title: Lessons learned from stakeholder-driven sustainability analysis of six national HIV programmes.
abstract: BACKGROUND
  In light of the decline in donor HIV funding, HIV programmes increasingly need to assess their available and potential resources and maximize their utilization. This article presents lessons learned related to how countries have addressed the sustainability of HIV programmes in a stakeholder-driven sustainability analysis.
  
  
  METHODS
  During HIV/AIDS Programme Sustainability Analysis Tool (HAPSAT) applications in six countries (Benin, Guyana, Kenya, Lesotho, Sierra Leone and South Sudan), stakeholders identified key sustainability challenges for their HIV responses. Possible policy approaches were prepared, and those related to prioritization and resource mobilization are analysed in this article.
  
  
  RESULTS
  The need to prioritize evidence-based interventions and apply efficiency measures is being accepted by countries. Five of the six countries in this study requested that the HAPSAT team prepare 'prioritization' strategies. Countries recognize the need to prepare for an alternative to 'universal access by 2015', acknowledging that their capacity might be insufficient to reach such high-coverage levels by then. There is further acceptance of the importance of reaching the most-at-risk, marginalized populations, as seen, for example, in South Sudan and Sierra Leone. However, the pace at which resources are shifting towards these populations is slow. Finally, only two of the six countries, Kenya and Benin, chose to examine options for generating additional financial resources beyond donor funding. In Kenya, three non-donor sources were recommended, yet even if all were to be implemented, it would cover only 25% of the funding needed.
  
  
  CONCLUSIONS
  Countries are increasingly willing to address the challenges of HIV programme sustainability, yet in different ways and with varying urgency. To secure achievements made to date and maximize future impact, countries would benefit from strengthening their strategic plans, operational plans and funding proposals with concrete timelines and responsibilities for addressing sustainability issues.
authors.affiliation: Abt Associates, International Health Division, 4550 Montgomery Avenue, Bethesda, MD 20814, USA. E-mail: katz@cantab.net.
authors.forename: Itamar
authors.initials: I
authors.lastname: Katz
authors.forename: Douglas
authors.initials: D
authors.lastname: Glandon
authors.forename: Wendy
authors.initials: W
authors.lastname: Wong
authors.forename: Brima
authors.initials: B
authors.lastname: Kargbo
authors.forename: Regina
authors.initials: R
authors.lastname: Ombam
authors.forename: Shanti
authors.initials: S
authors.lastname: Singh
authors.forename: Leslie
authors.initials: L
authors.lastname: Ramsammy
authors.forename: Anta
authors.initials: A
authors.lastname: Tal-Dia
authors.forename: Ibrahima
authors.initials: I
authors.lastname: Seck
authors.forename: John S
authors.initials: JS
authors.lastname: Osika
mesh_terms: D000293:Adolescent; D000328:Adult; D001541:Benin / Q000453:epidemiology; D005260:Female; D006172:Guyana / Q000453:epidemiology; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control*; D006291:Health Policy; D006292:Health Priorities; D006295:Health Resources; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D007927:Lesotho / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D015397:Program Evaluation; D012807:Sierra Leone / Q000453:epidemiology; D013397:Sudan / Q000453:epidemiology; D055815:Young Adult
keywords: HAPSAT; HIV; economic evaluation; policy analysis; resource allocation