From Pediatric to Adult HIV Care: What Works to Keep Adolescents Engaged-A Systematic Review of Transition Strategies

Adolescents living with HIV face unique challenges when transitioning from pediatric to adult care-including stigma, disclosure concerns, and loss of support-that undermine continuity. We systematically searched PubMed, Embase, and Web of Science through August 2025 in accordance with PRISMA 2020. Two reviewers independently screened records and appraised risk of bias using Joanna Briggs Institute (JBI) tools by study design; appraisals informed interpretation but did not determine inclusion. Thirty-two studies met criteria; given heterogeneity, findings were narratively synthesized. Post-transition outcomes were suboptimal: retention often declined to ~70% by two years and viral suppression to roughly two-thirds, below global targets. Older transfer age and minimal gaps between pediatric discharge and adult enrollment were associated with better retention. Structured programs combining early preparation, coordinated handoffs, psychosocial/peer support, and youth-friendly adult services consistently improved engagement (often >90% 12-month retention), though improvements in viral suppression were less uniform. JBI appraisal indicated mostly moderate methodological quality with common risks from confounding and incomplete follow-up, tempering certainty. Purposeful, well-supported transition models are essential to sustain treatment success into adulthood; future work should evaluate scalable delivery and long-term outcomes across diverse settings.