HIV Mortality Surveillance in Nigeria, A Systematic Review of Trends, Determinants, and Implications For Public Health Policy

Despite substantial progress in expanding antiretroviral therapy (ART) coverage and scaling up prevention interventions, Human Immunodeficiency Virus (HIV) related mortality remains a significant public health challenge in several high-burden settings, including Nigeria. Persistent data system fragmentation, late diagnosis, and socio-structural inequities have slowed progress toward epidemic control. This systematic review synthesizes evidence on the epidemiological trends, determinants, and surveillance performance of HIV mortality in Nigeria, highlighting implications for public health policy and Sustainable Development Goal (SDG) 3.3. A systematic review was conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 framework. Peer-reviewed studies, national surveillance reports, and institutional documents published between 2010 and 2024 were retrieved from PubMed, Scopus, Web of Science, African Journals Online (AJOL), and World Health Organization (WHO) databases. Thematic synthesis was guided by the Public Health Surveillance Theory (PHST), Health Systems Resilience Framework (HSRF), and Socio-Ecological Model of Mortality (SEMM). Data were analyzed across four domains: mortality trends, determinants, surveillance performance, and global comparators. Eighty-two studies met inclusion criteria. HIV-related deaths in Nigeria declined from approximately 220,000 in 2010 to 52,000 in 2023, though progress has plateaued since 2018. Key mortality drivers include late ART initiation, Tuberculosis (TB) and Non-communicable disease (NCD) co-infection, and structural factors such as stigma, poverty, and gender inequity. Institutional challenges including ART stock-outs, poor Electronic Medical RecordsAÿ(EMR-Civil Registration and Vital Statistics (CRVS) linkage, and weak mortality audit systems undermine timely surveillance. Nigeria’s CRVS capturesƒ_%<ƒ_%30% of deaths, withƒ_%<ƒ_%10% accurately certified, compared toƒ_%>ƒ_%95% capture in countries with integrated digital systems such as South Africa and Brazil. Reducing HIV mortality in Nigeria requires transforming mortality surveillance into an active public health intervention. Integrating electronic medical records with civil registration, expanding verbal autopsy coverage, institutionalizing mortality audits, and addressing structural inequities will strengthen health system resilience and accelerate progress toward HIV epidemic control and SDG targets by 2030

• Epidemiology and Determinants of Health
  • Epidemiology
  • Determinants of Health
• Determinants of Health
  • Income
  • Stigma/discrimination
• Population(s)
  • General HIV+ population
• Prevention, Engagement and Care Cascade
  • Engagement and Care Cascade
• Engagement and Care Cascade
  • Treatment
• Co-infections
  • Tuberculosis
• Co-morbidities
  • Cardiovascular
  • Other
• Health Systems
  • Governance arrangements