Qualitative Exploration of Healthcare Providers' Perspectives on HIV Service Vulnerability During Funding Disruption...

Nigeria's 2025 PEPFAR funding suspension served as an unplanned natural experiment, uniquely demonstrating that behavioral instability among patients and providers precedes, and is in many respects more disruptive than, actual commodity shortages. This distinction, rarely documented in prior literature, has direct implications for how HIV program resilience should be designed and measured. We conducted in-depth key informant interviews with 15 healthcare providers at a major antiretroviral therapy (ART) facility in northern Nigeria, analyzed using Braun and Clarke's reflexive thematic analysis framework. Despite stable antiretroviral drug stocks, acute uncertainty triggered panic-driven patient visits, rumor-driven information gaps, and precautionary dispensing restrictions. Laboratory services deteriorated rapidly, and implementing partner staff worked without pay for up to two months, temporarily masking systemic fragility. Persistent structural barriers, transport costs, stigma, and treatment fatigue impeded adherence, independent of funding status. Providers distinguished technical capacity, which they judged sufficient, from political will, which they found lacking; transition structures existed but remained unimplemented. Sustaining ART delivery requires proactive crisis communication, protected multi-month dispensing, resilient laboratory financing, and governance reforms to reduce donor dependence. Political commitment is the central determinant of sustainable domestic HIV program ownership in Nigeria.