HIV / STI
Characterizing the HIV care continuum among children and adolescents (<18 years old) with HIV in Eastern and Southern Africa in the era of “Treat All”: A systematic review and meta-analysis Nel Jason Haw* Nel Jason Haw Marcela Banegas Sita Lujintanon Allison Agwu Catherine Lesko Derek Ng
Background: The “Treat All” era for antiretroviral treatment (ART) increased HIV service delivery to children and adolescents (<18 years-old) with HIV (CAHIV). The goal is to reach ≥95% of people with HIV diagnosed, receiving ART, and virally suppressed. Data are limited for CAHIV. We conducted a systematic review and meta-analysis to describe the HIV care continuum among CAHIV during the “Treat All” era living in the UNAIDS Eastern and Southern African region, where two-thirds of CAHIV reside globally.
Methods: We searched PubMed, EMBASE, and the African Index Medicus databases for peer-reviewed articles published from 1 January 2010 to 1 June 2023. We included studies reporting ≥1 care continuum proportion among CAHIV in ≥1 country in the study region during the country’s “Treat All” implementation. We extracted the numerator and denominator of the relevant care continuum proportions and pooled proportions using random-effects logistic regression.
Results: Of the 10,279 studies screened, 178 met pre-specified criteria for data extraction. Studies came from 16 countries; many were from South Africa (36) and Ethiopia (30). The most common ages were 10-19 (36) and 0-14 (32). Most studies were conducted in health facilities (150) and were cohort studies with follow-up of ≥6 months (110). The care continuum pooled proportions (95% CI) are as follows: awareness of HIV diagnosis: 52% (43%, 58%); retained in care within 12 months of ART initiation: 57% (47%, 66%); adherent on ART: 73% (68%, 78%); has viral load test after ART initiation: 88% (85%, 90%); and achieved viral load suppression after at least 6 months on ART: 78% (76%, 80%).
Conclusion: During the age of “Treat All,” most children and adolescents with HIV in the Eastern and Southern African region who are diagnosed with HIV initiate ART, but other aspects of the care continuum are low, particularly HIV diagnosis, retention in care, and adherence to ART.
