International Journal of TROPICAL DISEASE & Health

Non-communicable diseases now account for a rising share of premature adult mortality in West Africa, and men carry a disproportionate part of that burden while remaining comparatively absent from screening, treatment and long-term follow-up. Peer-to-peer support, in which people who share a health condition or social position provide one another with informational, emotional, appraisal and practical assistance, has been proposed as a way of reaching men whom facility-centred services fail to hold. This critical narrative review examines whether the available evidence supports that proposition for West African men, and what a defensible strategic framework would look like. Literature published between January 2000 and 15 July 2026 was identified through PubMed, Europe PMC, PubMed Central, Crossref, the Directory of Open Access Journals, Semantic Scholar and Google Scholar, supplemented by citation tracking and searches of institutional sources. Evidence was appraised for design adequacy, measurement validity, contextual transferability and consistency, and synthesised thematically rather than study by study. Four findings emerge. Peer support produces modest and design-dependent improvements in behavioural and self-management outcomes in cardiometabolic disease, with weaker and less consistent effects on biomedical endpoints. Almost all sub-Saharan African evidence on peer and peer-adjacent models originates outside West Africa, and the West African record is dominated by nurse-led task-shifting and community-based screening rather than by peer-delivered care. Male-targeted delivery in barbershops, sports clubs, occupational groupings and faith settings is promising but has been tested overwhelmingly in high-income or Eastern and Southern African contexts. Sex-disaggregated outcome reporting is scarce enough that the specific claim that peer support improves outcomes among West African men cannot presently be verified. A four-domain framework covering reach, relational fit, clinical integration and system anchoring is proposed, with each component labelled according to whether it rests on established or hypothesised relationships. Priority research should establish sex-disaggregated cascade data, test male-tailored peer models against nurse-led comparators, and quantify the cost of peer infrastructure within existing primary care platforms.