Adolescents Living with HIV: Building Policy and Programmatic Evidence for Transitional Care Services

Background: WHO estimates 2.2 million adolescents are living with HIV (ALHIV) and 36% of perinatally infected children are entering adolescence in sub-Saharan Africa (SSA), even without access to ART (Ferrand et al. 2010). Transition into adulthood results in unique healthcare needs which are further complicated by HIV. A survey among providers combined with a detailed analysis of ALHIV policies and programs was completed to identify the needs of transitioning ALHIV.

Methods:  AIDSTAR-One conducted 40 in-depth interviews with PEPFAR and UNICEF in 10 SSA countries, and 29 online surveys with ALHIV service providers. A review of the white and grey literature was also conducted to gather transition-specific policy and practice information.

Results: Interviewees identified the need to create adolescent-specific HIV policies and services, emphasizing improving access to HIV testing. Current transition activities are small-scale and uncoordinated. The inconsistent definition of “adolescent” among countries results in lack of reporting among this demographic, resulting in a dearth of evidence-based programs and policies. ALHIV typically access services in pediatric or adult care, with little focus on the transition process.

Conclusions: This research demonstrates global commitment to prioritize ALHIV. At program level, addressing barriers to HIV testing, care, and treatment is critical.  Integrating psychosocial and clinical care and allowing ALHIV to lead their transition planning promotes holistic and individualized transitions.  At policy level, disaggregated data collection, reinforcing healthcare training, and adolescent clinical specialization is critical.  Multi-sectoral partnerships among civil society and donor governments will provide efficient and coordinated approaches to improve transition services for ALHIV.