Challenges for HIV-infected adolescents during transition from paediatric to adult HIV clinics in Africa

Excerpt

In 2017, about 250,000 adolescents aged 15–19 years acquired a new HIV infection (UNICEF 2018). Of the approximately 1.8 million adolescents (10–19 years old) living with HIV/AIDS, 1.5 million (85%) are in sub-Saharan Africa (UNAIDS 2017, 2018; UNICEF 2018). High HIV prevalence and incidence in sub-Saharan Africa exposes increasing numbers of adolescents and young adults to HIV through both perinatal infection and risky behaviours (UNICEF 2018). Before the early 2000s, when antiretroviral treatment (ART) came into common use in Africa, only about half of HIV-infected infants reached their second birthday (Newell et al. 2004). ART reduced the number of deaths caused by AIDS-related illnesses by about 42% between 2010 and 2017 (UNAIDS 2017, 2018). Increasing ART coverage in Africa has made it more likely that perinatally and behaviourally HIV-infected children will reach adulthood, but it has not eliminated the burden; instead, the burden has shifted to adolescents. Now, more than ever, public health must focus on transferring adolescents from paediatric to adult-centred care (Lowenthal et al. 2014), also called health care transition (Gilliam et al. 2011). HIV-infected adolescents are accountable for their disease progression and are left alone with the responsibility for managing their disease and their health (Dahourou et al. 2017). This is an especially vulnerable period because only 50% of HIV-infected adolescents transferred to adult-centred health care settings remain in care a year after transition (Ryscavage et al. 2016). …