Multi-month dispensing (MMD) of antiretroviral therapy has emerged as a promising differentiated service delivery model for stable HIV patients. In resource-constrained settings like rural Nigeria, MMD offers potential solutions to healthcare access barriers while improving clinical outcomes and reducing healthcare costs. Objective: This study evaluated the implementation outcomes, costeffectiveness, and patient retention rates of multi-month antiretroviral dispensing programs in rural Nigerian healthcare facilities. Methods: A mixed-methods approach combining quantitative analysis of program data from 36 high-volume HIV treatment facilities across Akwa Ibom and Cross River states, and qualitative assessment of healthcare provider and patient experiences with 6-month dispensing (6-MMD) implementation from 2020-2024. Results: Implementation of 6-MMD resulted in significant improvements in patient retention (93% vs 65.3% in control groups), reduced clinic visit frequency by 30.4%, and demonstrated cost-effectiveness with estimated savings of $122.10 per patient per year in direct medical costs. Rural patients showed particular preference for community-based MMD models, with 87% reporting improved treatment adherence. Conclusions: Multi-month dispensing represents a viable, cost-effective intervention for improving HIV care delivery in rural Nigeria, though implementation requires addressing infrastructure limitations and healthcare worker capacity constraints.