Maintain the gains: methods to evaluate the sustainability and scalability of HIV-related prevention, care, and treatment programs.

Purpose of review: The purpose of this review is to assess current methods for evaluating the sustainability and scalability of HIV prevention, care, and treatment programs - the maintenance, timeliness, and quality of which are priorities for global HIV epidemic control. We highlight specific opportunities to enhance methodological rigor for lasting HIV epidemic control.

Recent findings: Cost and cost-effectiveness of implementation strategies can prepare organizations for sustainability and scale-up. Organizational readiness for initial implementation and alignment with institutional structures are associated with program sustainment and scale-up capacity. Health systems capacity, including alignment between health ministries and external donors, builds capacity for sustainment. Due to limited resources and staffing instability, health systems may lack absorptive capacity to sustain programs once external funding is removed.

Summary: There is a growing body of scholarship retrospectively evaluating the durability and expansion of HIV prevention and treatment programs in practice, in addition to just in principle or theory (i.e. prospectively). To inform future decision-making and support sustained delivery across varying settings and populations, future work should prioritize longitudinal, mixed-methods approaches that assess the impact of policy changes, absorptive capacity, and integrating HIV treatment and prevention into existing health systems.