African Journal of Public Health and Health Systems | 13 April 2015
A Comparative Study of Retention and Viral Suppression Outcomes for Adolescents Transitioning from Paediatric to Adult HIV Care in Blantyre, Malawi, 2015
C, h, i, m, w, e, m, w, e, B, a, n, d, a, ,, T, i, y, a, m, i, k, e, M, w, a, l, e
Abstract
Adolescents living with HIV face challenges during the transition from paediatric to adult care, a period associated with risks of disengagement. In settings like Malawi, data on the long-term outcomes of this process are scarce. This study compared long-term retention in care and viral suppression between adolescents who transitioned from paediatric to adult HIV care and a matched cohort of non-transitioning adolescents entering adult care directly in Blantyre, Malawi. A retrospective cohort study utilised routine clinical data. Adolescents who had completed transition were identified and matched with a control group entering adult care without prior paediatric experience. Retention in care (defined as attending clinic within 90 days of a scheduled appointment) and viral suppression (<1000 copies/ml) were assessed over a multi-year period following transition or enrolment. Transitioned adolescents demonstrated significantly poorer retention in care compared to the control group (68% versus 82%). Viral suppression rates were also lower in the transitioned cohort, though the difference was less pronounced. Linked qualitative data highlighted unpreparedness for transition and perceived stigma in adult clinics as key barriers. The structured transition process was associated with inferior retention and viral suppression outcomes compared to standard entry into adult care. This suggests current transition protocols may be inadequate for ensuring continuity of care. Programmes should strengthen adolescent preparation prior to transition and ensure dedicated, youth-friendly support within adult clinics. Further operational research is required to develop and evaluate tailored transition models. HIV, adolescents, transition, retention, viral suppression, Malawi, sub-Saharan Africa This study provides comparative, long-term outcome data critical for informing national and regional policies on adolescent HIV care transition in high-burden settings.