Medical Science
| Open Access |
DOI: Projected Impact of International HIV Funding Withdrawal on HIV Transmission, Care Continuum Disruption, and AIDS-Related Mortality in Nigeria: A Dynamic Mathematical Modelling Study
Olanrewaju Eniade , International Foundation Against Infectious Disease in Nigeria, Abuja, Nigeria Ezekiel Ukwenga , NHS University Hospitals of Liverpool Group, Liverpool, United Kingdom Uchenna Akuka , Care of the elderly, Queen Elizabeth Hospital, Gateshead, United Kingdom Adewemimo Olaosebikan , International Foundation Against Infectious Disease in Nigeria, Abuja, Nigeria Elonna Obak , Health Improvement Scotland, National Health Service, Scotland, United Kingdom. Opeyemi Adeniyi , Department of Public Health, Faculty of Basic Medical Sciences, Adeleke University Ede, Osun State, Nigeria. Ojo Oluwatobi Samuel , Epidemiology and Medical Statistics, College of Medicine, University of IbadanAbstract
Background: Nigeria remains affected by HIV and highly dependent on donor-funded programmes. Reductions in international HIV financing may threaten HIV testing, treatment, viral suppression, and epidemic control. This study assessed the epidemiological impact of funding withdrawal on HIV transmission, care-continuum performance, and AIDS-related mortality in Nigeria.
Methods: A deterministic compartmental dynamic HIV transmission model was developed and calibrated using Nigeria-specific epidemiological and HIV care-continuum indicators obtained from UNAIDS, WHO, NACA, PEPFAR, and CDC reports. The model incorporated HIV transmission, diagnosis, antiretroviral therapy (ART) initiation, viral suppression, treatment interruption, and AIDS-related mortality. Five funding-retention scenarios were simulated over a 10-year projection horizon (2026–2036): status quo (100% retained funding), mild withdrawal (80%), moderate withdrawal (60%), severe withdrawal (40%), and extreme withdrawal (20%). Probabilistic sensitivity analyses using 500 Monte Carlo simulations were performed to evaluate model uncertainty.
Results: Under the extreme withdrawal scenario, diagnosis coverage declined to approximately 70%, ART coverage fell below 50%, and viral suppression decreased to nearly one-third of people living with HIV by 2036. Severe and extreme withdrawal scenarios produced marked increases in HIV incidence and AIDS-related mortality, with more than 700,000 excess HIV infections and approximately 90,000 excess AIDS-related deaths projected over the study period. The epidemiological burden increased disproportionately when retained funding fell below 60%. Abrupt funding withdrawal produced worse outcomes than gradual phased withdrawal. Sensitivity analyses identified HIV transmission rates, viral suppression, and AIDS-related mortality rates as key drivers of model outcomes.
Conclusion: Substantial reductions in external HIV financing could reverse recent gains in HIV epidemic control in Nigeria, resulting in worsening HIV care-continuum performance, increasing HIV transmission, and rising AIDS-related mortality. Sustained HIV financing and carefully managed transition strategies are essential to preserve long-term epidemic control.
Keywords
HIV/AIDS, Dynamic transmission modelling, HIV funding withdrawal, HIV care continuum, Nigeria, AIDS-related mortality
References
CDC. HIV and TB Overview: Nigeria. Global HIV and TB. December 2, 2025. Accessed May 10, 2026. https://www.cdc.gov/global-hiv-tb/php/where-we-work/nigeria.html
Brink D ten, Martin-Hughes R, Bowring AL, et al. Impact of an international HIV funding crisis on HIV infections and mortality in low-income and middle-income countries: a modelling study. The Lancet HIV. 2025;12(5):e346-e354. doi:10.1016/S2352-3018(25)00074-8
UNAIDS U. People living with HIV who have suppressed viral loads | Indicator Registry. 2026. Accessed May 10, 2026. https://indicatorregistry.unaids.org/indicator/people-living-hiv-who-have-suppressed-viral-loads
UNAIDS. Nigeria | UNAIDS. 2026. Accessed May 10, 2026. https://www.unaids.org/en/regionscountries/countries/nigeria
NACA. 2024 ANNUAL HIV PROGRAM PERFORMANCE REVIEW - NACA Nigeria. 2024. Accessed May 10, 2026. https://naca.gov.ng/2024-annual-hiv-program-performance-review/
PHIS3. Nigeria National HIV Surveillance Report January 2024. Phis3project. 2024. Accessed May 10, 2026. https://www.phis3project.org.ng/phis3-resources/nigeria-national-hiv-surveillance-report-january-2024/
PEPFAR. The United States President’s Emergency Plan for AIDS Relief - United States Department of State. United States Department of State. 2025. Accessed May 10, 2026. https://www.state.gov/pepfar/
WHO. HIV data and statistics. 2024. Accessed May 10, 2026. https://www.who.int/teams/global-hiv-hepatitis-and-stis-programmes/hiv/strategic-information/hiv-data-and-statistics
GARNETT GP, ANDERSON RM. Balancing sexual partnership in an age and activity stratified model of HIV transmission in heterosexual populations. IMA Journal of Mathematics Applied in Medicine & Biology. 1994;11(3):161-192. doi:10.1093/imammb/11.3.161
Knight J, Kaul R, Mishra S. Risk heterogeneity in compartmental HIV transmission models of ART as prevention in Sub-Saharan Africa: A scoping review. Epidemics. 2022;40:100608. doi:10.1016/j.epidem.2022.100608
J. Jaime Caro, Andrew H. Briggs, Uwe Siebert, Karen M. Kuntz. Modeling Good Research Practices-Overview: A Report of the ISPOR-SMDM Modeling Good Research Practices Task Force–1. 2012. Accessed May 10, 2026. https://journals.sagepub.com/doi/10.1177/0272989X12454577
Roy Anderson, Robert May. Infectious Diseases of Humans: Dynamics and Control | Oxford Academic. 1991. Accessed May 10, 2026. https://academic.oup.com/book/53038
Dankwa EA, Cavalli L, Balasubramanian R, et al. Calibration of transmission-dynamic infectious disease models: A scoping review and reporting framework. PLOS Computational Biology. 2025;21(11):e1013647. doi:10.1371/journal.pcbi.1013647
Briggs AH, Weinstein MC, Fenwick EAL, Karnon J, Sculpher MJ, Paltiel AD. Model Parameter Estimation and Uncertainty Analysis: A Report of the ISPOR-SMDM Modeling Good Research Practices Task Force Working Group–6. Med Decis Making. 2012;32(5):722-732. doi:10.1177/0272989X12458348
Hontelez JAC, Goymann H, Berhane Y, et al. The impact of the PEPFAR funding freeze on HIV deaths and infections: a mathematical modelling study of seven countries in sub-Saharan Africa. eClinicalMedicine. 2025;83. doi:10.1016/j.eclinm.2025.103233
United Nations. UNAIDS GLOBAL AIDS UPDATE 2025: Aids, Crisis and the Power to Transform. UNITED NATIONS; 2025. Accessed May 13, 2026. https://www.unaids.org/sites/default/files/2025-07/2025-global-aids-update-JC3153_en.pdf
WHO. Potential impact of funding cuts on the HIV response. 2025. Accessed May 13, 2026. https://www.who.int/news/item/26-03-2025-new-study-highlights-the-potential-impact-of-funding-cuts-on-the-hiv-response
Cluver L, Makangila G, Hillis S, et al. Protecting Africa’s children from extreme risk: a runway of sustainability for PEPFAR programmes. The Lancet. 2025;405(10490):1700-1712. doi:10.1016/S0140-6736(25)00401-5
Kulohoma BW, Wesonga CA. HIV response financing challenges in Sub-Saharan Africa: barriers to achieving the 95-95-95 UNAIDS targets. Front Public Health. 2025;13:1658229. doi:10.3389/fpubh.2025.1658229
Download and View Statistics
Copyright License
Copyright (c) 2026 Olanrewaju Eniade , Ezekiel Ukwenga, Uchenna Akuka, Adewemimo Olaosebikan, Elonna Obak, Opeyemi Adeniyi, Ojo Oluwatobi Samuel
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors retain the copyright of their manuscripts, and all Open Access articles are disseminated under the terms of the Creative Commons Attribution License 4.0 (CC-BY), which licenses unrestricted use, distribution, and reproduction in any medium, provided that the original work is appropriately cited. The use of general descriptive names, trade names, trademarks, and so forth in this publication, even if not specifically identified, does not imply that these names are not protected by the relevant laws and regulations.