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Introduction
The high prevalence of HIV among Nigerian youth aged 15-24, particularly adolescent girls and young women, poses a substantial public health concern. Various factors, such as multiple concurrent sexual relationships, transgenerational sex, and transactional sex, contribute to their vulnerability to HIV, influenced by sociocultural contexts that differ across the country. Research indicates that adolescents account for about 7% of the total number of individuals with HIV in Nigeria, with young women disproportionately affected compared to their male counterparts (Arije et al. 2023). Consequently, there is an urgent need to address this health behavior problem through targeted interventions tailored to this population’s specific needs and challenges.

Figure 1: HIV prevalence among young people aged 15-24 disaggregated by sex Source- Report of the Gender Assessment of the HIV Response in Nigeria 2022, UNAIDS (2021))

The graph above clearly highlights that HIV prevalence among young women between the ages of 15- 24 is doubled that of you men between the ages of 15-24 (women 0.6 vs men 0.3) according to the report of the Gender Assessment of the HIV Response in Nigeria in 2022 support by UNAIDS (2021) data

Figure 2. Number of young people living with HIV aged 15-24 years disaggregated by sex (Source- Report of the Gender Assessment of the HIV Response in Nigeria 2022, UNAIDS (2021))

According to the table above young women between the ages of 15 -24 living with HIV account for two-thirds (63%) of young people living with HIV (110,000 vs 64,000) according to the report of the Gender Assessment of the HIV Response in Nigeria in 2022 support by UNAIDS (2021) data.


Figure 3: Comprehensive knowledge of HIV in different populations NDHS (2018)

The National Demographic Health Survey of 2018 also highlights the significant knowledge gap on HIV by the target population which stood at 38.5. Considering the age of the target population, this is considerably on the high side and constitutes a significant public health challenge that would require immediate intervention, NDHS (2018)

The proposed school-based program for preventing HIV among Nigerian youths will be guided by theoretical frameworks and intervention mapping, focusing on evidence-based behavior change interventions. The Social and Behavior Change Communication (SBCC), Diffusion of Innovations theory, and the Health Belief Model form the basis for the intervention design (Gallant and Maticka-Tyndale, 2004; Arije et al. 2023). These frameworks have previously guided successful interventions in Nigeria and other similar locations, highlighting the potential for effective implementation and impact.

The SBCC framework emphasizes the importance of addressing knowledge, attitudes, and behaviors related to HIV prevention (Gallant and Maticka-Tyndale, 2004). Through targeted communication and strategic behavior change techniques, the intervention will aim to improve youths’ knowledge about HIV transmission and prevention, enhance positive attitudes towards HIV prevention, and promote protective behaviors. In contrast, the Diffusion of Innovations theory underscores the significance of leveraging social networks and involving peers in disseminating information and promoting positive norms regarding HIV prevention (Arije et al. 2023). Peer education, a crucial component of the proposed intervention, is consistent with this approach, fostering long-term behavior changes among high-risk HIV groups (He et al. 2020).

Several constraints could impede the implementation and effectiveness of the proposed intervention, such as cultural and religious beliefs, political barriers, or limited funding. Addressing these constraints requires a comprehensive intervention mapping approach, involving a systematic process of program planning, design, implementation, and evaluation in accordance with local contexts (Gallant and Maticka-Tyndale, 2004). By involving community leaders and local stakeholders in the development and implementation of the program, the intervention can be tailored to be culturally sensitive and contextually appropriate, ensuring its success and sustainability (Chizoba et al., 2020).

Furthermore, the Health Belief Model provides valuable insight into factors influencing individuals’ decisions to adopt protective behaviors related to HIV prevention, such as perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and self-efficacy (Rosenstock, 1974). By addressing these factors, the intervention will not only impart knowledge and skills but also target the cognitive determinants associated with HIV risk behaviors among Nigerian youths.

Given the complex nature of the health behavior problem and various sociocultural factors influencing HIV prevalence among Nigerian youths, the proposed intervention seeks a holistic approach by incorporating multiple components tailored to the target population. The program’s components will include peer education, innovative and adaptive HIV prevention solutions, school-based sexual and reproductive health education, and community engagement initiatives that address the gendered nature of HIV vulnerability (Arije et al. 2023).




Needs Assessment and Logic Model of Problem

The needs assessment is a critical first step in the development of the proposed school-based HIV prevention program for Nigerian youths aged 15-24. This process involves gathering information about the target population’s unique needs and challenges, identifying knowledge gaps, attitudes, and behaviors related to HIV prevention, and understanding potential barriers, both sociocultural and systemic, affecting the implementation and success of the intervention (Hart, 2011; Theunissen et al., 2013).

To conduct a comprehensive needs assessment, a planning group comprising key stakeholders, such as health professionals, teachers, community leaders, and youth representatives, can convene to discuss and evaluate existing literature and local data related to HIV prevalence and risk factors among Nigerian youths. The review should cover various aspects such as health problem, behavioral factors, geographic location, implications of the identified problem, and constraints on interventions. This approach ensures that diverse perspectives and insights are considered, leading to a more accurate representation of the health behavior problem at hand and enabling the development of targeted, culturally appropriate solutions (Gallant and Maticka-Tyndale, 2004; Chizoba et al., 2020).

Informed by the needs assessment, a logic model of the problem can be developed to visually depict the links between the identified causes, determinants, and outcomes of HIV transmission among the target population (Figure 4). The logic model will highlight the essential program objectives, provide a clear rationale for their inclusion, and delineate the pathways through which the intervention aims to achieve its desired outcomes.

Figure 4: Logic Model of Problem for Preventing HIV among Youths in Nigeria

Behavioral factors affecting HIV prevention among Nigerian youths include inadequate knowledge about HIV transmission and prevention methods, misconceptions about the disease, low condom use during sexual encounters, and limited access to prevention resources (O et al., 2013; Durosinmi-Etti et al., 2022). Furthermore, cultural factors and social stigma surrounding HIV and sexual health discussions can impede the effectiveness of prevention efforts (Iwelunmor et al., 2014).

Environmental factors, such as limited access to healthcare services, poor infrastructural facilities, and inadequate trained human resources providing services, also contribute to the high prevalence of HIV in this population. Additionally, social determinants, like gender inequality, economic disparities, and weak policymaking, play a crucial role in perpetuating the vulnerability of Nigerian youths to HIV transmission (Arije et al. 2023; Chizoba et al., 2020).

To address these identified factors, the program must provide accurate information on HIV transmission and prevention, promote open discussions around sexual health, create supportive environments for youths to make informed decisions about their sexual health, and ensure the availability of adequate healthcare services and resources. Overall, the needs assessment and the logic model of the problem serve as invaluable tools that lay the foundation for a comprehensive, effective, and contextually appropriate school-based HIV prevention program for Nigerian youths.


Program Outcomes and Objectives; Logic Model of Change

The primary aim of the school-based HIV prevention program for Nigerian youths is to promote positive behavior changes and reduce HIV vulnerability in the target population aged 15-24 (Adebajo et al., 2019; Nigeria Ministry of Health, 2019). Based on the needs assessment findings and guided by the logic model of the problem, specific program outcomes and objectives are formulated to achieve measurable short-term and long-term results.

The program outcomes comprise reductions in HIV incidence and improvements in HIV knowledge, attitudes, and protective behaviors among Nigerian youths. These outcomes, when achieved, will contribute to the overall goal of reducing the adverse impact of the HIV epidemic on the Nigerian population, particularly among adolescent girls and young women who exhibit disproportionately high infection rates (UNAIDS, 2019).

To attain the desired outcomes, several objectives have been identified through a thorough analysis of the problem determinants, including efforts to:

Increase comprehensive knowledge about HIV transmission, prevention methods, and the importance of early diagnosis and treatment among youths (UNAIDS, 2016).
Address misconceptions and reduce the stigma surrounding HIV, fostering supportive environments for open discussions and informed decision-making about personal sexual health (Nigeria Ministry of Health, 2019).
Enhance self-efficacy among youths in adopting protective behaviors, such as condom use, safer sex practices, and regular HIV testing (UNAIDS, 2016).
Encourage positive attitudes toward HIV prevention, highlighting the benefits of protective behaviors and the shared responsibility of both partners in maintaining sexual health (Nigeria Ministry of Health, 2019).
Strengthen access to essential healthcare services, such as HIV testing, counseling, and treatment, as well as the availability of prevention resources like condoms (UNAIDS, 2016).
Engage communities and stakeholders in creating a supportive environment for behavior change through capacity building, collaboration, and resource mobilization (Nigeria Ministry of Health, 2019).

The logic model of change (Figure 5) provides a visual representation of the intervention’s proposed causal pathway, connecting the identified determinants and program objectives to the desired outcomes. This model allows stakeholders to understand the program’s planned components, potential mediators, and targeted indicators of success. In addition, the logic model of change can serve as a valuable tool for assessing the intervention’s progress and facilitating any necessary adaptations to maximize its impact (W.K. Kellogg Foundation, 2004).

Overall, the program outcomes and objectives, in conjunction with the logic model of change, form the foundation of the proposed school-based HIV prevention program for Nigerian youths. These elements serve as a roadmap to guide intervention design, implementation, and evaluation, ensuring that the program is evidence-based, targeted, and effective in addressing the complex health challenges faced by the target population. By addressing the specific needs of the target population and leveraging proven behavior change techniques, the program has the potential to significantly reduce HIV vulnerability among Nigerian youths, contributing to the ongoing efforts to combat the HIV epidemic and promote overall public health in Nigeria.

Figure 5: Logic Model of Change for Preventing HIV among Youths in Nigeria


Program Design

To address the health behavior problem among Nigerian youths effectively, the program design will incorporate various evidence-based behavior change methods and practical applications. Drawing on the theoretical frameworks, such as the Social and Behavior Change Communication (SBCC) and Diffusion of Innovations theory, the intervention aims to deliver targeted and contextually appropriate solutions.

Figure 6: Behaviour change matrix for Preventing HIV among Youths in Nigeria (Zimmerman, Kamal and Kim, 2013)

One key component of the program design is peer education, which aligns with the Diffusion of Innovations theory and has proven to be effective in promoting long-term behavior changes among high-risk HIV groups (He et al., 2020). Trained peer educators, who share similar characteristics with the target population, will facilitate learning sessions, group activities, and discussions that address knowledge gaps, attitudes, and misconceptions about HIV prevention, as well as promote positive social norms and protective behaviors.

The program design will also incorporate school-based sexual and reproductive health education tailored to the needs and cultural sensitivities of the target population (Wight et al., 2016). This component includes interactive lessons on HIV transmission, prevention methods, and the importance of early diagnosis and treatment. The curriculum will also address barriers to adopting protective behaviors, such as lack of self-efficacy or gender norms, providing youths with the knowledge and skills necessary to make informed decisions about their sexual health.

Furthermore, the intervention will engage local communities and stakeholders in the development and implementation processes, ensuring that the program is culturally relevant, acceptable, and sustainable. Community engagement initiatives may include involving religious leaders, parents, and local organizations in the planning process and promoting positive social norms through public awareness campaigns, intergenerational dialogues, and capacity-building efforts (Bertrand et al., 2018).

Pre-Testing within Program Production

The pre-testing phase is a vital component of the program production process, aimed at assessing the intervention’s relevance, effectiveness, and acceptability before full-scale implementation. This phase ensures that the program is tailored to address the unique needs and challenges faced by the target population and adheres to local cultural sensitivities.

During this phase, the program materials, activities, and training resources will undergo a preliminary evaluation involving members of the planning group, including teachers, health professionals, peer educators, and community representatives. They will review the materials for clarity, coherence, and consistency with the program’s objectives and context.

Additionally, feedback from the target population will be collected through interviews, focus groups, or surveys, verifying the program’s relevance and appropriateness, particularly concerning cultural issues and comprehension abilities (Adefuye et al., 2017). This feedback will inform refinements and adjustments to the intervention before further implementation and scale-up.

The pre-testing phase may also include conducting pilot implementations in selected schools, which provides a valuable opportunity for real-world assessment of the intervention’s practical aspects, such as logistics, resource allocation, and potential barriers to success. Insights from this pilot can guide further refinements and adaptations, ensuring that the school-based HIV prevention program is optimally designed, effective, and sustainable for addressing the health behavior problem among Nigerian youths.



Implementation Strategy

The success of the proposed school-based HIV prevention program for Nigerian youths relies on a well-structured and thoughtfully planned implementation strategy. By incorporating both the linkage approach and diffusion theory, the intervention aims to maximize its impact and sustainability while addressing the specific needs of the target population.

The linkage approach emphasizes the importance of building partnerships and collaborations with local stakeholders, including schools, health professionals, and community organizations. By fostering close relationships with these entities, the intervention can ensure cultural appropriateness, contextual relevance, and long-term sustainability. Moreover, as part of the linkage approach, early adopter stakeholders can be identified to promote diffusion of the intervention within communities, in line with the Diffusion of Innovations theory (Arije et al., 2023).

The implementation strategy consists of several pivotal steps:

1. Establishing partnerships with local stakeholders, such as schools, health professionals, and community organizations, to lay the foundation for close collaboration and support throughout the program.
2. Developing training materials and resources for teachers and peer educators, incorporating the behavior change methods and practical applications identified during intervention design.
3. Conducting training sessions for teachers and peer educators on the program’s content, objectives, and delivery methods, ensuring consistency and quality in program implementation.
4. Launching the program in selected schools through a phased approach, with ongoing support and supervision provided by the program team.
5. Engaging with the local community and promoting positive social norms around HIV prevention through public awareness campaigns, intergenerational dialogues, and capacity-building efforts.
6. Monitoring the program’s progress through regular meetings with teachers, peer educators, school administrators, and other stakeholders, facilitating feedback loops that enable continuous improvements.

By systematically following these steps and considering potential constraints, such as cultural or political barriers, the implementation strategy aims to ensure the program’s success in promoting positive behavior changes and reducing HIV vulnerability among Nigerian youths aged 15-24.

Evaluation Plan

The evaluation plan for the school-based HIV prevention program comprises two critical components: process evaluation and effect evaluation. This comprehensive approach allows for the assessment of the program’s implementation, fidelity, and impact on the targeted outcomes of reducing HIV vulnerability and promoting positive behavior changes among Nigerian youths.

Process evaluation involves assessing the context, reach, dose delivered, dose received, recruitment, and fidelity of the program’s implementation. This evaluation ensures that the program is being implemented as intended, identifies potential barriers, and informs refinements and adaptations when necessary. Data collection methods for the process evaluation may include surveys, observations, and document reviews (Baranowski et al., 2002).


Discussion / Implications of the Intervention / Future Research and Limitations

The proposed school-based HIV prevention program for Nigerian youth aged 15-24, grounded in the Social and Behavior Change Communication (SBCC) and Diffusion of Innovations Theory, aims to address behavioral, social, and environmental factors associated with HIV transmission. Aligned with existing policies, such as the National HIV Strategy for Adolescents and Young People, the intervention engages local stakeholders for effective implementation (Arije et al., 2023).

However, conservative cultural and religious beliefs may challenge the program’s acceptance in some regions. Collaborating with community leaders and contextualizing materials will be vital (Gallant and Maticka-Tyndale, 2004). Potential biases in self-reported data and lack of control groups in the evaluation plan may limit the inference of causality. Future research could utilize objective measures and quasi-experimental designs (Finkbeiner et al., 2013).

For wider dissemination, assessing scalability and exploring adaptations for diverse sociocultural contexts is essential (Iwelunmor et al., 2014). By refining the program’s design, implementation, and evaluation methods, and examining broader implications, this intervention can contribute to reducing HIV vulnerability among Nigerian youth and beyond.