Structural factors and the HIV prevention and treatment cascades: where are we? - Sinead Delany-Moretlwe and James Hargreaves

There remains an unmet need for HIV prevention, particularly among key populations including adolescent girls and young women in Africa. The treatment cascade framework, and its associated 90:90:90 targets, has galvanised action to expand testing and treatment for prevention. The prevention cascade framework hopes to do the same for primary prevention, mapping the steps needed to achieve high coverage of efficacious prevention tools. Both frameworks illustrate how ART-based HIV prevention offers real promise for reducing HIV incidence at a population level. However, challenges remain.

Overcoming structural barriers along the treatment and prevention cascades will be essential to achieving impact on HIV incidence and other health outcomes at a population level."

This Learning Lab explores how social and structural factors have the potential to undermine the promise of these frameworks by acting at each step along the cascades. However - as the presenters explain - evidence shows that these same structural factors can be amenable to intervention within programmatic timeframes.

Sinead Delany-Moretlwe is Associate Professor and Director of Research at Wits RHI. A South African-born medical doctor, her experience is primarily in sexual and reproductive health and HIV prevention research. Currently she is a principal investigator on a large phase III trial of injectable cabotegravir as PrEP, and three demonstration projects of PrEP for adolescent girls and young women, with a particular focus on evaluating interventions that may address the social and structural barriers to PrEP use in young women.

James Hargreaves is the Director of the Centre for Evaluation at the London School of Hygiene & Tropical Medicine where he is also a Professor in Epidemiology and Evaluation with a focus in social epidemiology and public health evaluation. His primary interests include the socioeconomic epidemiology of HIV/AIDS and tuberculosis and in developing interventions to address these public health issues.

Download a pdf of the presentation here.


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

Interventions to strengthen the HIV prevention cascade: a systematic review of reviews


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