Pharmaceutical Supply Chain Resilience in HIV/AIDS Programs: An Evaluation of CDC/PEPFAR-Supported Systems in Nigeria

Abstract

Background: Nigeria hosts one of the world's largest HIV/AIDS epidemics, with an estimated prevalence of 1.4-2.1% among adults aged 15-49 years. The President's Emergency Plan for AIDS Relief (PEPFAR) and the Centers for Disease Control and Prevention (CDC) have invested over $6 billion in Nigeria's HIV/AIDS response since 2003, with significant emphasis on pharmaceutical supply chain systems. Methods: This study employs a mixed-methods approach, synthesizing quantitative performance data from PEPFAR monitoring systems (2018-2021) and qualitative assessments of governance structures. Data sources included Country Operational Plans, supply chain performance indicators, stockout reports, and stakeholder interviews from government agencies, implementing partners, and civil society organizations. Results: PEPFAR-supported supply chain systems demonstrated both resilience and vulnerability. While achieving 85% antiretroviral therapy (ART) coverage among identified patients and maintaining buffer stocks during the COVID-19 pandemic, the systems experienced recurring stockouts affecting 18% of facilities annually. Governance challenges included fragmented coordination between the National Agency for the Control of AIDS (NACA) and Federal Ministry of Health, with over 70% of HIV funding originating from external donors. Conclusions: Despite significant achievements in treatment scale-up, Nigerian pharmaceutical supply chains remain heavily donor-dependent with systemic vulnerabilities. Strengthening country ownership, integrating supply systems, and addressing human resource constraints are critical for long-term sustainability.