Tracking progress toward the UNAIDS 95‑95‑95 targets is essential for evaluating HIV programme performance across subpopulations, age groups and settings. This review aimed to synthesise published evidence on progress toward the three UNAIDS cascade targets among adolescents and young adults (AYA) living with HIV in sub‑Saharan Africa (SSA). The focus was on quantifying the proportions aware of HIV status, initiating antiretroviral treatment (ART) among those diagnosed, and achieving viral load suppression among those on ART.
This systematic review and meta‑analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‑Analyses (PRISMA) checklist. The authors searched multiple bibliographic and regional databases, supplemented by grey literature, to identify studies reporting progress on at least one of the UNAIDS 95‑95‑95 cascade outcomes published between 2015 and 2025.
Databases searched included PubMed/MEDLINE, Embase, Scopus, CINAHL, African Index Medicus (AIM) and African Journals Online (AJOL), in addition to grey literature sources. Eligible articles were those published from 2015 to 2025 that reported progress on one or more of the three UNAIDS targets among AYA. The review used WHO‑defined AYA age bands (10–14, 15–19, 20–24 years) for primary meta‑analysis and performed supplementary analyses using the age bands reported in individual studies.
Full‑text articles were managed and screened using Rayyan software. Data extraction was performed independently for each included study. Independent study estimates were pooled using random‑effects models and 95% confidence intervals were calculated for pooled proportions. Risk of bias was assessed at the individual study level using an adapted Joanna Briggs Institute (JBI) tool.
The search identified 8,435 records. After screening, 220 full texts were assessed for eligibility and 37 studies met inclusion criteria. Included studies originated from 13 SSA countries: South Africa, Uganda, Botswana, Eswatini, Rwanda, Lesotho, Malawi, Cameroon, Democratic Republic of Congo, Ghana, Nigeria, Tanzania and Zimbabwe. The most commonly reported age range among studies was 15–24 years (19 studies, 51%). Approximately half of the included studies (18, 49%) reported only one cascade outcome, while 13 studies (40%) reported all three cascade outcomes.
Across the included studies, pooled proportions for all adolescents and young adults combined were:
These pooled estimates represent aggregated progress along the UNAIDS cascade for the AYA population in SSA as captured by the included studies.
When using the 15–24 year age band—reported by a substantial subset of studies—the pooled cascade proportions were:
The source reports these pooled proportions specifically for the 15–24 year group; details for the 10–14 and 20–24 bands were addressed through WHO band analyses and supplementary study age bands as available in the included studies.
The synthesis indicates that meaningful gaps remain across the UNAIDS cascade for AYA in SSA. Although initiation of ART among those diagnosed appears relatively high in pooled estimates, awareness of HIV‑positive status and viral load suppression among those on treatment remain below the 95% targets. The review authors conclude that closing these gaps will require HIV programmes to prioritise AYA‑responsive services that support earlier diagnosis, facilitate linkage and continuity of care, and sustain long‑term treatment engagement.
The review also highlights the importance of using standardised definitions aligned with UNAIDS recommendations to improve comparability across studies and to more accurately monitor progress for this age group.
Significant gaps persist throughout the UNAIDS cascade for adolescents and young adults living with HIV in sub‑Saharan Africa. The authors recommend prioritising services tailored to AYA needs to improve diagnosis, linkage, retention and sustained viral suppression. The review is registered on PROSPERO with registration number CRD42024561024.