Mark, D., Taing, L., Cluver, L., et al. Journal of the International AIDS Society (May 2017), 20(Suppl 3):21491, doi:10.7448/IAS.20.4.21491.
This commentary discussed the challenges of the transition of HIV care for adolescents living with HIV. This transition entails changing from pediatric- to adult-focused services while increasing self-management responsibilities. Poorly planned transitions can result in poor treatment outcomes. There are few policies with clear definitions, tools, and standard operating procedures to support the transition process. Age of consent laws for testing, care, and treatment and the criminalization of sex work, drug use, and same-sex relationships reduce access to services. At the facility level, it is challenging to implement individualized approaches in low-resource settings. Where protocols exist, they are often ignored due to lack of time and resources, as well as misconceptions that adolescents already possess sufficient knowledge regarding self-care. The authors recommended identifying barriers to transition and addressing them at the community, family, and social levels. There is insufficient evidence for effective transition implementation, which reduces the capacity of governments and programs to prioritize interventions. Governments should adopt adolescent-specific policies and provide guidance on appropriate transitional care, the authors said. HIV services should be tailored to meet the individual needs of adolescents; and transition policies should be enacted at the facility level. It is critical to involve youth in designing appropriate programs, and to conduct community mobilization to enhance linkages and supportive services.