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Identifying strategies for sustaining evidence-based HIV prevention interventions for AYA in Nigeria: evidence from a
Juliet Iwelunmor1, Titilola Gbaja-Biamila1,2, Folahanmi T Akinsolu2,3,4
1Division of Infectious Diseases, Washington University School of Medicine in St. Louis, St. Louis, MO, United States.
Introduction:
Sustaining evidence-based HIV prevention interventions remains a persistent challenge, particularly in low- and middle-income countries where programs often rely on time-limited funding. This study explored youth-generated strategies for sustaining HIV prevention interventions among adolescents and young adults (AYA) in Nigeria following initial implementation.
Methods:
We conducted a national crowdsourcing open call inviting Nigerian AYA (aged 14-24 years) to propose strategies for sustaining HIV prevention services through maintaining intervention activities (A), preserving benefits (B), and strengthening capacity (C). The open call was part of the 4 Youth By Youth (4YBY) initiative. Submissions were received as text, images, or short videos and were de-identified prior to analysis. Two trained qualitative researchers conducted inductive thematic analysis with iterative codebook development. Emergent findings were subsequently interpreted using the PLAN (People, Learning, Adaptation, and Nurturing) framework and the Dynamic Sustainability Framework to examine youth-defined sustainment mechanisms. Demographic data were analyzed descriptively.
Results:
Of 105 submissions received, 70 met eligibility criteria and were included in the analysis. Youth proposed actionable strategies across three sustainment domains: maintaining delivery activities, preserving intervention value, and strengthening enabling infrastructure. Strategies included youth leadership development, institutional integration, digital adaptation, stigma reduction, participatory monitoring, and diversified financing. Across domains, youth emphasized relational engagement, adaptive learning, and capacity building as mechanisms for long-term viability.
Conclusion:
Nigerian AYA articulated practical, context-responsive strategies for sustaining HIV prevention interventions. Centering youth perspectives highlights relational, structural, and adaptive mechanisms necessary for sustaining evidence-based interventions in resource-limited settings.
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