HIV care cascade of adolescents and young adults in sub-Saharan Africa: a systematic review and meta-analysis
- 1School of Health Sciences and Public Health, University of Pretoria - Hatfield Campus, Pretoria, South Africa
- 2Department of Student Affairs, University of Pretoria, Pretoria, South Africa
- 3Department of Library Science, University of Pretoria, Pretoria, South Africa
Abstract
Objectives: Tracking the progress of the Joint United Nations Programme on HIV/AIDS (UNAIDS) 95–95–95 targets is essential for evaluating HIV programme performance and improving outcomes across all subpopulations, age groups and geographical settings. We conducted a systematic review and synthesis of the UNAIDS 95–95–95 targets among adolescents and young adults (AYA) living with HIV in sub-Saharan Africa (SSA).
Design: The systematic review and meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist.
Data sources: The search was conducted from the following databases: PubMed/MEDLINE, Embase, Scopus, CINAHL, African Index Medicus (AIM) and African Journals Online (AJOL) and grey literature sources.
Eligibility criteria: Articles that were published from 2015 to 2025 reported progress on at least one of the 95–95–95 targets were searched. We performed meta-analysis using WHO-defined AYA age bands (10–14, 15–19 and 20–24 years) and supplementary analysis of age bands of the included studies.
Data extraction and synthesis: Full-text articles were downloaded from Rayyan software and data extraction was performed independently for each included study. We pooled independent study estimates and calculated 95% CIs intervals using random-effects models. Risk of bias was assessed at individual study level using the adapted Joanna Briggs Institute (JBI) tool.
Results: The search yielded 8435 articles, of which 220 were eligible for full‐text screening and 37 were included. The studies originated from 13 (South Africa, Uganda, Botswana, Eswatini, Rwanda, Lesotho, Malawi, Cameroon, Democratic Republic of Congo, Ghana, Nigeria, Tanzania and Zimbabwe) SSA countries. The most reported age range 15–24 years (n=19, 51%). Half (n=18, 49%) of the studies reported one of three cascade outcomes and (n=13, 40%) all three. The progress toward UNAIDS target for all AYAs was 73–84–71, pooled proportion of those aware of their HIV-positive status was 73% (95% CI 65% to 81%), 84% (95% CI 77% to 91%) of diagnosed initiated antiretroviral treatment (ART) and 71% (95% CI 64% to 79%), those on ART achieved viral load suppression. The pooled proportion of HIV-positive diagnosed was 73% (95% CI 63% to 82%), 83% (95% CI 75% to 90%) ART initiated and 82% (95% CI 72% to 92%) viral load suppressed for 15–24 years old.
Conclusion: Significant gaps persist throughout the UNAIDS cascade of AYA in SSA. To close these gaps, HIV programmes must prioritise AYA-responsive services that support earlier diagnosis, facilitate linkage and continuity of care and sustain long-term treatment engagement. Standardised definitions aligned with UNAIDS recommendations are essential.
PROSPERO registration number: CRD42024561024.
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BibTeX
@article{silinda2026care,
title = {{HIV care cascade of adolescents and young adults in sub-Saharan Africa: a systematic review and meta-analysis}},
author = {Patricia Silinda and Shirley Baloyi and Kuhlula Maluleke and Estelle Grobler and Clarence Yah and Alfred Musekiwa},
journal = {BMJ Open},
year = {2026},
month = oct,
doi = {10.1136/bmjopen-2025-107159},
url = {https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2025-107159},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - HIV care cascade of adolescents and young adults in sub-Saharan Africa: a systematic review and meta-analysis
AU - Patricia Silinda
AU - Shirley Baloyi
AU - Kuhlula Maluleke
AU - Estelle Grobler
AU - Clarence Yah
AU - Alfred Musekiwa
PY - 2026
DA - 2026/10/07
JO - BMJ Open
DO - 10.1136/bmjopen-2025-107159
UR - https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2025-107159
AB - Objectives: Tracking the progress of the Joint United Nations Programme on HIV/AIDS (UNAIDS) 95–95–95 targets is essential for evaluating HIV programme performance and improving outcomes across all subpopulations, age groups and geographical settings. We conducted a systematic review and synthesis of the UNAIDS 95–95–95 targets among adolescents and young adults (AYA) living with HIV in sub-Saharan Africa (SSA). Design: The systematic review and meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Data sources: The search was conducted from the following databases: PubMed/MEDLINE, Embase, Scopus, CINAHL, African Index Medicus (AIM) and African Journals Online (AJOL) and grey literature sources. Eligibility criteria: Articles that were published from 2015 to 2025 reported progress on at least one of the 95–95–95 targets were searched. We performed meta-analysis using WHO-defined AYA age bands (10–14, 15–19 and 20–24 years) and supplementary analysis of age bands of the included studies. Data extraction and synthesis: Full-text articles were downloaded from Rayyan software and data extraction was performed independently for each included study. We pooled independent study estimates and calculated 95% CIs intervals using random-effects models. Risk of bias was assessed at individual study level using the adapted Joanna Briggs Institute (JBI) tool. Results: The search yielded 8435 articles, of which 220 were eligible for full‐text screening and 37 were included. The studies originated from 13 (South Africa, Uganda, Botswana, Eswatini, Rwanda, Lesotho, Malawi, Cameroon, Democratic Republic of Congo, Ghana, Nigeria, Tanzania and Zimbabwe) SSA countries. The most reported age range 15–24 years (n=19, 51%). Half (n=18, 49%) of the studies reported one of three cascade outcomes and (n=13, 40%) all three. The progress toward UNAIDS target for all AYAs was 73–84–71, pooled proportion of those aware of their HIV-positive status was 73% (95% CI 65% to 81%), 84% (95% CI 77% to 91%) of diagnosed initiated antiretroviral treatment (ART) and 71% (95% CI 64% to 79%), those on ART achieved viral load suppression. The pooled proportion of HIV-positive diagnosed was 73% (95% CI 63% to 82%), 83% (95% CI 75% to 90%) ART initiated and 82% (95% CI 72% to 92%) viral load suppressed for 15–24 years old. Conclusion: Significant gaps persist throughout the UNAIDS cascade of AYA in SSA. To close these gaps, HIV programmes must prioritise AYA-responsive services that support earlier diagnosis, facilitate linkage and continuity of care and sustain long-term treatment engagement. Standardised definitions aligned with UNAIDS recommendations are essential. PROSPERO registration number: CRD42024561024.
SN - 2044-6055
SN - 2044-6055
ER -