The HIV prevention cascade: integrating theories of epidemiological, behavioural, and social science into programme design and monitoring

Hargreaves, J; Delany-Moretlwe, S; Hallett, T; Johnson, S; Kapiga, S; Bhattacharjee, P; Dallabetta, G; Garnett, G Lancet HIV, 2016;

The HIV prevention cascade is emerging as a new approach to guide the design and monitoring of HIV prevention programmes in a way that integrates these multiple perspectives. This approach recognises that translating the efficacy of direct mechanisms that mediate HIV prevention (including prevention products, procedures, and risk-reduction behaviours) into population-level effects requires interventions that increase coverage.

In this Personal View, Hargreaves et al show how this approach can integrate understanding of the multiple determinants of HIV incidence within programme design so as to translate the efficacy of HIV prevention tools and behaviours to effects at the population level.

An HIV prevention cascade approach suggests that high coverage can be achieved by targeting three key components:

  1. demand-side interventions that improve risk perception and awareness and acceptability of prevention approaches
  2. supply-side interventions that make prevention products and procedures more accessible and available
  3. adherence interventions that support ongoing adoption of prevention behaviours, including those that do and do not involve prevention products

Programmes need to develop delivery platforms that ensure these interventions reach target populations, to shape the policy environment so that it facilitates implementation at scale with high quality and intensity, and to monitor the programme with indicators along the cascade.

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