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HIV prevention cascade theory and its relation to social dimensions of health: a case for Nigeria

Authors Joe-Ikechebelu NN, Azuike EC, Nwankwo BE, Ezebialu IU, Ngene WO, Eleje GU

Received 27 March 2019

Accepted for publication 18 July 2019

Published 21 August 2019 Volume 2019:11 Pages 193—200

DOI https://doi.org/10.2147/HIV.S210190

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Melinda Thomas

Peer reviewer comments 2

Editor who approved publication: Professor Bassel Sawaya


Ngozi N Joe-Ikechebelu,1,2 Emmanuel C Azuike,1,2 Basil E Nwankwo,1,3 Ifeanyichukwu U Ezebialu,1,4 Williams O Ngene,1,5 George U Eleje6

1Health Promotion and Practice Research Unit, Chukwuemeka Odumegwu Ojukwu University Teaching Hospital, Awka, Nigeria; 2Department of Community Medicine, Chukwuemeka Odumegwu Ojukwu University Teaching Hospital, Awka, Nigeria; 3Office of the Chief Medical Director, Chukwuemeka Odumegwu Ojukwu University, Teaching Hospital, Awka, Nigeria; 4Department of Obstetrics and Gynecology, Chukwuemeka Odumegwu Ojukwu University Teaching Hospital, Awka, Nigeria; 5Department of Physiotherapy, Chukwuemeka Odumegwu Ojukwu University Teaching Hospital, Awka, Nigeria; 6Effective Care Research Unit, Department of Obstetrics and Gynecology, Nnamdi Azikiwe University, Nnewi Campus, Awka, Nigeria

Correspondence: George U Eleje
Effective Care Research Unit, Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University, Nnewi Campus, P.M.B., Nnewi, Anambra State 5025, Nigeria
Tel +234 806 811 7444
Email georgel21@yahoo.com

Background: Nigeria has the second largest HIV epidemic in the world and one of the highest rates of new infection in sub-Saharan Africa. Within the last three decades, majority of HIV programs in Nigeria were treatment strategies with few prevention approaches. The persistence of HIV prevalence despite the treatment blueprint has led to a concerted call to HIV Prevention Cascade (HPC) theory which ensures continuous sophisticated interrelationship that stretches beyond the biomedical interventions of treatment. To our knowledge, there is no previous review on HPC theory in Nigerian context.
Objectives: The aim of this review was to explore and outline the HIV/AIDS prevention cascade theory in relation to the achievement of the global 90-90-90 target set by the United Nations Programme on HIV and AIDS and suggest possible avenues to maximize on strengths and weaknesses of HPC in Nigeria.
Methods: In this mini-review, the authors utilized standardized search measures in the review of published articles in credible domains across the HPC in PubMed, Research gate, Google Scholar, Mendeley Reference Manager and Cochrane Library from January 1980 to December 2018. Referenced sections of the articles identified were used to hand-search additional references not retrieved by the initial search engines. The authors performed an evaluation of selected studies on three cascade theories: epidemiological, behavioral and social science with an integration of the supply, demand and adherence sides.
Results: We included nine review articles reporting three different cascade theories. Only one included study applied the cascade theories exclusively in Nigerian context. We could only conduct narrative synthesis.
Conclusion: There is scarceness of currently published evidence on HPC in Nigerian context. HPC allows for a paradigm shift and sequential process of events to eliminate the epidemic of HIV using HIV prevention perspectives in Nigerian settings. Since data are sparse, more research is needed on HPC theory.

Keywords: HIV, epidemic, HPC, prevention, cascade theory, social dimensions, Nigeria


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