Disparities Within the 95-95-95 Cascade in Cameroon: Sub-Population Gaps, Structural Determinants, and Equity-Centred Policy Solutions — A Systematic Review
Abstract:
The UNAIDS 95-95-95 targets must be achieved within all populations and geographies, not merely at national averages. Cameroon’s national cascade data mask profound sub-population disparities that this study systematically characterises. A systematic review of peer-reviewed and grey literature from 2017 to 2023 was conducted following PRISMA 2020 guidelines. Data from 136 included studies were synthesised to quantify cascade performance across key sub-populations: adolescents (10–24 years), men who have sex with men (MSM), female sex workers (FSW), pregnant and breastfeeding women (PBFW), and populations in conflict-affected regions. Structural determinants were identified through thematic synthesis of governance, service delivery, stigma, and legal environment data. Young people aged 15–24 achieved only 20.7% HIV status awareness at CAMPHIA 2017–18 — over 40 percentage points below adult women. ART coverage among MSM and FSW was 0–25% across study sites, while only 13.2% of HIV health centres provided key population-specific services. Adolescents achieved pooled viral load suppression (VLS) of 53.3–67%, some 28 percentage points below the adult average. Young MSM achieved 34% VLS and young FSW 43%. The Stigma Index 2.0 (2024) documented 14.75% care abandonment among PLHIV. The conflict-affected North-West region paradoxically achieved 93.5% adult VLS through intensive differentiated service delivery, while children’s VLS reached only 80%. Cameroon’s sub-population cascade disparities reflect structural exclusions — driven by stigma, criminalisation, inadequate youth-specific care, and VL monitoring deficits — requiring targeted legal, policy, and programmatic interventions.References:
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