Effects of transition from paediatric to adult <scp>HIV</scp> care on virological outcomes in sub‐Saharan Africa: A systematic review and meta‐analysis

Abstract

Abstract Background HIV remains a major global burden, with 2.4 million children and adolescents affected, 84% living in sub‐Saharan Africa. As adolescents age, transitioning from paediatric to adult HIV care represents a critical period that may significantly affect antiretroviral therapy (ART) adherence, retention in care and virological suppression. A systematic evaluation of evidence from sub‐Saharan Africa is essential to quantify the effects of healthcare transition on virological outcomes, especially viral suppression. Methods We systematically searched three electronic databases: PubMed, Scopus and Embase for studies published between January 1, 2015, and March 5, 2025, using keywords HIV, adolescents, transition to adult care and virological outcome. A narrative synthesis was used to summarize the findings, and meta‐analyses were conducted using random‐effects models to estimate pooled proportions with corresponding 95% confidence intervals. Heterogeneity between studies was quantified using the I 2 statistic, and potential sources of variability were explored through subgroup analyses based on study characteristics. The risk of bias for the included studies was assessed according to the study design using the Newcastle–Ottawa Scale. This review was registered with PROSPERO (CRD420251005361). Results The systematic search identified 1324 articles, of which 8 met the predefined inclusion criteria and were included in the final analysis. These studies consisted of 13 819 adolescents and young adults aged between 10 and 26 years. The pooled proportions of viral suppression were 75% (95% confidence interval [CI]: 68%–81%, I 2 : 89.2%, p &lt; 0.0001) before transition and 67% (95% CI: 44%–84%, I 2 : 95.7%, p &lt; 0.0001) after transition. Conclusion There is a decline in viral suppression following the transition from paediatric to adult HIV care in sub‐Saharan Africa, indicating the need for targeted strategies to sustain suppression post‐transition. Future large‐scale longitudinal studies should use standardized transition age definitions, consistent follow‐up durations and uniform virological suppression thresholds to ensure robust and comparable evidence.