- Design
- Systematic review and random-effects meta-analysis of 37 studies in 13 countries
- Population
- Adolescents and young adults with HIV in sub-Saharan Africa
- Primary outcome
- Proportions aware of status, on ART and virally suppressed (UNAIDS 95-95-95)
- Effect
- 73% (95% CI 65 to 81), 84% (77 to 91), 71% (64 to 79)
This systematic review and meta-analysis pooled 37 studies from 13 sub-Saharan African countries, published 2015 to 2025, reporting at least one of the three UNAIDS 95-95-95 targets in adolescents and young adults. Risk of bias was assessed with an adapted Joanna Briggs tool.
Across all adolescents and young adults the pooled cascade was 73% aware of status (95% CI 65 to 81), 84% of those diagnosed on antiretroviral therapy (77 to 91) and 71% of those on therapy virally suppressed (64 to 79). For ages 15 to 24 it was 73%, 83% and 82%.
Gaps persist at each step, and the authors call for services that support earlier diagnosis, linkage and long-term engagement. Only 40% of studies reported all three steps and definitions varied, which limits comparison.
The data come from African settings; the Indian adolescent cascade differs, but the lesson about the diagnosis step carries over.
- Viral suppression among young people on therapy (71%) lagged the diagnosis and treatment steps.
- Offer HIV testing to adolescents with risk exposure rather than waiting for symptoms.
- Monitor viral load in young patients on therapy and explore adherence barriers early.
- Use consistent definitions when reporting cascade data in your service.
Why it matters
It shows where programmes lose young people along the cascade.
Don't overread it
Pooled estimates from heterogeneous studies in sub-Saharan Africa do not describe Indian services.
The statistics, in plain English
The confidence intervals are wide (for example 64 to 79% for suppression) because the studies differ in setting and methods. The pooled figures are a general picture, not a measure for any one country or clinic.
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