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. 2016 Oct 24;1(3):e000004.
doi: 10.1136/bmjgh-2015-000004. eCollection 2016.

Systematic review and meta-analysis of the adolescent HIV continuum of care in South Africa: the Cresting Wave

Brian C Zanoni  1   2 , Moherndran Archary  3   4 , Sarah Buchan  5 , Ingrid T Katz  1   2   6 , Jessica E Haberer  1   2
Affiliations

Systematic review and meta-analysis of the adolescent HIV continuum of care in South Africa: the Cresting Wave

Brian C Zanoni et al. BMJ Glob Health. .

Abstract

Context: South Africa has the most HIV infections of any country in the world, yet little is known about the adolescent continuum of care from HIV diagnosis through viral suppression.

Objective: To determine the adolescent HIV continuum of care in South Africa.

Data sources: We searched PubMed, Google Scholar and online conference proceedings from International AIDS Society (IAS), International AIDS Conference (AIDS) and Conference on Retrovirology and Opportunistic Infections (CROI) from 1 January 2005 to 31 July 2015.

Data extraction: We selected published literature containing South African cohorts and epidemiological data reporting primary data for youth (15-24 years of age) at any stage of the HIV continuum of care (ie, diagnosis, treatment, retention, viral suppression). For the meta-analysis we used six sources for retention in care and nine for viral suppression.

Results: Among the estimated 867 283 HIV-infected youth from 15 to 24 years old in South Africa in 2013, 14% accessed antiretroviral therapy (ART). Of those on therapy, ∼83% were retained in care and 81% were virally suppressed. Overall, we estimate that 10% of HIV-infected youth in South Africa in 2013 were virally suppressed.

Limitations: This analysis relies on published data from large mostly urban South Africa cohorts limiting the generalisability to all adolescents.

Conclusions: Despite a large increase in ART programmes in South Africa that have relatively high retention rates and viral suppression rates among HIV-infected youth, only a small percentage are virally suppressed, largely due to low numbers of adolescents and young adults accessing ART.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Flow diagram of literature reviewed for meta-analysis of retention in care and viral suppression for HIV-infected adolescents and young adults in South Africa published or presented between 1 January 2005 and 31 July 2015.
Figure 2
Figure 2
Systematic review: Perinatally HIV-infected infants in South Africa, total HIV-infected children aged 0–14 and the approaching wave of HIV-infected adolescents expected to enter adult care by 2023.
Figure 3
Figure 3
(A) Meta-analysis retention: Forest plot of the proportion of HIV-infected adolescents and young adults in South Africa retained in care. (B) Meta-analysis viral suppression: Forest plot of the proportion of virally suppressed HIV-infected adolescents and young adults in South Africa.
Figure 4
Figure 4
Estimate of the absolute number of South African HIV-infected adolescents and young adults aged 15–24 completing the HIV continuum of care.
See this image and copyright information in PMC

References

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