The association between diagnosis disclosure and adherence to antiretroviral therapy among adolescents living with HIV in sub-Saharan Africa: a protocol for systematic review and meta-analysis

Introduction: More than eight in ten of the world's 1.65 million adolescents living with human immunodeficiency virus (ALHIV) live in sub-Saharan Africa (SSA). Suboptimal adherence to antiretroviral therapy (ART) and poor viral suppression are reported among ALHIV which may in turn compromise the gains achieved so far. The evidence on whether knowing one's own human immunodeficiency virus (HIV) status and self-disclosure to others benefit adherence to ART or not is inconclusive. This review aims to estimate the association between knowing one's HIV status and self-disclosure on adherence to ART among ALHIV in SSA. Methods: Comprehensive search strings will be used to identify relevant observational studies published in English up to May 2020 in major databases: Excerpta Medica database (EMBASE), PubMed, and Ovid/MEDLINE. To access African studies and also to freely access subscription-based articles, the African Index Medicus (AIM) and the WHO HINARI databases will be searched. The AfroLib database will be searched to access the gray literature of African studies. We will use the COVIDENCE software for title/abstract screening, full-text screening, quality assessment, and data extraction. Two authors will independently screen retrieved articles, and a third author authorized to resolve conflicts will handle disagreements. The Joanna Briggs Institute's (JBI) critical appraisal tools will be used to assess study quality. Appropriate statistical tests will be conducted to quantify the between studies heterogeneity and for the assessment of publication bias. We will check individual study influence analysis and also do subgroup analysis. The STATA version 14.2 will be used for statistical analysis. Discussion: A high-level adherence to ART is required to achieve adequate viral suppression and improve quality of life. Consequently, the evidence on how adherence to ART differs with knowledge of one's own HIV status and self-disclosure may help guide interventions aimed at improving adherence to ART.