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We synthesized evidence from qualitative studies on factors that promote or undermine engagement with HIV services among adolescents living with HIV in sub\u2010Saharan Africa.<\/jats:p><jats:p><jats:bold>Methods<\/jats:bold>: We systematically searched five databases for studies published between 2005 and 2016 that met pre\u2010defined inclusion criteria. We used a meta\u2010ethnographic approach to identify first, second and third order constructs from eligible studies, and applied a socio\u2010ecological framework to situate our results across different levels of influence, and in relation to each stage of the HIV cascade.<\/jats:p><jats:p><jats:bold>Results and discussion<\/jats:bold>: We identified 3089 citations, of which 24 articles were eligible for inclusion. Of these, 17 were from Southern Africa while 11 were from Eastern Africa. 6 explored issues related to HIV testing, 11 explored treatment adherence, and 7 covered multiple stages of the cascade. Twelve third\u2010order constructs emerged to explain adolescents' engagement in HIV care. Stigma was the most salient factor impeding adolescents' interactions with HIV care over the past decade. Self\u2010efficacy to adapt to life with HIV and support from family or social networks were critical enablers supporting uptake and retention in HIV care and treatment programmes. Provision of adolescent\u2010friendly services and health systems issues, such as the availability of efficient, confidential and comfortable services, were also reported to drive sustained care engagement. Individual\u2010level factors, including past illness experiences, identifying mechanisms to manage pill\u2010taking in social situations, financial (in)stability and the presence\/absence of future aspirations also shaped adolescents HIV care engagement.<\/jats:p><jats:p><jats:bold>Conclusions<\/jats:bold>: Adolescents' initial and ongoing use of HIV care was frequently undermined by individual\u2010level issues; although family, community and health systems factors played important roles. Interventions should prioritise addressing psychosocial issues among adolescents to promote individual\u2010level engagement with HIV care, and ultimately reduce mortality. Further research should explore issues relating to care linkage and ART initiation in different settings, particularly as \u201ctest and treat\u201d policies are scaled up.<\/jats:p>","DOI":"10.7448\/ias.20.1.21922","type":"journal-article","created":{"date-parts":[[2017,9,26]],"date-time":"2017-09-26T13:49:54Z","timestamp":1506433794000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":37,"title":["Scaling a waterfall: a meta\u2010ethnography of adolescent progression through the stages of HIV care in sub\u2010Saharan Africa"],"prefix":"10.1002","volume":"20","author":[{"given":"Shannon","family":"Williams","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenny","family":"Renju","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ludovica","family":"Ghilardi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alison","family":"Wringe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,9,15]]},"reference":[{"key":"e_1_2_9_2_1","unstructured":"UNICEF.For every child end AIDS \u2013 seventh stocktaking report.New York;2016."},{"key":"e_1_2_9_3_1","volume-title":"|Joint United Nations Programme on HIV\/AIDS. 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