, health systems, intervention  
gaps, policy reform.  
INTRODUCTION  
Nigeria is among the most affected countries in the world by the HIV epidemic with approximately 1.8 million  
people living with HIV in Nigeria, representing a national prevalence of 1.3% among adults aged 15–49 years  
(NACA, 2024; UNAIDS, 2024). Nigeria accounts for the second-largest HIV burden in the world, following  
South Africa, contributes significantly to global pediatric HIV infections, largely through mother-to-child  
transmission (Chizoba et al., 2020; NACA, 2023). The epidemiological profile of HIV in Nigeria reflects a  
heterogeneous epidemic, with prevalence rates ranging from 0.5% in some northern states to over 5% in parts  
of the South-Central region, shaped by gender, geography, and socioeconomic factors (Federal Ministry of  
Health [FMoH], 2021).  
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Since the early 2000s, Nigeria’s HIV response has been heavily funded by international partners. PEPFAR alone  
has invested over US$6 billion since 2004, while the Global Fund has contributed more than US$2.9 billion  
across four funding cycles (PEPFAR, 2023; The Global Fund, 2024). These investments have associated with  
measurable progress, in 2023, ART coverage exceeded 90% of diagnosed individuals, and viral suppression rates  
increased to approximately 86%, aiming at the UNAIDS 95-95 targets (UNAIDS, 2023).  
However, despite these achievements, Nigeria’s HIV response is still facing systemic and programmatic  
challenges. The sustainability of interventions remains uncertain due to dependence on donors, underfunding  
within the country, geographic inequities, and reduced demand for services because of stigma (Adebayo et al.,  
2022). In addition, fragmented monitoring systems, insufficient data use, and verticalized funding structures  
limit the effectiveness of program coordination (NACA, 2022; WHO, 2023).  
Consequently, as the global HIV response transitions toward long-term sustainability, Nigeria must reposition  
its strategies to ensure that external investments translate into durable, domestically owned health gains. This  
review, therefore, examines the gaps in HIV-funded interventions in Nigeria, focusing on their implementation  
effectiveness, sustainability, and policy implications.  
Specifically, the review addresses three guiding questions:  
1. What progress has been documented progress through HIV-funded interventions in Nigeria between 2018  
and 2025?  
2. What are the persistent gaps undermining their efficiency and sustainability?  
3. What strategic pathways can strengthen domestic ownership and align Nigeria’s HIV response with UHC  
and global epidemic control targets?  
METHODS  
Study Design  
This review was designed as a narrative synthesis of literature and does not constitute a systematic review.  
Consequently, PRISMA reporting guidelines were not followed, and formal risk-of-bias assessment or  
quantitative quality scoring of included studies were not undertaken.  
Literature Search Strategy  
A comprehensive literature search was conducted to identify peer-reviewed articles, policy reports, and program  
evaluations relevant to HIV-funded interventions in Nigeria between 2018 and 2025. Electronic databases,  
including PubMed, Web of Science, Scopus, and Google Scholar, were searched alongside institutional  
repositories from UNAIDS, the National Agency for the Control of AIDS (NACA), the World Health  
Organization, the Global Fund, and PEPFAR. Search terms combined keywords and Boolean operators related  
to HIV financing, donor-funded programs, antiretroviral therapy coverage, service integration, sustainability,  
and health-system performance in Nigeria. Search results were screened at the title and abstract level for  
relevance to the study objectives, and sources that met the inclusion criteria were retained for full-text review;  
consistent with the narrative review design of this study, PRISMA reporting guidelines and a formal PRISMA  
flow diagram were not applied.  
Data Extraction and Synthesis  
Data extraction focused on three core domains: funding source and program scope, including major donors,  
funding magnitude, and the primary focus of supported interventions; program outcomes, such as antiretroviral  
therapy coverage, viral suppression, prevention service coverage, and maternal–child health outcomes; and  
implementation challenges, encompassing gaps related to service accessibility, funding sustainability, health  
system integration, and data availability or use. Thematic synthesis was conducted through a four-stage process  
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comprising initial familiarization with the extracted data, identification of recurrent patterns across studies,  
systematic coding into five thematic domains of gaps coverage, funding, system integration, monitoring, and  
stigma and a narrative synthesis that linked funding inputs to observed implementation outcomes.  
Quality Assurance and Credibility  
To ensure rigor, the review cross-validated quantitative estimates against multiple data sources particularly  
UNAIDS, NACA, and WHO dashboards. Only studies using clearly described methodologies or nationally  
recognized data sources (e.g., NAIIS, Demographic  
Health Survey, or PEPFAR evaluation reports) were included. Institutional and peer-reviewed data were  
triangulated to enhance credibility.  
Data Overview  
Table 1 Summary of major HIV funding sources estimated financial contributions, programmatic focus, and  
implementation characteristics in Nigeria (2018–2025).  
Funding Source Period  
Total  
Programmatic  
Focus Areas  
Key Achievements Source  
of  
Support  
Estimated  
Investment  
(US$)  
PEPFAR(U.S.)  
2004  
2025  
- >6.0 billion  
ART scale-up,  
PMTCT,  
laboratory  
Over 1.5M PLHIV  
on ART; 86% viral  
suppression  
PEPFAR,  
2024  
strengthening, key  
population  
(2023)  
programs,  
surveillance  
The Global  
Fund  
2003  
2025  
- >2.9 billion  
HIV prevention,  
procurement,  
supply chain  
management,  
community  
systems  
Strengthened  
national ART  
logistics and  
supply chain  
systems  
Global fund,  
2024  
UNAIDS &  
WHO  
Ongoing Technical  
support  
Policy  
coordination,  
epidemic  
modeling, 95-95-  
95 monitoring  
Standardized  
national indicators  
and treatment  
cascade  
UNAIDS,  
2023  
WHO,2023  
UNICEF  
2015–  
2025  
~200 million  
Improved early  
infant diagnosis  
and child ART  
coverage  
UNICEF,  
2023  
PMTCT, pediatric  
ART, adolescent  
health  
Domestic  
(NACA/FMoH) funding  
National Variable(~10–  
Coordination,  
surveillance,  
Strengthened  
strategic  
NACA,  
2024  
15% of total)  
frameworks but  
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domestic  
procurement  
limited fiscal  
autonomy  
FMoH,  
2024  
Note: Funding figures represent approximate cumulative disbursements or commitments reported in publicly  
available donor and national documents for the period 2018–2025. Estimates were synthesized from annual  
reports and country investment profiles and may vary slightly across sources due to differences in reporting  
cycles, currency conversion, and classification of expenditures. Figures are intended to provide indicative  
magnitude rather than audited totals.  
Overview of HIV-Funded Interventions in Nigeria  
Evolution and Structure of HIV Financing  
Nigeria’s HIV response has evolved through multiple funding streams that reflect the country’s dependency on  
international partners. Following the 2003 emergency response, the United States President’s Emergency Plan  
for AIDS Relief (PEPFAR) became the principal donor, focusing on prevention of mother-to-child transmission  
(PMTCT), ART scale-up, and laboratory strengthening (PEPFAR, 2023). The Global Fund to Fight AIDS,  
Tuberculosis and Malaria has complemented these efforts by investing in procurement, supply-chain logistics,  
and community-based prevention programs (Global Fund, 2024). Other multilateral actors such as UNAIDS,  
UNICEF, WHO, and the World Bank provide technical assistance, while national coordination lies with the  
National Agency for the Control of AIDS (NACA) and the Federal Ministry of Health (FMoH) (NACA, 2023).  
Figure 1. Conceptual Model Linking HIV Funding Inputs to Implementation Outcomes and Sustainability  
Programmatic Achievements (2018 – 2025)  
Table 2. Nigeria achieved substantial progress across key HIV program indicators between 2018 and 2025.  
Indicator  
2018  
2020  
2023  
2025  
Sources  
People living with HIV 1.9 million  
(PLHIV)  
1.8 million  
1.8 million  
< 1.7 million  
UNAIDS, 2024  
Adult prevalence (15- 1.4 %  
49 yrs)  
1.3 %  
80%  
76%  
1.3 %  
90%  
86%  
≤ 1.1 %  
95%  
NACA, 2023  
People on ART (% of 67 %  
PLHIV)  
PEPFAR, 2023  
Viral suppression (% of 59%  
ART clients)  
95%  
UNAIDS, 2023  
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PMTCT coverage (%  
of HIV+ pregnant  
women)  
47%  
62%  
78%  
≥ 90 %  
UNICEF, 2024  
HIV testing coverage 48%  
(15–49 yrs)  
63%  
71%  
≥ 90 %  
FMoH, 2023  
These results reflect the positive impact of donor-funded initiatives, yet they face underlying inequities and  
sustainability constraints, particularly in rural and conflict-affected areas.  
Identified Gaps in HIV-Funded Interventions  
Despite remarkable progress, persistent gaps continue to affect Nigeria’s path to epidemic control. This part  
synthesizes evidence under five thematic domains derived from literature and institutional assessments.  
Coverage and Accessibility Gaps  
Although PEPFAR and Global Fund programs expanded testing and treatment, coverage disparities remain  
pronounced. ART centers are concentrated in urban areas and tertiary facilities, leaving rural and northern  
populations underserved (Adebayo et al., 2022). Key populations such as men who have sex with men (MSM),  
people who inject drugs (PWID), and female sex workers are facing structural and legal barriers that limit access  
to prevention and care (Emmanuel et al., 2025). In 2023, key population ART coverage was estimated at 60–65  
%, far below the national average (UNAIDS, 2024). Mobile outreach and community-based ART models have  
improved testing uptake but remain small-scale due to limited domestic co-funding. Cultural stigma, gender  
inequality, and insecurity in North-East Nigeria further constrain service expansion (WHO, 2023).  
Funding and Sustainability Gaps  
Nigeria’s HIV response remains heavily donor-dependent, with external funding accounting for approximately  
75% of total program expenditure (National Agency for the Control of AIDS [NACA], 2023). Domestic  
budgetary contributions fluctuate annually and frequently fall below pledged commitments. When donor  
disbursements decline or are re-allocated, program continuity is threatened, resulting in stock-outs of  
antiretroviral medicines or diagnostic commodities (Nigeria Health Watch, 2024). Limited private-sector  
engagement and weak state-level fiscal capacity further exacerbate this fragility. Moreover, donor priorities may  
shape program design in ways that promote vertical, disease-specific interventions that are not fully aligned with  
national health-system strengthening agendas (U.S. President’s Emergency Plan for AIDS Relief [PEPFAR],  
2023).  
Service Integration and Health System Gaps  
Many HIV interventions in Nigeria operate as isolated programs with minimal integration into primary health  
care. For instance, ART delivery is often separated from maternal and child health (MCH) or tuberculosis (TB)  
services, increasing operational inefficiency (Goldstein et al., 2023; Umar, 2021). Although PEPFAR introduced  
differentiated service-delivery (DSD) models, scale-up within PHC facilities has been inconsistent. Supply-chain  
and laboratory capacity also remain weak. Periodic shortages of rapid test kits and viral-load reagents have been  
reported in over one-third of states (FMoH, 2023). Staffing limitations, particularly the shortage of trained  
medical laboratory scientists and data officers, undermine service quality and continuity.  
Monitoring, Evaluation, and Data Gaps  
Robust data systems are vital for program accountability. Yet Nigeria’s HIV monitoring relies on fragmented  
reporting frameworks: PEPFAR’s MER system, Global Fund grant dashboards, and the national DHIS2 database  
often operate in parallel, limiting interoperability (CDC Nigeria, 2022). Real-time data for identifying retention  
drop-offs and viral-suppression gaps remain insufficient. Subnational disaggregation by gender, age, or key  
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population is incomplete, constraining precision targeting. Furthermore, local research and implementation-  
science capacity are underdeveloped, resulting in heavy reliance on external evaluators.  
Stigma, Discrimination, and Sociocultural Barriers  
Social stigma continues to impede prevention and treatment uptake. Studies across Lagos, Kano, and Rivers  
States Nigeria show that over 30% of PLHIV experience workplace or community discrimination (Odimegwu  
et al., 2017; Ali et al., 2025). Criminalization of same-sex relationships and drug use deters key populations from  
accessing services, creating hidden epidemics (Emmanuel et al., 2025). Provider bias and inadequate  
confidentiality practices reinforce distrust in health facilities, while gender-based violence and harmful norms  
reduce women’s ability to negotiate safer sex or access ART. These sociocultural factors highlight that  
biomedical interventions alone are insufficient without broader legal and societal reforms.  
Summary of Identified Gaps  
Table 3. Summary of Persistent Gaps in HIV-Funded Interventions in Nigeria (2018–2025)  
Gap Domain  
Underlying Factors  
Data Source  
Implications for  
Sustainability  
Coverage &  
Accessibility  
Urban concentration  
of facilities; legal  
barriers for key  
populations;  
UNAIDS (2024);  
Adebayo et al., 2022  
Unequal epidemic control;  
regional resurgence risk  
insecurity in North-  
East  
Funding &  
Sustainability  
≥ 75 % donor  
funding; weak  
NACA, 2023  
PEPFAR,2023  
High dependency; program  
disruption risk  
domestic support;  
volatile budget lines  
Service Integration  
Monitoring & Data  
Vertical programs;  
limited PHC  
linkages; supply-  
chain bottlenecks  
FMoH,2023;  
Emmanuel et al.,  
2025  
Inefficiency; limited system  
resilience  
Fragmented systems  
(MER, DHIS2); low  
subnational  
CDC Nigeria, 2022;  
WHO, 2023  
Weak accountability and  
decision support  
granularity  
Stigma & Socio-  
cultural  
Criminalization,  
gender inequality,  
provider bias  
UNAIDS,2023; Ali et Reduced service uptake and  
al., 2025 retention  
Overall, Nigeria’s HIV response illustrates a paradox of high donor investment yet modest systemic  
transformation. Donor-funded programs have improved treatment access but have not fully built self-sustaining  
national structures. Persistent inequities, limited domestic financing, and weak governance continue to impede  
long-term epidemic control.  
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Programmatic Successes and Innovations  
Despite persistent gaps, Nigeria’s HIV response between 2018 and 2025 demonstrated measurable successes  
that reveal documented improvements associated with coordinated donor and national efforts.  
Community-Based Service Delivery  
One of the most significant innovations was the shift toward community-based antiretroviral therapy (CBART)  
and differentiated service delivery (DSD) models. PEPFAR-supported community ART programs extended  
medication refills to community pharmacies and outreach centers, reducing clinic congestion and improving  
retention (PEPFAR, 2023). Studies in Lagos and Benue States of Nigeria reported retention rates above 90%  
after 12 months in CBART cohorts, compared with 78% in facility-based models (NACA, 2023; Ibiloye, 2024).  
Community-based HIV self-testing and index partner testing increased case identification, particularly among  
men and adolescents who historically had low facility attendance (UNAIDS, 2024; Mwango et al., 2020). These  
approaches exemplify how decentralized delivery can strengthen equity and cost-effectiveness when adequately  
funded.  
PMTCT and Pediatric HIV Control  
Progress in prevention of mother-to-child transmission (PMTCT) has been one of Nigeria’s strongest  
achievements. UNICEF-supported programs integrated HIV testing into antenatal and immunization clinics,  
increasing PMTCT coverage from 47% (2018) to 78% (2023) (UNICEF, 2024). Early infant diagnosis  
turnaround times declined through the expansion of dried-blood-spot transport networks, while point-of-care  
testing shortened result delivery. Pediatric ART coverage, historically below 30%, improved substantially  
following the introduction of child-friendly dolutegravir formulations and multi-month dispensing (FMoH,  
2023). These interventions highlight how donor support can catalyze innovation when linked with national  
policy adoption.  
Laboratory and Supply-Chain Strengthening  
Global Fund grants under the Resilient and Sustainable Systems for Health (RSSH) initiative enhanced Nigeria’s  
laboratory network and supply-chain efficiency. Automated viral-load testing platforms and the creation of zonal  
sample-referral systems improved national testing capacity (Global Fund, 2024). Integration of the Logistics  
Management Information System (LMIS) within NACA’s DHIS2 framework enabled near real-time commodity  
tracking, reducing stock-out frequency from 32 % (2019) to 11 % (2023).  
Digital Health and Data Innovation  
Donor-driven investments accelerated digital transformation. The Nigeria HIV Data Repository (NHDR) a joint  
NACA/CDC platform harmonized multiple reporting streams and allowed analytics for treatment-cascade  
monitoring (CDC Nigeria, 2022). Mobile-based adherence applications (“e-Tracker” and “CliniPAK”) piloted  
under PEPFAR improved follow-up reminders and data completeness. These digital tools strengthened program  
transparency and accountability, laying a foundation for evidence-based planning.  
Sustainability and Transition Challenges  
While donor programs have produced measurable outcomes, long-term sustainability remains precarious as  
global priorities shift and funding plateaus.  
Fiscal Dependence and Limited Domestic Investment  
Nigeria’s fiscal reliance on external donors persists domestic contributions cover less than 20 % of total HIV  
expenditure (NACA, 2023). When Global Fund and PEPFAR disbursements were temporarily delayed in 2020  
and 2025 respectively, several state programs reported ARV shortages and interrupted services delivery  
underscoring the fragility of continuity (Nigeria Health Watch, 2025). Establishing predictable domestic  
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financing streams through earmarked health taxes or inclusion within the National Health Insurance Authority  
(NHIA) remains critical.  
Institutional and Governance Weaknesses  
Weak inter-ministerial coordination and overlapping donor reporting frameworks create inefficiency. State-level  
HIV agencies often lack legal autonomy and budgetary authority to implement sustainable programs.  
Furthermore, donor-driven priorities sometimes overshadow local epidemiological realities, resulting in short-  
term output targets rather than systemic capacity building (PEPFAR, 2023).  
Human Resource Constraints  
Ahigh turnover of among skilled health workers and limited incentives for rural deployment undermine program  
continuity. Donor-funded training often benefits temporary staff without retention strategies, leading to a  
revolving-door workforce (WHO, 2023). Integrating HIV services into general-health workforce plans and task-  
shifting policies can strengthen resilience.  
Transition Risks  
Experiences from Ghana, Kenya, and Botswana indicate that abrupt funding transitions can reduce service  
quality unless preceded by phased domestic absorption (UNAIDS, 2023; Part, 2025). Nigeria faces similar risk  
unless explicit transition frameworks are institutionalized. Sustainable financing requires co-financing models,  
public-private partnerships, and performance-based grants tied to outcome indicators.  
Policy and Strategic Recommendations  
Drawing from the synthesis of gaps and successes, the following recommendations provide a roadmap toward a  
more resilient, domestically owned HIV response in Nigeria.  
Strengthening Domestic Health Financing  
To enhance the sustainability of Nigeria’s HIV response, domestic health financing must be substantially  
strengthened (Olakunde & Ndukwe, 2015; Ogbuabor et al., 2023). This requires increasing federal and state  
budgetary allocations dedicated to HIV programs and formally integrating HIV services within National Health  
Insurance Authority (NHIA) benefit packages. The introduction of earmarked levies such as taxes on  
telecommunications services or alcohol consumption could provide stable, locally generated revenue streams to  
supplement existing funding. In addition, institutionalizing Medium-Term Expenditure Frameworks (MTEFs)  
would support predictable, multi-year financial planning and reduce vulnerability to abrupt donor funding  
fluctuations.  
Integration of HIV Services into Primary Health Care  
Integrating HIV services into the primary health care (PHC) system is essential for improving access, efficiency,  
and equity (Goldstein et al., 2023; Dzinamarira et al., 2025). HIV testing, antiretroviral therapy, tuberculosis  
services, and reproductive-health interventions should be embedded within the Basic Health Care Provision  
Fund (BHCPF) platform to ensure nationwide coverage. Expanding differentiated service-delivery models  
across all PHC facilities would enhance client-centered care and decongest tertiary facilities. Furthermore,  
strengthening supply-chain integration through unified procurement and distribution under the Central Medical  
Stores would reduce fragmentation and minimize commodity stock-outs.  
Enhancing Data Systems and Implementation Science  
Robust data systems are critical for evidence-based decision-making and program optimization (Njoka, 2015;  
Ogundeko-Olugbami et al., 2025). Donor-supported and national monitoring frameworks should be harmonized  
into a single, interoperable DHIS2-based platform to improve data completeness and reduce reporting burdens.  
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Investment in implementation science is also needed, including support for local universities and research  
institutions to conduct operational research and real-time program evaluations. The use of geo-spatial analytics  
can further strengthen targeting of under-served populations and enable more efficient allocation of limited  
resources.  
Addressing Stigma and Legal Barriers  
Persistent stigma and restrictive legal frameworks continue to undermine equitable access to HIV services  
(Stangl et al., 2022; Boakye et al., 2024). Legal reforms aimed at amending laws that criminalize same-sex  
relationships and hinder key-population programming are necessary to improve service uptake and trust in the  
health system. Anti-stigma training should be institutionalized for healthcare providers, alongside enforcement  
of workplace policies that protect the rights of people living with HIV. Expanding community-led advocacy  
initiatives and peer-navigation networks would further support demand creation and retention in care among  
marginalized populations.  
Building Multi-Sectoral Partnerships  
A resilient HIV response requires coordinated engagement beyond the health sector. Private-sector corporate  
social responsibility (CSR) initiatives can be leveraged to support procurement of HIV commodities and  
community education programs (Makwara et al., 2024; Marqusee et al., 2024; Elendu et al., 2025). Collaboration  
with ministries responsible for education, youth, and labor is also essential for implementing workplace-based  
testing, prevention initiatives, and adolescent-focused interventions. Finally, donor investments should be  
deliberately aligned with national health-system strengthening priorities to avoid parallel structures and promote  
long-term sustainability.  
CONCLUSION  
Nigeria’s HIV response stands at a pivotal moment showing a remarkable epidemiological progress threatening  
with structural fragility. Donor funding primarily from PEPFAR and the Global Fund has been instrumental in  
scaling ART coverage and modernizing service delivery. Yet sustainability is undermined by financial  
dependency, fragmented governance, and persistent inequities. Bridging these gaps requires transitioning from  
donor-driven, vertical programs to integrated, and domestically financed systems anchored in primary health  
care. Emphasizing community-based service delivery, robust data systems, and legal reforms will help secure  
equitable epidemic control. Aligning Nigeria’s HIV strategy with the Sustainable Development Goals and  
universal health-coverage agenda will not only preserve donor gains but also embed the response within a  
stronger national health architecture capable of confronting future epidemics.  
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