Nepal has been experiencing a concentrated HIV epidemic among key populations (KPs) and priority populations (PPs) for HIV. It has been estimated that 30,300 people are living in Nepal with HIV, with an annual adult Human Immunodeficiency Virus (HIV) prevalence of 0.11% and incidence of 0.02% per year. According to National Center for AIDS and STD Control (NCASC), HIV prevalence among KPs is disproportionately higher, 6.2% among men who have sex with men (MSM), 11% among transgender people, 2.2% among female sex workers (FSWs), and 3% among people who inject drugs (PWID). Of the estimated people living with HIV (PLHIV) in the country, it is estimated that 99.9% of HIV positive adults know their HIV status. Among adults PLHIV who know their HIV status, 91.6% are receiving antiretroviral therapy (ART). With the population who are on ART, 70.9% have achieved sustained HIV viral load (VL) suppression. The data suggests that Nepal is close to reaching HIV epidemic control, but still has pockets which need to be addressed. Nepal’s “National HIV/AIDS Strategic Plan 2021–2026” is aligned with global recommendations for the HIV response.
 
The National HIV Strategic Plan (NHSP), Nepal has embarked on a “FastTrack” approach towards ending the acquired immune deficiency syndrome (AIDS) epidemic as a public health threat by 2030, through achieving the ambitious 95-95-95 targets by 2026.
The NHSP 2021-2026 largely follows the NHSP 2016-2021, which prioritized key interventions to achieve the fast-track targets. Significant improvement in the treatment cascade is needed.  and to keeps the momentum and further accelerate the progress to achieve the goal of ending AIDS by 2030, a forward looking new strategic plan is needed
 
The key areas for fast-track actions of NHSP 2021-2026 are to:
 
Identify and reach key and vulnerable populations with a combination of differentiated services;

As Nepal gets closer to attaining the 95-95-95 targets for treatment coverage and reaching epidemic control. Major programmatic challenges include enrolling those who were previously diagnosed with HIV onto the treatment, retaining the service beneficiaries in the treatment, minimizing interruption in treatment (IIT), improving access to VL testing services, and achieving sustained VL coverage and suppression.
 
According to NCASC fact sheet 2023, the prevailing gaps in the HIV cascade in Koshi province is estimated to be 6% gap in case detection, 26% in linkages to treatment and 14% in VL suppression. These highlights limited access to HIV testing services, low retention in care among those diagnosed and insufficient linkages to ART for individuals newly diagnosed with HIV. The USAID Sustainable HIV Epidemic Control will be implementing HIV prevention, treatment, care, and support services primarily in FSWs and their clients, MSM, male sex workers(MSWs),   transgender people and PLHIV, their partners and children in four districts of Koshi Province, namely Ilam, Jhapa, Morang and Sunsari, in close coordination with Blue Diamond Society (BDS) and their implementing partners and national networks of KPs and PLHIV and community based organizations (CBOs).
 
The USAID Sustainable HIV Epidemic Control will deliver relevant and efficient direct service delivery that is effective in scaling, and sustaining HIV services and systems for long-term epidemic control with focus on filling existing HIV prevention, case finding, and treatment gaps, on building long-term sustainability to attain and maintain epidemic control.
 
The USAID Sustainable HIV Epidemic Control will receive technical assistance (TA) from Meeting Targets and Maintaining Epidemic Control (EpiC Nepal) for quality service delivery.