Impact of differentiated service delivery approaches on retention in care, adherence, and viral suppression among adolescents aged 10–19 years living with HIV in eastern and southern Africa: a systematic review

Background Differentiated service delivery (DSD) is increasingly shaping HIV care across eastern and southern Africa, although evidence of its effectiveness among adolescents aged 10–19 living with HIV (ALHIV) remains unclear. We synthesised evidence on DSD effects on retention, adherence, and viral suppression among ALHIV. Methods Following PRISMA 2020 guidelines, we searched six databases (Jan 1, 2010–Mar 14, 2026) for randomised and non-randomised studies. Records were independently screened in Rayyan and extracted using a standardised form. We extracted outcome definitions, age- and sex-effect estimates, assessed risk of bias, and graded evidence certainty using GRADE. Findings Of 3578 records screened, 11 studies in six countries were included (N = 89–3103). Retention (nine studies) was high but varied across settings. In Malawi, Teen Clubs reduced attrition (aOR 0.27 [95% CI 0.16–0.45]). Older adolescents had higher attrition than younger ones (aOR 2.14 [95% CI 1.12–4.11]). Sex-disaggregated retention in three studies showed no difference. Adherence (four studies) varied: in Uganda, a psychosocial intervention improved adherence (visit 4: OR 2.69 [95% CI 1.32–5.50]; p=0.0070), while Teen Clubs in Namibia and family-centred care in Eswatini reported no difference. Viral outcomes (eight studies) were heterogeneous; virological failure decreased in Zimbabwe (aPR 0.58 [95% CI 0.36–0.94]), and suppression rose with Malawi Teen Clubs (72/80 [90%] vs. 44/79 [56%]; p=0.0010). Interpretation Evidence on DSD impact among ALHIV is limited and of low certainty. Research using standardised, age- and sex-disaggregated outcomes is needed. Funding Directorate–General for Development Cooperation and Humanitarian Aid (DGD), Belgium.