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Abstract
HIV Testing Services Uptake Among Adolescent Girls and Young Women in Sub-Saharan Africa: A Systematic Review and Meta-Analysis
BACKGROUND:
Adolescent girls and young women (AGYW) in sub-Saharan Africa remain disproportionately affected by HIV, yet uptake of HIV testing services (HTS) remains suboptimal. Understanding the effectiveness of different service delivery models is critical to improving access and early diagnosis in this priority population.
AIM:
To estimate the pooled uptake of HIV testing services among AGYW in sub-Saharan Africa and to identify the most effective delivery models.
METHODS:
We conducted a random-effects meta-analysis of seven trial arms and cohorts involving 4,410 participants. Eligible studies included interventions evaluating HTS uptake among AGYW across South Africa, Zambia, Malawi, and Uganda. Delivery models assessed included HIV self-testing, sports-based community programs, integrated clinic services, and standard-of-care approaches.
RESULTS:
Seven studies met the inclusion criteria. The pooled proportion of AGYW completing HIV testing was 0.68 (95% CI: 0.51–0.85), with high between-study heterogeneity. Choice-based HIV self-testing and integrated service delivery models achieved the highest uptake, exceeding 0.92, while sports-based interventions and standard clinic-based models demonstrated comparatively lower coverage. These findings suggest that decentralized and flexible testing approaches significantly improve reach among AGYW.
CONCLUSION:
HIV testing uptake among AGYW in sub-Saharan Africa remains variable but can be substantially improved through innovative delivery models such as self-testing and integrated services. Efforts to scale up these approaches are essential to enhance early diagnosis and linkage to care. However, findings should be interpreted with caution due to limited studies, heterogeneity, and reliance on self-reported outcomes.
KEYWORDS: HIV testing services; adolescent girls; young women; sub-Saharan Africa; HIV self-testing; meta-analysis.
References
Pettifor A, Lippman SA, Kimaru L, Haber N, Mayakayaka Z, Selin A, et al. HIV self-testing among young women in rural South Africa: a randomized controlled trial comparing clinic-based HIV testing to the choice of either clinic testing or HIV self-testing with secondary distribution to peers and partners. EClinicalMedicine. 2020;21:100327.
Kidman R, Waidler J, Palermo T. Uptake of HIV testing among adolescents and associated adolescent-friendly services. BMC Health Serv Res. 2020;20(1):881.
Wilson KS, Mugo C, Katz DA, Manyeki V, Mungwala C, Otiso L, et al. High acceptance and completion of HIV self-testing among diverse populations of young people in Kenya using a community-based distribution strategy. AIDS Behav. 2022;26(3):964-974.
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2026 Christine Muhumuza, Ruth Mpirirwe , Bridget Tamale , Michael Muhoozi