A systematic review of unintended pregnancy among adolescents living with HIV in Africa

Clinical Snapshot

Key Findings

• P Value: Not reported

• Effect Size: Prevalence ranged from 18.8% (South Africa) to 60.0% and 73.9% (Kenya) across three included studies; no pooled estimate calculated

• Primary Outcome: Prevalence of unintended pregnancy among adolescents living with HIV in Africa

• Nnt Or Sensitivity: Not applicable; no NNT, sensitivity/specificity, or hazard ratio calculable from available data. The wide prevalence range (18.8%–73.9%) across three studies precludes meaningful summary statistics without individual patient data.

• Confidence Interval: Not reported for any individual study estimate

Clinical Application

The review's primary clinical implication — integrating sexual and reproductive health (SRH) services into HIV care programmes — is feasible and aligns with existing WHO and UNAIDS recommendations. However, the evidence base is too thin to support specific programmatic decisions about intervention type, intensity, or resource allocation. Implementation would require context-specific needs assessments. Direct applicability to Australian clinical practice is very limited. Australia's HIV epidemiology among adolescents differs substantially from sub-Saharan Africa in prevalence, transmission routes, and healthcare access. However, the findings are relevant to: (1) Australian clinicians and NGOs working in global health partnerships with African health systems; (2) RACGP and ASHM guidance on culturally safe SRH care for newly arrived African-background adolescents in Australia who may be living with HIV; (3) TGA-approved contraceptive options and PBS-listed ART regimens that may interact (e.g., enzyme-inducing ARTs reducing hormonal contraceptive efficacy — a consideration not addressed in this review). The RACGP Red Book recommends opportunistic SRH screening for all adolescents, which would apply to ALHIV in Australian primary care settings. Adolescent females (aged 10–19 years) living with HIV attending HIV care and treatment services in sub-Saharan Africa, particularly in Eastern and Southern African settings. Most directly applicable to clinic-based populations in Kenya and South Africa where included studies were conducted.

Abstract

Adolescent pregnancy remains a significant public health concern across Africa, with Eastern and Southern regions experiencing the highest burden. Among adolescents living with HIV(ALHIV), the challenge is intensified by socio-economic, cultural, and healthcare factors that increase vulnerability to unintended pregnancy. This systematic review examined the prevalence of unplanned pregnancy and associated factors among adolescents living with HIV in Africa. Following PRISMA guidelines and registered in PROSPERO (CRD42024564479), a search of Medline, EMBASE, and CINAHL identified relevant studies published between 2011 and 2023. Of the 550 retrieved articles, only three met the inclusion criteria. Reported prevalence rates varied widely, ranging from 18.8% in South Africa to 60.0% and 73.9% in Kenya, indicating a substantial and uneven burden across settings. Factors associated with unintended pregnancy included involvement with boyfriends or acquaintances rather than spouses, reflecting limited agency and structural vulnerabilities. Documented adverse outcomes included miscarriage, stillbirth, and abortion, although one study did not specify outcomes. Overall, the review highlights persistently high rates of unplanned pregnancy among adolescents living with HIV and underscores the need to integrate sexual and reproductive health services into HIV care, address stigma, and strengthen context-specific interventions. Les grossesses adolescentes demeurent un problème majeur de santé publique en Afrique, les régions de l'Est et du Sud étant les plus touchées. Chez les adolescentes vivant avec le VIH (AVVIH), ce défi est exacerbé par des facteurs socio-économiques, culturels et liés aux soins de santé qui accroissent leur vulnérabilité aux grossesses non désirées. Cette revue systématique a examiné la prévalence des grossesses non planifiées et les facteurs associés chez les adolescentes vivant avec le VIH en Afrique. Conformément aux directives PRISMA et enregistrée dans PROSPERO (CRD42024564479), une recherche dans Medline, EMBASE et CINAHL a permis d'identifier les études pertinentes publiées entre 2011 et 2023. Sur les 550 articles recensés, seuls trois répondaient aux critères d'inclusion. Les taux de prévalence rapportés variaient considérablement, allant de 18,8 % en Afrique du Sud à 60,0 % et 73,9 % au Kenya, ce qui témoigne d'une prévalence importante et inégale selon les contextes. Parmi les facteurs associés aux grossesses non désirées figurait le fait d'avoir des relations avec des petits amis ou des connaissances plutôt qu'avec des conjoints, reflétant un manque d'autonomie et des vulnérabilités structurelles. Les issues défavorables documentées incluaient les fausses couches, les mortinaissances et les avortements, bien qu'une étude n'ait pas précisé ces issues. Globalement, cette analyse met en évidence des taux toujours élevés de grossesses non désirées chez les adolescentes vivant avec le VIH et souligne la nécessité d'intégrer les services de santé sexuelle et reproductive aux soins du VIH, de lutter contre la stigmatisation et de renforcer les interventions adaptées au contexte.

References

1. 1.Hope, M., Lwigale, F., Tumwine, C., Kiggundu, R., Mwanja, H., & Nartey, E. (2026). A systematic review of unintended pregnancy among adolescents living with HIV in Africa. African Journal of Reproductive Health. https://doi.org/10.29063/ajrh2026/v30i12.11