Country ownership and sustainable programming of the HIV response in South Africa: A scoping review

Background: Concerns have arisen regarding the extent to which South Africa’s HIV response can be country-owned and sustainable given substantial foreign investment and technical support. Objectives: To assess the extent to which South Africa’s national HIV response is country-owned. Method: We conducted a scoping review of South African literature using the Global Health Initiative Framework for country ownership. Results: South Africa has clear aspirations for what should be accomplished and strategies are aligned with national and international priorities. Although South Africa has leveraged community-based strategies to reach key populations (KPs), most are supported by international donors, which poses a sustainability challenge. Despite robust capacity strengthening and training programmes, South Africa continues to face healthcare worker shortages. While it is commendable that South Africa funds nearly 70% of the national HIV response, the funds mainly support HIV treatment. This may create dependency on international partners. Conclusion: South Africa appears to be progressing well along the spectrum of country ownership, but sustained efforts are required to combat HIV. Greater ownership over KP programming and prevention services are especially needed to achieve greater impact.