Background: HIV/AIDS remains a major public health problem globally. The majority of people living with HIV are from Sub-Saharan Africa, particularly adolescent girls and young women (AGYW) aged 15-24 years. HIV testing is crucial as it is the gateway to HIV prevention, treatment, and care; therefore this study determined the prevalence and factors associated with self-reported HIV testing among AGYW in Rwanda. Methods: We conducted secondary data analysis on the AGYW using data extracted from the nationally representative population-based 2019/2020 cross-sectional Rwanda Demographic and Health Survey (DHS). We described the characteristics of study participants and determined the prevalence of HIV testing and associated factors using the multivariable logistic regression model. We adjusted all our analyses for unequal sampling probabilities using survey weights. Results: There were a total of 5,732 AGYW, with the majority (57%) aged 15-19 years, 83% were not living with a man, 80% were from rural areas, 29% were from the East region, and 20% had a history of pregnancy. Self-reported HIV testing prevalence was 55.4% (95%CI: 53.7 to 57.0%). The odds of ever having an HIV test were significantly higher for those aged 20-24 years (aOR 2.87, 95%CI: 2.44 to 3.37); with higher education (aOR 2.41, 95%CI:1.48 to 3.93); who were rich (aOR 2.06, 95%CI:1.57 to 2.70); with access to at least one media (aOR 1.64, 95%CI: 1.14 to 2.37); who had ever been pregnant (aOR 16.12, 95%CI: 9.60 to 27.07); who ever had sex (aOR 2.40, 95%CI: 1.96 to 2.95); and those who had comprehensive HIV knowledge (aOR 1.34, 95%CI: 1.17 to 1.54). Conclusions: We report an unmet need for HIV testing among AGYW in Rwanda. We recommend a combination of strategies to optimize access to HIV testing services, especially among the 15-19 years adolescent girls, including facility-based testing, school and community outreach, awareness campaigns on HIV testing, and home-based testing through HIV self-testing.

The Joint United Nations Programme on HIV/AIDS called for the end of the HIV pandemic by 2030 by setting the 95-95-95 HIV cascade targets. This cascade is used to monitor the progress of different populations in different settings. The progress of adolescents and young adults (AYA) living with HIV in sub-Saharan Africa (SSA) toward these targets remains unknown. We propose to conduct a systematic review and meta-analysis to assess the proportion of AYA retained at each step of the HIV care cascade in SSA. Studies published between 2015 to date that reported on the HIV care cascade among AYA in SSA will be included. The following databases will be searched: PubMed/MEDLINE, Embase, Scopus, CINAHL, African Index Medicus (AIM), African Journals Online (AJOL), SABINET African Journals, HINARI (for institutional access to global journals) and University institutional repositories and gray literature sources will be searched. Two reviewers will independently screen titles and abstracts, assess the full texts for eligibility, and extract data. Disagreements will be resolved by consensus and consultation with a third reviewer. The number and proportion of AYA retained in the HIV care cascade from HIV diagnosis, initiation of ART, and viral suppression will be used for the meta-analysis. Random-effect statistical models will be used to estimate the pooled proportion of AYA retained at each step of the cascade. The results will be graphically represented via forest plots. Variability across studies will be assessed via heterogeneity test statistics (I2). This systematic review aims to synthesize current evidence and identify gaps in the treatment cascade. The findings of this meta-analysis provide guidance for designing a framework to improve the care and treatment of AYA living with HIV. PROSPERO registration number CRD42024561024

We conducted a retrospective cohort analysis of routine programmatic data to identify predictors of antiretroviral therapy (ART) initiation, retention in care (RiC), and viral load suppression (VLS) among adolescents and young adults (AYA) aged 10–24 years living with HIV in the Ekurhuleni District, South Africa. Time-to-event outcomes were analysed using Cox proportional hazards regression models. Of the 6667 AYA diagnosed with HIV, 5271 (79.5%) were aged 20–24 years, 5754 (86.8%) were female, and 5430 (81.9%) initiated ART. The median time to ART initiation was 0.0 months (interquartile range [IQR]: 0.00–0.13), indicating that most AYA initiated ART on the same day as HIV diagnosis or within a few days thereafter. Time to ART initiation did not differ significantly across age groups (log-rank χ²(2) = 5.83, p = 0.054). Retention in care was suboptimal, with 56% retained in care at five years. Compared with AYA aged 10–14 years, those aged 15–19 years (adjusted hazard ratio [aHR] = 2.29, 95% confidence interval [CI]: 1.38–3.82; p = 0.001) and 20–24 years (aHR = 2.54, 95% CI: 1.55–4.18; p < 0.001) had a higher hazard of retention in care. AYA who were pregnant at ART initiation also had a higher hazard of retention than those who were not pregnant (aHR = 1.26, 95% CI: 1.13–1.42; p < 0.001). Although 81% of AYA achieved VLS, this proportion remained below the UNAIDS third 95 target of 95% viral suppression among people receiving ART. Compared with AYA aged 10–14 years, those aged 20–24 years had a higher hazard of VLS (aHR = 1.05, 95% CI: 1.03–1.07; p < 0.001). Compared with AYA who initiated ART at World Health Organization (WHO) clinical stage I, those at WHO stage II had a lower hazard of VLS (aHR = 0.76, 95% CI: 0.65–0.89; p = 0.001). These findings highlight the importance of age and clinical and pregnancy-related factors in HIV care outcomes among AYA. Targeted, AYA-centred interventions that support timely ART initiation, sustained engagement in care, and viral suppression are essential to improve treatment outcomes in this population.

Objectives: Tracking the progress of the Joint United Nations Programme on HIV/AIDS (UNAIDS) 95–95–95 targets is essential for evaluating HIV programme performance and improving outcomes across all subpopulations, age groups and geographical settings. We conducted a systematic review and synthesis of the UNAIDS 95–95–95 targets among adolescents and young adults (AYA) living with HIV in sub-Saharan Africa (SSA). Design: The systematic review and meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Data sources: The search was conducted from the following databases: PubMed/MEDLINE, Embase, Scopus, CINAHL, African Index Medicus (AIM) and African Journals Online (AJOL) and grey literature sources. Eligibility criteria: Articles that were published from 2015 to 2025 reported progress on at least one of the 95–95–95 targets were searched. We performed meta-analysis using WHO-defined AYA age bands (10–14, 15–19 and 20–24 years) and supplementary analysis of age bands of the included studies. Data extraction and synthesis: Full-text articles were downloaded from Rayyan software and data extraction was performed independently for each included study. We pooled independent study estimates and calculated 95% CIs intervals using random-effects models. Risk of bias was assessed at individual study level using the adapted Joanna Briggs Institute (JBI) tool. Results: The search yielded 8435 articles, of which 220 were eligible for full‐text screening and 37 were included. The studies originated from 13 (South Africa, Uganda, Botswana, Eswatini, Rwanda, Lesotho, Malawi, Cameroon, Democratic Republic of Congo, Ghana, Nigeria, Tanzania and Zimbabwe) SSA countries. The most reported age range 15–24 years (n=19, 51%). Half (n=18, 49%) of the studies reported one of three cascade outcomes and (n=13, 40%) all three. The progress toward UNAIDS target for all AYAs was 73–84–71, pooled proportion of those aware of their HIV-positive status was 73% (95% CI 65% to 81%), 84% (95% CI 77% to 91%) of diagnosed initiated antiretroviral treatment (ART) and 71% (95% CI 64% to 79%), those on ART achieved viral load suppression. The pooled proportion of HIV-positive diagnosed was 73% (95% CI 63% to 82%), 83% (95% CI 75% to 90%) ART initiated and 82% (95% CI 72% to 92%) viral load suppressed for 15–24 years old. Conclusion: Significant gaps persist throughout the UNAIDS cascade of AYA in SSA. To close these gaps, HIV programmes must prioritise AYA-responsive services that support earlier diagnosis, facilitate linkage and continuity of care and sustain long-term treatment engagement. Standardised definitions aligned with UNAIDS recommendations are essential. PROSPERO registration number: CRD42024561024.