@article{fdi:010090145,
  title = {{T}rends in {HIV} testing, the treatment cascade, and {HIV} incidence among men who have sex with men in {A}frica : a systematic review and meta-analysis},
  author = {{S}tannah, {J}. and {S}oni, {N}. and {L}am, {J}. {K}. {S}. and {G}iguere, {K}. and {M}itchell, {K}. {M}. and {K}ronfli, {N}. and {L}armarange, {J}oseph and {M}oh, {R}. and {N}ouaman, {M}. and {K}ouame, {G}. {M}. and {B}oily, {M}. {C}. and {M}aheu-{G}iroux, {M}.},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground {G}ay, bisexual, and other men who have sex with men ({MSM}) are disproportionately affected by {HIV}. {I}n {A}frica, {MSM} face structural barriers to {HIV} prevention and treatment that increase their vulnerability to {HIV} acquisition and transmission, and undermine the {HIV} response. {I}n this systematic review, we aimed to explore progress towards increases in {HIV} testing, improving engagement in the {HIV} treatment cascade, and {HIV} incidence reductions among {MSM} in {A}frica. {M}ethods {W}e searched {E}mbase, {MEDLINE}, {G}lobal {H}ealth, {S}copus, and {W}eb of {S}cience for cross-sectional and longitudinal studies reporting {HIV} testing, knowledge of status, care, antiretroviral therapy ({ART}) use, viral suppression, and {HIV} incidence among {MSM} in {A}frica published between {J}an 1, 1980, and {M}arch 3, 2023. {W}e pooled surveys using {B}ayesian generalised linear mixed-effects models, used meta-regression to assess time trends, and compared {HIV} incidence estimates among {MSM} with those of all men. {F}indings {O}f 9278 articles identified, we included 152 unique studies published in 2005-23. {I}n 2020, we estimate that 73% (95% credible interval [{C}r{I}] 62-87) of {MSM} had ever tested for {HIV}. {HIV} testing in the past 12 months increased over time in central, western, eastern, and southern {A}frica (odds ratio per year [{OR}year] 1·23, 95% {C}r{I} 1·01-1·51, n=46) and in 2020 an estimated 82% (70-91) had tested in the past 12 months, but only 51% (30-72) of {MSM} living with {HIV} knew their {HIV} status. {C}urrent {ART} use increased over time in central and western ({OR}year 1·41, 1·08-1·93, n=9) and eastern and southern {A}frica ({OR}year 1·37, 1·04-1·84, n=17). {W}e estimated that, in 2020, 73% (47-88) of all {MSM} living with {HIV} in {A}frica were currently on {ART}. {N}evertheless, we did not find strong evidence to suggest that viral suppression increased, with only 69% (38-89) of {MSM} living with {HIV} estimated to be virally suppressed in 2020. {W}efound insufficient evidence of a decrease in {HIV} incidence over time (incidence ratio per year 0·96, 95% {C}r{I} 0·63-1·50, n=39), and {HIV} incidence remained high in 2020 (6·9 per 100 person-years, 95% {C}r{I} 3·1-27·6) and substantially higher (27-199 times higher) than among all men. {I}nterpretation {HIV} incidence remains high, and might not be decreasing among {MSM} in {A}frica over time, despite some increases in {HIV} testing and {ART} use. {A}chieving the {UNAIDS} 95-95-95 targets for diagnosis, treatment, and viral suppression equitably for all requires renewed focus on this key population. {C}ombination interventions for {MSM} are urgently required to reduce disparities in {HIV} incidence and tackle the social, structural, and behavioural factors that make {MSM} vulnerable to {HIV} acquisition.},
  keywords = {{AFRIQUE}},
  booktitle = {},
  journal = {{L}ancet {H}iv},
  volume = {10},
  numero = {8},
  pages = {528--542},
  ISSN = {2352-3018},
  year = {2023},
  DOI = {10.1016/s2352-3018(23)00111-x},
  URL = {https://www.documentation.ird.fr/hor/fdi:010090145},
}