Abstract:
Introduction: The number of adolescents with perinatally or behaviourally acquired HIV is increasing in low-income
countries, and especially in sub-Saharan Africa where HIV prevalence and incidence are the highest. As they survive into
adulthood in the era of antiretroviral therapy, there is a pressing need to transfer them from paediatric to adult care, known
as the transition of care. We conducted a narrative review of recent evidence on their transition outcomes in Africa,
highlighting the specific needs and challenges in these populations and settings, and the different models of care for
transition.
Areas covered: We searched PubMed bibliographic database, HIV conference content, and grey literature from January 2000
to August 2016 with the following keywords: HIV infections AND (adolescents or youth) AND transition AND Africa. All
qualitative and quantitative, experimental and observational studies including HIV-infected patients aged 10–24 years with
information on transition were eligible.
Results: Few data on transition outcomes for HIV-infected adolescents are available from Africa settings. Studies mainly from
Southern and East Africa reported on the barriers to successful transition, highlighting several gaps. These included lack of
adequate infrastructure, staff training and communication between paediatric and adult clinicians as well as the fear of
stigma of adolescents and youth living with HIV. Most countries have no specific national guidelines on when to disclose HIV
status or when and how to transition to adult care. Several models of care adapted to the adolescent transition question
have been implemented in specific settings. These models include teen clinics, peer educators or the use of social media.
However, regardless of the model, services are increasingly overburdened and have insufficient human resources.
Furthermore, very high attrition has been observed among adolescents and youth compared to younger children or older
adults. There is a need to identify sub-groups at higher risk of loss to follow-up for targeted care and peer support.
Expert commentary: Although the available HIV-related data on adolescent transition outcomes are limited, there is
evidence of their increased vulnerability during this period. Standardized data gathering, analysis, and reporting systems
specific to adolescent transition are essential to improve understanding and adolescent outcomes in Africa.