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TropicalMed
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Adolescent HIV Care and Transition Strategies: Challenges, Outcomes, and Interventions
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Adolescent HIV Care and Transition Strategies: Challenges, Outcomes, and Interventions

A special issue of Tropical Medicine and Infectious Disease (ISSN 2414-6366). This special issue belongs to the section "Infectious Diseases".

Deadline for manuscript submissions: 30 September 2025 | Viewed by 8552

Special Issue Editor

Dr. Brian C. Zanoni

E-Mail Website
Guest Editor
Department of Pediatrics, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA 30322, USA
Interests: adolescent HIV; transition care; retention in care; interventions; care continuum; mHealth

Special Issue Information

Dear Colleagues,

As of 2019, there were more than 5.1 million adolescents and young adults (AYAs) ages 15 to 24 years living with HIV globally.  Despite advances in treatment, including simpler regimens with fewer side effects, AYAs continue to have poor outcomes regarding adherence to medication, engagement in care, and viral suppression. Although this is a diverse population including adolescents with perinatally acquired HIV and non-perinatally acquired HIV, both groups continue to have high rates of morbidity and mortality compared to other age groups. The period of transition to adult care is an especially vulnerable time for AYAs with HIV, resulting in high rates of disengagement in care. Structured interventions to support transition to adult HIV care are critical to ensure engagement in care beyond adolescence. Technological advances in mobile health, long-acting injectable medication, and artificial intelligence offer potential solutions to the barriers facing AYAs during this vulnerable period. Given this background, this targeted Special Issue seeks to identify high-impact original research and review articles highlighting the challenges, solutions, outcomes, and interventions to improve outcomes among AYAs with HIV.

Dr. Brian C. Zanoni
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • adolescent HIV
  • transitions of care
  • retention in care
  • continuum of care
  • interventions
  • mHealth

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Published Papers (6 papers)

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Research

12 pages, 241 KiB  
Article
Patterns, Barriers and Facilitators of Responsiveness to Text Message Medication Reminders Among Youth Living with HIV in Southwest Nigeria
by Mobolanle Balogun, Aniekan E. Ulor, Mayowa Odofin, Olufunmilola Idowu, Mmeli V. Chukwu, Abiola Aina, Oluwanifemi Adeshina, Hameed Adelabu, Lisa M. Kuhns, Amy K. Johnson, Kehinde M. Kuti, Nadia A. Sam-Agudu, Titilope Badru, Marbella Cervantes, Robert Garofalo, Babafemi Taiwo and Alani S. Akanmu
Trop. Med. Infect. Dis. 2025, 10(5), 137; https://doi.org/10.3390/tropicalmed10050137 - 17 May 2025
Viewed by 678
Abstract
The iCARE Nigeria study is evaluating a daily text message medication reminder intervention (TXTXT) to improve viral suppression and medication adherence among youth living with HIV (YLH), aged 15–24 years. In this sub-study, we evaluated text message responsiveness (text-back) at 24 weeks of [...] Read more.
The iCARE Nigeria study is evaluating a daily text message medication reminder intervention (TXTXT) to improve viral suppression and medication adherence among youth living with HIV (YLH), aged 15–24 years. In this sub-study, we evaluated text message responsiveness (text-back) at 24 weeks of the intervention as an indicator of engagement, as well as barriers and facilitators at one of six clinical study sites. Differences in responses by age group, birth sex, schooling status, education, mode of infection, and weekend/weekday and holiday/non-holiday periods were analyzed using t-test and multiple linear regression. Focus group discussions were conducted among three groups (low, average, and high text message responsiveness) and analyzed using a rapid content analysis approach. Overall, TXTXT responsiveness was 26.5% (4606/17,367); older age (18–24 years) and weekdays (versus weekends) were significantly associated with higher responsiveness. Facilitators included being comfortable receiving personalized text messages. Barriers included a lack of airtime and messages received late. Overall, text-back responsiveness to daily medication adherence messages among YLH was low, better among older participants, and higher on weekdays. Addressing barriers and promoting facilitators may improve responsiveness. Full article
(This article belongs to the Special Issue Adolescent HIV Care and Transition Strategies: Challenges, Outcomes, and Interventions)
17 pages, 2816 KiB  
Article
“I-We-I”: Visualizing Adolescents’ Perceptions and Apprehension to Transition to Adult HIV Care at a Supportive Transition Facility in the Cape Town Metropole, South Africa
by Charné Petinger, Brian van Wyk and Talitha Crowley
Trop. Med. Infect. Dis. 2025, 10(5), 126; https://doi.org/10.3390/tropicalmed10050126 - 6 May 2025
Viewed by 1260
Abstract
Adolescents living with HIV (ALHIV) (10–19 years) make up approximately 4.2% (320,000) of people living with HIV in South Africa. Adolescence is a developmental period characterized by pervasive biological, social and psychological changes, which challenges adherence and retention in care for ALHIV on [...] Read more.
Adolescents living with HIV (ALHIV) (10–19 years) make up approximately 4.2% (320,000) of people living with HIV in South Africa. Adolescence is a developmental period characterized by pervasive biological, social and psychological changes, which challenges adherence and retention in care for ALHIV on antiretroviral therapy (ART). Further, as ALHIV grow “older”, they are expected to transition to the adult HIV treatment programme, where they should assume greater responsibility for managing their chronic condition and healthcare pathway. Whereas it is imperative that ALHIV are transitioned when they are ready, little is known about the challenges and experiences of ALHIV before and during transition. The aim of this paper was to report on the experiences and challenges of transition for ALHIV who received ART at an adolescent-friendly service that is adjunct to a public primary healthcare facility in the Western Cape province of South Africa. Methods: Photovoice methods were employed to explore the transition experiences of ALHIV on ART at a “supportive transition” public health facility in the Cape Town Metro in South Africa. Participants took pictures that depict their experience pre- and during transition to adult care and discussed these in groups with peers. Audio data were digitally recorded and transcribed verbatim and subjected to thematic analysis using Atlas.Ti version 24. Results: The emergent themes described their apprehension to transitioning to adult care; self-management; challenges to adherence; the need for psychosocial support; and how adolescent-friendly services were filling the gap. Conclusions: We illuminate the “I-We-I” configuration, to reflect (the first “I”) individual ALHIV experiences as isolated before being transferred to the supportive facility; how they experience a sense of belonging and family (“we”) in the supportive facility; but face apprehension about transitioning to adult care in the local clinic, where they have to self-manage (final “I”). Full article
(This article belongs to the Special Issue Adolescent HIV Care and Transition Strategies: Challenges, Outcomes, and Interventions)
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24 pages, 1536 KiB  
Article
The Effect of a Life-Stage Based Intervention on Depression in Youth Living with HIV in Kenya and Uganda: Results from the SEARCH-Youth Trial
by Florence Mwangwa, Jason Johnson-Peretz, James Peng, Laura B. Balzer, Janice Litunya, Janet Nakigudde, Douglas Black, Lawrence Owino, Cecilia Akatukwasa, Anjeline Onyango, Fredrick Atwine, Titus O. Arunga, James Ayieko, Moses R. Kamya, Diane Havlir, Carol S. Camlin and Theodore Ruel
Trop. Med. Infect. Dis. 2025, 10(2), 55; https://doi.org/10.3390/tropicalmed10020055 - 14 Feb 2025
Viewed by 1005
Abstract
Depression among adolescents and young adults with HIV affects both their wellbeing and clinical care outcomes. Integrated care models are needed. We hypothesized that the SEARCH-Youth intervention, a life-stage-based care model that improved viral suppression, would reduce depressive symptoms as compared to the [...] Read more.
Depression among adolescents and young adults with HIV affects both their wellbeing and clinical care outcomes. Integrated care models are needed. We hypothesized that the SEARCH-Youth intervention, a life-stage-based care model that improved viral suppression, would reduce depressive symptoms as compared to the standard of care. We conducted a mixed-methods study of youth with HIV aged 15–24 years in SEARCH-Youth, a cluster-randomized trial in rural Uganda and Kenya (NCT03848728). Depression was assessed cross-sectionally with the PHQ-9 screening tool and compared by arm using targeted minimum loss-based estimation. In-depth semi-structured interviews with young participants, family members, and providers were analyzed using a modified framework of select codes pertaining to depression. We surveyed 1,234 participants (median age 21 years, 80% female). Having any depressive symptoms was less common in the intervention arm (53%) compared to the control (73%), representing a 28% risk reduction (risk ratio: 0.72; CI: 0.59–0.89). Predictors of at least mild depression included pressure to have sex, physical threats, and recent major life events. Longitudinal qualitative research among 113 participants found that supportive counseling from providers helped patients build confidence and coping skills. Integrated models of care that address social threats, adverse life events, and social support can be used to reduce depression among adolescents and young adults with HIV. Full article
(This article belongs to the Special Issue Adolescent HIV Care and Transition Strategies: Challenges, Outcomes, and Interventions)
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21 pages, 1136 KiB  
Article
Mapping the Transition of Adolescents to Adult HIV Care: A Mixed-Methods Perspective from the Cape Town Metropole, South Africa
by Charné Petinger, Brian van Wyk and Talitha Crowley
Trop. Med. Infect. Dis. 2025, 10(1), 5; https://doi.org/10.3390/tropicalmed10010005 - 24 Dec 2024
Cited by 3 | Viewed by 1708
Abstract
(1) Background: Globally, an estimated 1.7 million adolescents (aged 10–19 years) were living with HIV in 2023, with 82% residing in sub-Saharan Africa. For ALHIV, transitioning to adult care involves assuming responsibility for their own health and disease management, posing significant challenges to [...] Read more.
(1) Background: Globally, an estimated 1.7 million adolescents (aged 10–19 years) were living with HIV in 2023, with 82% residing in sub-Saharan Africa. For ALHIV, transitioning to adult care involves assuming responsibility for their own health and disease management, posing significant challenges to persistent engagement in care. There is a paucity in health policies guiding this transition in many sub-Saharan African countries. Overburdened and poorly functioning health systems struggle to provide optimal care for ALHIV amidst the rising HIV pandemic in this priority population. (2) Methods: This study employed a mixed-methods design, comprising a descriptive qualitative study with healthcare workers and managers and a cross-sectional survey to examine the practices and pathways in which the transition to adult HIV care occurs in the Cape Town Metropole, South Africa. (3) Results: We delineate three distinct ways in which transition occurs (transfer-only, adolescent-friendly, and supportive transition). A successful transition involves a sufficient level of self-management of their chronic condition and healthcare journey, which is preceded by adequate preparation pre-transition, and the monitoring of engagement post-transition. This ideally requires developing relevant health policies and implementing guidelines signaling political will and providing the impetus and agency of implementation at the service level in South Africa. Full article
(This article belongs to the Special Issue Adolescent HIV Care and Transition Strategies: Challenges, Outcomes, and Interventions)
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7 pages, 209 KiB  
Article
Transitioning Adolescents to Adult HIV Care in the United States: Implementation Lessons from the iTransition Intervention Pilot Trial
by Amanda E. Tanner, Sulianie Mertus, Mohammed Sheikh Eldin Jibriel, Rakira Urquhart, Keenan Phillips, Nadia Dowshen, Srija Dutta, Madeleine H. Goldstein, Susan Lee, Kayla Knowles, Kaja Darien, Kelly L. Rulison, Julia Madden and Sophia A. Hussen
Trop. Med. Infect. Dis. 2024, 9(12), 297; https://doi.org/10.3390/tropicalmed9120297 - 3 Dec 2024
Cited by 2 | Viewed by 1243
Abstract
Although every youth in pediatric/adolescent HIV care will need to transition to adult-oriented care, there are no existing evidence-based interventions to optimize health through this process. Healthcare transition poses a persistent challenge to the health of youth living with HIV, which may result [...] Read more.
Although every youth in pediatric/adolescent HIV care will need to transition to adult-oriented care, there are no existing evidence-based interventions to optimize health through this process. Healthcare transition poses a persistent challenge to the health of youth living with HIV, which may result in gaps in care engagement, medication adherence, and viral suppression. Our process evaluation of iTransition, a multilevel mobile health (mHealth) intervention, included iterative interviews with youth, providers, and Transition Champions. These data, along with team meeting notes, highlight the important role the intervention plays in addressing healthcare transition-related challenges, positioning it to fill a critical gap for both youth and providers. It also highlights important individual (e.g., competing priorities of youth and providers), clinical (e.g., electronic health record integration), and contextual (e.g., clinical policies during COVID-19 pandemic) challenges to intervention reach and implementation. More work is needed to refine interventions to support care continuity for youth living with HIV as they transition to adult-oriented care. Full article
(This article belongs to the Special Issue Adolescent HIV Care and Transition Strategies: Challenges, Outcomes, and Interventions)
21 pages, 498 KiB  
Article
Mixed Methods Evaluation of a Youth-Friendly Clinic for Young People Living with HIV Transitioning from Pediatric Care
by Hannah Chew, Kemberlee Bonnet, David Schlundt, Nina Hill, Leslie Pierce, Aima Ahonkhai and Neerav Desai
Trop. Med. Infect. Dis. 2024, 9(9), 198; https://doi.org/10.3390/tropicalmed9090198 - 28 Aug 2024
Cited by 4 | Viewed by 1577
Abstract
(1) Background: Adolescents and young adults face challenges when transitioning to adult care due to emerging adulthood and changing providers and insurance. Young people living with HIV (YPLHIV) have additional obstacles with mental health and stigma. During transition, only 55% of YPLHIV are [...] Read more.
(1) Background: Adolescents and young adults face challenges when transitioning to adult care due to emerging adulthood and changing providers and insurance. Young people living with HIV (YPLHIV) have additional obstacles with mental health and stigma. During transition, only 55% of YPLHIV are retained in care, and 65% are virally suppressed. To address these challenges, the Adolescent and Young Adult Health Care Transition Clinic (AYAHCTC) was created at Vanderbilt University Medical Center in 2017. This mixed methods study evaluates the initial cohort and solicits YPLHIVs’ perspectives on transition barriers and facilitators. (2) Methods: Quantitative analyses (n = 21) characterized patients’ demographics, clinical engagement, and retention. Qualitative interviews (n = 5) captured patients’ transition experiences. (3) Results: This study, conducted in the Southeastern USA, included a cohort where 47.6% were born abroad, with all participants being US citizens by birth or naturalization. Patients’ mean age at first visit was 19.6 years. The average AYAHCTC duration was 2.21 years. First-year engagement and retention were 100% and 95.5%, respectively. Viral suppression rates improved from 66.7% at the first visit to 81.0% at the last visit. Eleven patients transitioned out of AYAHCTC. Qualitative analyses indicate that barriers to transition include leaving trusted providers, reduced parental guidance, developing autonomy, and perceived loss of confidentiality in adult clinic environment. Transition was facilitated by youth-friendly services, clear communication, and strong relationships with AYAHCTC providers. (4) Conclusions: YPLHIV positively viewed AYAHCTC experiences. Future directions include optimizing services to build YPLHIVs’ independence, supporting YPLHIV experiencing stigma, assuaging concerns about switching providers, collaborating with adult clinics to maintain confidentiality, and designing interventions focused on adherence during transition. Full article
(This article belongs to the Special Issue Adolescent HIV Care and Transition Strategies: Challenges, Outcomes, and Interventions)
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