Health services' responses to transitioning adolescents to adult HIV care in South Africa

Abstract

BACKGROUND: Adolescents living with human immunodeficiency virus (HIV) aged 10-19 years account for 1.7 million globally, with 82% residing in sub-Saharan Africa. Older adolescents (15-19 years) assume greater responsibility for their own care, often leading to reduced adherence, lower retention, and poorer health outcomes. Understanding the role of healthcare workers (HCWs), key stakeholders in the HIV care continuum, is essential to strengthening transition practices and health system responses. AIM: To describe HCWs' perspectives on transition practices for adolescents living with HIV in the Cape Town Metropole, South Africa. SETTING: Six public primary health facilities in the Cape Town Metropole, South Africa. METHODS: A descriptive qualitative design was used. Data were collected through in-depth, semi-structured interviews with 16 HCWs and analysed thematically. RESULTS: Healthcare workers identified challenges to optimal transition (theme 1), including delayed disclosure, low adolescent readiness, and inconsistent transition processes. Health service responses (theme 2), such as youth clubs and provider-adolescent relationships, were supportive but unevenly applied. Gaps and recommendations (theme 3) included improving youth club management and ensuring system-wide support to enhance engagement and continuity of care. CONCLUSION: Successful transition to adult HIV care requires structural and psychosocial support mechanisms. Healthcare workers play a critical role and should be supported to consistently implement adolescent-friendly services during and post-transition. CONTRIBUTION: This study offers system-level insights to inform policy, HCW training, and integrated models of care tailored to adolescents living with HIV in primary health settings in South Africa.