OBJECTIVES : The population of adolescent girls and young women (AGYW) (ages 10-29) is notably vulnerable to HIV and have several times more infections than their male peers. This review identifies gaps in knowledge about AGYW in South Africa (SA) and Botswana, including features relevant to viral transmission.

METHODS : Using the PICOS model, multiple databases were searched for papers published from 2014-July 2019 that addressed HIV among AGYW in SA and Botswana. Metanalyses were conducted including forest plots construction, calculation of pooled rates, and subgroup analysis when applicable.

RESULTS : 120 data sources were included for review (110 full-text publications and 10 grey literature sources). HIV infection prevalence among AGYW is 15.7% in SA and 9.5% in Botswana, with higher prevalence in urban (18.0%) vs. rural (15.5%) areas and among is females aged 25-29 (38.0%) vs. those aged 10-24 (12.0%). Countrywide data show an incidence of 4.7/100 person-years in SA and up to 7.2/100 person-years in SA female sex workers. 44% of HIV infected AGYW in SA and Botswana are unaware of their status, resulting in late diagnosis for many. 59% of those who know they are infected receive antiretroviral therapy (ART). 84% of treated females achieve viral suppression. Low adherence to treatment may be one of the barriers for drug effectiveness. Progress toward 90-90-90 targets in Botswana (73%-74%-94%) appears better than that of SA (53%-62%-82%). STDs are very common among HIV-positive AGYW (30%); analysis of HSV-2 prevalence shows that it can affect almost 35% of this subpopulation. A limitation of the study is the overall limited data on HIV-infected AGYW in Botswana.

CONCLUSIONS : Understanding AGYW in SA and Botswana and their role in the HIV infection pathway can allow for the design of more effective ways of reaching them in order to prevent further infections.