Adolescent transition among young people with perinatal HIV in high-income and low-income settings

To summarize evidence for health outcomes among adolescents and young people living with HIV (AYLHIV) who have transitioned to adult care/adulthood, views of AYLHIV and providers on the transition process, and the effect of adolescent and youth friendly services (AYFS) on outcomes.

A total of 43 studies were identified [n = 13 high-income countries (HICs), n = 30 low-/middle-income countries (LMICs)]. In HICs, around 75% of patients were retained in care at approximately 4 years posttransition. In LMICs, retention worsened from older adolescence into young adulthood. Across both contexts, comparisons of mortality, immunological, and virological outcomes were hampered by a limited number of studies and/or different definitions and study durations. AYLHIV and providers reported several factors that could aid transition and AYFS had generally positive outcomes.

Overall, outcomes varied by study and context; direct comparison was severely hampered by the inclusion of different populations of AYLHIV (sometimes with small numbers and a lack of comparison groups), the use of different outcome definitions, varying follow-up duration, and the lack of a specific transition process in LMICs. Future studies need to consider harmonizing definitions and implementing unique patient identifiers, and data linkage techniques to improve the evidence base on long-term outcomes.