Background: Sustaining evidence-based interventions in resource-limited settings is critical to optimize gains in health outcomes. A previous review of the sustainability of health interventions in sub-Saharan Africa (SSA) in 2015, highlighted a gap in the measurement and conceptualization of sustainability in SSA. This review provides an update and expands upon the original review to account for developments in the past few years and recommendations for promoting sustainability. Methods: We searched five databases for studies published between 2015 and 2022 in accordance with PRISMA guidelines. Studies were included if they reported on the sustainability of health interventions implemented in SSA. Two researchers independently extracted information from each article using a validated data extraction tool. Findings: Twenty-nine publications with 27 distinct interventions were included in the review. Twelve countries were represented in this review, with Uganda (n=7) having the most representation of available studies. Compared to the 2015 review, a slightly higher proportion of studies had a clear definition of sustainability (69% versus 51% in the 2015 review). However, only seven studies discussed framing their sustainability assessment using a theory or conceptual framework. Four key factors emerged as important determinants of sustainability: people, learning, adaptation, and nurturing. The most prevalent facilitators of sustainability were related to micro-level factors (e.g., intervention fit, stakeholder engagement), while salient barriers were related to structural level factors (e.g., limited financial resources). This review highlights some progress in the documentation of sustainability in evidence-based intervention in SSA.

After transferring from SLU's Madrid to St. Louis Campus Dr. Juliet Iwelunmor was assigned as Patrick's faculty mentor. During Patrick's mentor meeting, Dr. Iwelunmor invited Patrick to join her research group. This systematic review was the first project Patrick worked on after joining the lab. As the project developed Patrick was entrusted to present the review at the 2022 Conference on the Science of Dissemination and Implementation in Washington, D.C. Patrick wishes to thank Dr. Juliet for her continuing trust and mentorship during his introduction to the research world.