Skip to main content

Barriers and Facilitators to the Successful Transition of Adolescents Living with HIV from Pediatric to Adult Care in Low and Middle-Income Countries: A Systematic Review and Policy Analysis


The purpose of this systematic review was twofold. First, we sought to summarize the literature on barriers and facilitators to successful healthcare transition for adolescents living with HIV from low- and middle-income countries (LMICs). Next, we assessed healthcare transition-related policies in countries from which we identified barriers and facilitators to determine the extent to which practice and policy meet to address the country-specific needs of adolescents living with HIV during healthcare transition. Ten studies met inclusion criteria. We identified four sub-themes of barriers to healthcare transition: emotional and psychological burden, effects of HIV disease, logistical and systemic impediments, and HIV stigma. We also identified five sub-themes of facilitators of healthcare transition: social support, skills development for adolescents and the adult treatment team, transition readiness, multidisciplinary teams, and transition coordination. Of the 12 countries from which we identified barriers and facilitators to healthcare transition among adolescents living with HIV, only five (Uganda, Kenya, Thailand, Brazil, and Cambodia) had healthcare transition-specific guidelines. Moreover, there was substantial variation across country-specific guidelines regarding the existence of protocols to monitor and enforce guidelines, and whether there were allocated funds to assist healthcare clinics with implementation. Our review has led to several recommendations to facilitate successful healthcare transition, including the development of surveillance systems to monitor and evaluate efforts to address adolescents' needs during healthcare transition, the development of guidelines specific to healthcare transition and based upon barrier and facilitators identified within target countries, and the incorporation of caregivers and training for the adult treatment team pre- and post-healthcare transition.

This is a preview of subscription content, access via your institution.

Fig. 1


  1. WHO. Maternal, newborn, child and adolescent health: HIV and youth. [online]. 2019. Available from: Accessed 10 Jan 2019.

  2. UNICEF. HIV/AIDS: Adolescents and Young People. [Online]. 2017. Available from: Accessed 10 Jan 2019.

  3. Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention. HIV Among Youth. [Online]. 2019. Available from: . Accessed 10 July 2017.

  4. UNAIDS. End adolescents AIDS. [Online]. 2017. Available from: Accessed 24 Apr 2019.

  5. UNICEF. United Nations Children’s Fund, For Every Child, End AIDS—Seventh Stocktaking Report. [Online]. 2016. Available from: Accessed 24 Apr 2019.

  6. UNAIDS. UNAIDS data 2017. [Online]. 2017. Available from: Accessed 24 Apr 2019.

  7. Foster C, McDonald S, Frize G, Ayers S, Fidler S. “Payment by Results”—financial incentives and motivational interviewing, adherence interventions in young adults with perinatally acquired HIV-1 infection: a pilot program. AIDS Patient Care STDs. 2014;28(1):28–32.

    Article  Google Scholar 

  8. Judd A, Sohn AH, Collins IJ. Interventions to improve treatment, retention and survival outcomes for adolescents with perinatal HIV-1 transitioning to adult care: moving on up. Curr Opin HIV AIDS. 2016;11(5):477–86.

    Article  CAS  Google Scholar 

  9. Zanoni BC, Archary M, Buchan S, Katz IT, Haberer JE. Systematic review and meta- analysis of the adolescent HIV continuum of care in South Africa: the Cresting Wave. BMJ Global Health. 2016;1(3):e000004.

    Article  Google Scholar 

  10. Ryscavage P, Macharia T, Patel D, Palmeiro R, Tepper V. Linkage to and retention in care following healthcare transition from pediatric to adult HIV care. AIDS Care. 2016;28(5):561–5.

    Article  Google Scholar 

  11. Tepper V, Zaner S, Ryscavage P. HIV healthcare transition outcomes among youth in North America and Europe: a review. J Int AIDS Soc. 2017;20:21490.

    Article  Google Scholar 

  12. Committee on Pediatric AIDS. Transitioning HIV-infected youth into adult health care. Pediatrics. 2013;132(1):192–7.

    Article  Google Scholar 

  13. Blum RW, Garell D, Hodgman CH, Jorissen TW, Okinow NA, Orr DP, Slap GB. Transition from child-centered to adult health-care systems for adolescents with chronic conditions: a position paper of the Society for Adolescent Medicine. J Adolesc Health. 1993;14(7):570–6.

    Article  CAS  Google Scholar 

  14. Rosen DS. Transition from pediatric to adult-oriented health care for the adolescent with chronic illness or disability. Adolesc Med (Philadelphia, Pa.). 1994;5(2):241–8.

    CAS  Google Scholar 

  15. Mugavero MJ, Amico KR, Horn T, Thompson MA. The state of engagement in HIV care in the United States: from cascade to continuum to control. Clin Infect Dis. 2013;57(8):1164–71.

    Article  Google Scholar 

  16. Maternal and Child Health Bureau. Moving on: transition from child-centered to adult health care for youth with disabilities. Washington, DC: US Department of Health and Human Services Health Resources and Services Administration, Maternal and Child Health Bureau; 1992.

    Google Scholar 

  17. Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Department of Health and Human Services. Available at Accessed 25 July 2017.

  18. WHO. Adolescent HIV Testing, Treatment, and Care: Transition [Online]. 2014. Available from: Accessed 8 May 2017.

  19. New York state Department of Health Aids Institute. Clinic guidelines programme; Principles, challenges, and barriers in transitioning care. [Online]. Available from:. Accessed 5 May 2017.

  20. Jao J, Fairlie L, Griffith DC, Agwu AL. The challenge of and opportunities for transitioning and maintaining a continuum of care among adolescents and young adults living with HIV in resource limited settings. Curr Trop Med Rep. 2016;3(4):149–57.

    Article  Google Scholar 

  21. Lipsey MW, Wilson DB. Practical meta-analysis. Thousand Oaks: Sage Publications Inc; 2001.

    Google Scholar 

  22. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(4):264–9.

    Article  Google Scholar 

  23. Learning and Development Division, Public Health Resource Unit. Headington, Oxford: Institute of Health Sciences. [Online]. 2017. Available from:∼casp/resources/rct∼tool.htm. Accessed 5 May 2019.

  24. Hansudewechakul R, Pongprapass S, Kongphonoi A, Denjanta S, Watanaporn S, Sohn AH. Transition of Thai HIV-infected adolescents to adult HIV care. J Int AIDS Soc. 2015;18(1):20651.

    Article  CAS  Google Scholar 

  25. Katusiime C, Parkes-Ratanshi R, Kambugu A. Transitioning behaviourally infected HIV-positive young people into adult care: experiences from the young person’s point of view. S Afr J HIV Med. 2013.

    Article  Google Scholar 

  26. Pinzón-Iregui MC, Ibanez G, Beck-Sagué C, Halpern M, Mendoza RM. “… like because you are a grownup, you do not need help”: experiences of transition from pediatric to adult care among youth with perinatal HIV infection, their caregivers, and health care providers in the Dominican Republic. J Int Assoc Provid AIDS Care (JIAPAC). 2017;16(6):579–87.

    Article  Google Scholar 

  27. Machado DM, Galano E, de Menezes Succi RC, Vieira CM, Turato ER. Adolescents growing with HIV/AIDS: experiences of the transition from pediatrics to adult care. Braz J Infect Dis. 2016;20(3):229–34.

    Article  Google Scholar 

  28. Pettitt ED, Greifinger RC, Phelps BR, Bowsky SJ. Improving health services for adolescents living with HIV in sub-Saharan Africa: a multi-country assessment. Afr J Reprod Health. 2013;17(4):17–31.

    PubMed  Google Scholar 

  29. Inzaule SC, Hamers RL, Kityo C, de Wit TF, Roura M. Long-term antiretroviral treatment adherence in HIV-infected adolescents and adults in Uganda: a qualitative study. PLoS ONE. 2016;11(11):e0167492.

    Article  CAS  Google Scholar 

  30. Kung TH, Wallace ML, Snyder KL, Robson VK, Mabud TS, Kalombo CD, Bekker LG. South African healthcare provider perspectives on transitioning adolescents into adult HIV care. S Afr Med J. 2016;106(8):804–8.

    Article  Google Scholar 

  31. Nyabigambo A, Muliira JK, Atuyambe L, Babikako HM, Kambugu A, Ndoleriire C. Determinants of utilization of a no-cost HIV transition clinic: a cross-sectional study of young adults living with HIV/AIDS. Adolesc Health Med Ther. 2014;5:89.

    Article  Google Scholar 

  32. Yi S, Ngin C, Pal K, Khol V, Tuot S, Sau S, Chhoun P, Mburu G, Choub SC, Chhim K, Ly P. Transition into adult care: factors associated with level of preparedness among adolescents living with HIV in Cambodia. AIDS Res Ther. 2017;14(1):33.

    Article  Google Scholar 

  33. Lolekha R, Boon-yasidhi V, Na-Nakorn Y, Manaboriboon B, Vandepitte WP, Martin M, Tarugsa J, Nuchanard W, Leowsrisook P, Lapphra K, Suntarattiwong P. The Happy Teen programme: a holistic outpatient clinic-based approach to prepare HIV-infected youth for the transition from paediatric to adult medical care services in Thailand. J Int AIDS Soc. 2017;20:21500.

    Article  Google Scholar 

  34. Republic of Uganda Ministry of Health. Consolidated guidelines for prevention and treatment of HIV in Uganda. [Online]. 2016. Available from: Accessed 12 June 2018.

  35. Uganda AIDS Commission. National HIV and AIDS Strategic Plan 2015/2016-2019/2020. [Online]. 2015. Available from: Accessed 15 June 2018.

  36. Uganda AIDS Commission. National HIV and AIDS Monitoring and Evaluation Plan 2015/2016-2019/2020. [Online]. 2015. Available from: Accessed 15 June 2018.

  37. Thailand Ministry of Health. Thailand National Guidelines on HIV/AIDS Treatment and Prevention 2017. [Online]. 2017. Available from: Accessed 7 July 2018.

  38. UNAIDS. Thailand launches new national strategy to end the AIDS epidemic by 2030. [Online]. 2017. Available from: Accessed 4 August 2018.

  39. Avert. HIV and AIDS in Thailand.[Online]. 2018. Available from: Accessed 5 Sept 2019.

  40. Secretaria de Vigilância em Saúde, Ministério da Saúde. Recomendações para a atenção integral a adolescentes e jovens vivendo com HIV/Aids. [Online]. 2013. Available from: Accessed 7 Aug 2018.

  41. Kingdom of Cambodia Ministry of Health. National HIV clinical management guidelines for Adults and Adolescents. [Online]. 2017. Available from: Accessed 8 Sept 2018.

  42. PEPFAR. Cambodia Country Operational Plan 2017 Strategic Direction Summary. [Online]. 2017. Available from Accessed 9 May 2018.

  43. Kenya Ministry of Health, National AIDS & STI Control Programme. Guidelines on use of antiretroviral drugs for treating and preventing HIV infection in Kenya. 2016. Available from: Accessed 9 Sept 2018.

  44. Kenya Ministry of Health. Kenya HIV Prevention Revolution Road Map: Countdown to 2030. 2014. Available from: Accessed 11 Nov 2018.

  45. Kenya Ministry of Health. Kenya AIDS Response Progress Report 2016. 2016. Available from: Accessed 11 Nov 2018.

  46. World Health Organization. HIV and adolescents: guidance for HIV testing and counselling and care for adolescents living with HIV: recommendations for a public health approach and considerations for policy-makers and managers.

  47. MacDonell K, Naar-King S, Huszti H, Belzer M. Barriers to medication adherence in behaviorally and perinatally infected youth living with HIV. AIDS Behav. 2013;17(1):86–93.

    Article  Google Scholar 

  48. PEPFAR. Uganda Country Operational Plan 2018 Strategic Direction Summary. [Online]. 2018. Available from Accessed 9 May 2018.

  49. PEPFAR. PEPFAR Asia Regional Program, 2017 Regional Operational Plan [Online] 2017. Available from: Accessed 9 May 2018.

Download references

Author information

Authors and Affiliations



CJ and TDR reviewed manuscripts for inclusion. All authors participated in drafting the manuscript, and read and approved the final manuscript.

Corresponding author

Correspondence to Tiarney D. Ritchwood.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Jones, C., Ritchwood, T.D. & Taggart, T. Barriers and Facilitators to the Successful Transition of Adolescents Living with HIV from Pediatric to Adult Care in Low and Middle-Income Countries: A Systematic Review and Policy Analysis. AIDS Behav 23, 2498–2513 (2019).

Download citation

  • Published:

  • Issue Date:

  • DOI:


  • Adolescent
  • HIV
  • Transition
  • Healthcare
  • Policy