By Tolu Abidemi

A leading public health pharmacist and supply chain expert, Mercy Itopa, has warned that Nigeria’s HIV response risks reversal unless greater attention is given to sustaining Multi-Month Dispensing (MMD) of antiretroviral therapy (ART) in rural communities.

In a paper made available to newsmen, and a copy of which was obtained by this medium, Itopa highlighted how MMD, the practice of giving stable HIV patients several months’ worth of medication at once, is transforming treatment outcomes across underserved areas of Nigeria.

She noted, however, that fragile implementation and weak logistics still threaten its long-term impact.

According to the paper, MMD has reduced clinic congestion, lowered transportation costs for patients, and improved adherence, particularly for those living in remote villages.

“For many rural patients, the nearest clinic is hours away,” she wrote. “MMD is not just a convenience, it is a lifeline that keeps treatment sustainable.”

Itopa explained that traditional monthly refill models placed a heavy burden on patients, often forcing them to choose between missing work and collecting their medications.

The result, she said, was high rates of missed appointments and poor adherence, which undermined Nigeria’s HIV control strategy.

Citing her work with APIN Public Health Initiatives, a leading implementing partner of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), with funding from the U.S. Centers for Disease Control and Prevention (CDC), she recalls how introducing differentiated service delivery models, including MMD in Southwestern Nigeria, eased the workload on health facilities while giving patients greater autonomy over their care. “We saw firsthand how patient satisfaction improved when people no longer had to make endless trips to clinics,” she noted in the paper.

Her paper also tied MMD to improved supply chain management. By predicting demand more accurately and distributing drugs in bulk, health facilities could minimize stockouts and reduce wastage.

“The model works only if the supply chain works,” she cautioned, stressing the need for robust data and logistics systems.

Itopa compared Nigeria’s progress with successful rollouts in countries like Uganda and Zambia, where MMD has been institutionalized as part of national HIV policy.

The paper noted that despite its benefits, MMD implementation in Nigeria remains uneven.

Some states have adopted it aggressively, while others lag due to poor planning, inadequate drug storage facilities, and weak distribution channels. For patients in those areas, the promise of MMD remains out of reach.

Her analysis also warned that without greater policy support and donor alignment, Nigeria risks losing the gains already made.

“If facilities run out of stock midway through multi-month dispensing cycles, patients will be left stranded with no safety net,” she cautioned.

By linking pharmacy expertise with administrative foresight, Itopa argued that MMD should be seen not just as a clinical intervention but as a systems reform.

She called for collaboration between pharmacists, administrators, and policymakers to ensure nationwide consistency.

In the paper, she insisted that scaling up MMD in ART is one of the most cost-effective strategies Nigeria can pursue in its HIV fight.

“Every missed dose creates room for resistance,” she wrote. “MMD closes that gap by ensuring treatment is uninterrupted.”

Her conclusions echo concerns raised by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the United States President’s Emergency Plan for AIDS Relief (PEPFAR) that sustaining treatment adherence is central to achieving epidemic control.

For rural Nigeria, where poverty and distance are constant barriers, MMD offers what she described as “the most practical hope for continuity of care.