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We conducted a systematic review and meta-analysis quantifying under-reporting of known HIV-positive status using objective knowledge proxies. Databases were searched for studies providing self-reported and biological\/clinical markers of prior knowledge of HIV-positive status among PLHIV. Random-effects models were used to derive pooled estimates of levels of under-reporting. Thirty-two estimates from 26 studies were included (41,465 PLHIV). The pooled proportion under-reporting known HIV-positive status was 20% (95% confidence interval 13\u201326%, I\n                    <jats:sup>2<\/jats:sup>\n                    \u2009=\u200999%). In sub-group analysis, under-reporting was higher among men who have sex with men (32%, number of estimates [N\n                    <jats:sub>e<\/jats:sub>\n                    ]\u2009=\u200910) compared to the general population (9%, N\n                    <jats:sub>e<\/jats:sub>\n                    \u2009=\u200910) and among Black (18%, N\n                    <jats:sub>e<\/jats:sub>\n                    \u2009=\u20095) than non-Black (3%, N\n                    <jats:sub>e<\/jats:sub>\n                    \u2009=\u20093) individuals. Supplementing self-reported data with biological\/clinical proxies may improve the validity of the \u2018first 90\u2019 estimates.\n                  <\/jats:p>","DOI":"10.1007\/s10461-021-03310-z","type":"journal-article","created":{"date-parts":[[2021,5,27]],"date-time":"2021-05-27T21:02:56Z","timestamp":1622149376000},"page":"3858-3870","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Under-Reporting of Known HIV-Positive Status Among People Living with HIV: A Systematic Review and Meta-analysis"],"prefix":"10.1007","volume":"25","author":[{"given":"Nirali","family":"Soni","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katia","family":"Gigu\u00e8re","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie-Claude","family":"Boily","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica M.","family":"Fogel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathieu","family":"Maheu-Giroux","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dobromir","family":"Dimitrov","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan H.","family":"Eshleman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7050-4787","authenticated-orcid":false,"given":"Kate M.","family":"Mitchell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,5,28]]},"reference":[{"key":"3310_CR1","unstructured":"WHO. 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