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

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.