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Systematic review and meta-analysis of the adolescent HIV continuum of care in South Africa: the Cresting Wave
  1. Brian C Zanoni1,2,
  2. Moherndran Archary3,4,
  3. Sarah Buchan5,
  4. Ingrid T Katz1,2,6,
  5. Jessica E Haberer1,2
  1. 1Massachusetts General Hospital, Boston, Massachusetts, USA
  2. 2Harvard Medical School, Boston, Massachusetts, USA
  3. 3University of KwaZulu-Natal Nelson Mandela School of Medicine, Durban, South Africa
  4. 4Department of Pediatrics, King Edward Hospital, Durban, South Africa
  5. 5Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
  6. 6Brigham and Women's Hospital, Boston, Massachusetts, USA
  1. Correspondence to Dr Brian C Zanoni; bzanoni{at}


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.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

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  • Handling editor Seye Abimbola

  • Contributors BCZ conceptualised and designed the study, performed the literature review, assisted with the analysis, drafted the initial manuscript, reviewed and revised the manuscript and approved the final manuscript as submitted. SB and JEH carried out the initial analyses, reviewed and revised the manuscript and approved the final manuscript as submitted. MA and ITK provided information on data sources, method design and critically reviewed the manuscript and approved the final manuscript as submitted.

  • Funding BCZ is supported by the National Institute of Health (grant number 5T32AI 052074).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.