Transition of adolescents from paediatric to adult HIV care in South Africa: a policy review

Abstract

The successful roll-out and improved delivery of antiretroviral therapy (ART) services has led to paediatric HIV patients surviving to reach adolescence. Adolescents living with HIV (ALHIV) are challenged when transitioning to adult HIV care programmes where they must negotiate new care pathways, changes in healthcare providers and self-manage their chronic condition, in addition to dealing with the psychological and physiological developmental changes of adolescence. The transition process needs to be well guided, to ensure that ALHIV on ART maintain optimal adherence and remain engaged in care. Viral suppression and retention in care are significantly lower for older adolescents (15–19 years) compared to children and younger adolescents under 15 years – coinciding with the post-transition period. Comprehensive and structured transition protocols may have a significant impact on positive health outcomes. In sub-Saharan Africa, there is a dearth of policies and implementation guidelines for ALHIV who are transitioning to adult HIV care. The current review reports on policies and guidelines for transitioning ALHIV to adult HIV care in South Africa. Eight policies were identified, which were developed at global (n = 2), national (n = 2) and provincial levels (n = 1), and guided implementation (n = 3). Current national and provincial policies provide guidance on when to transition a patient clinically to facilitate the switch to adult ART regimens. Although global policies and implementation guidelines emphasise specific and comprehensive care for ALHIV on ART, these are not carried over to national and provincial policies in South Africa. Further development of policies is required to guide comprehensive, adolescent-friendly transition processes for ALHIV on ART in South Africa.