Transitioning a large-scale HIV/AIDS treatment program from an international partner to a local Nigerian implementing partner: a before-after early outcomes assessment study.

Background: HIV prevention, treatment, and care across the globe have been heavily dependent on donor funding and international aid, particularly across the Global South, with the highest contribution from the United States Government (USG) through PEPFAR. PEPFAR's shift towards HIV care sustainability involves transitioning HIV/AIDS treatment programs from international to local partners. Despite the increasing focus on these transitions, there is limited evidence of effective models and the outcome of such transitions, particularly in low- and middle-income countries like Nigeria. This study evaluates the transition of a large-scale HIV/AIDS program from an international implementing partner (FHI 360) to a local partner, Excellence Community Education Welfare Scheme (ECEWS) in Nigeria, highlighting the processes and early outcomes.

Methods: The study used a before-after design to analyse programme data from Akwa Ibom and Cross River States, comparing indicators before, during and after the transition of HIV services from FHI 360 to the local partner ECEWS. A transition model was developed with stakeholder engagement. De-identified client data were abstracted from the Electronic Medical Records and District Health Information System (DHIS2) database for the pre-transition period (January-June 2022) and post-transition period (July-December 2022) and compared. Outcomes compared included HIV testing services, on-schedule refill appointments, and viral load testing uptake. Statistical analyses were performed using STATA version 14, with significance at p < 0.05.

Results: A total of 405,702 individuals were tested for HIV between January 2022 and December 2022, with 116,138 (29%) tested before and 289,564 (71%) tested after the transition period. The average number of monthly tests increased by 149%, from 19,356 to 48,260 (p = 0.001), between the two periods. Additionally, on-schedule refill appointments improved significantly post-transition, increasing from 97.8 to 98.2% (p < 0.001), while viral load testing uptake improved from 96 to 99%. Success was attributed to comprehensive planning, strong stakeholder engagement, flexible communication strategies, and a robust monitoring and evaluation (M&E) system, which were outcomes of the transition model.

Conclusion: HIV/AIDS treatment program transitions to indigenous partners can be successfully achieved without compromising service accessibility, care quality, or treatment outcomes. Our study findings highlight the importance of collaborative planning in sustaining program outcomes during transitions with the aim of sustaining service delivery during this period. A systematic approach, utilising a well-structured transition model, facilitates a seamless transfer and provides a strategic framework for Nigerian programs.