A Meta-Analysis of Retention and Virological Outcomes for Adolescents Transitioning from Paediatric to Adult HIV Care in Blantyre, Malawi, 2015

The transition from paediatric to adult HIV care represents a high-risk period for adolescents living with HIV, with frequent disruptions in continuity of care. In Blantyre, Malawi, an urban setting with a high HIV prevalence, assessing the outcomes of this transition is necessary for health system strengthening. This meta-analysis aimed to synthesise evidence on long-term retention in care and viral suppression outcomes for adolescents who have transitioned from paediatric to adult HIV clinics in Blantyre, Malawi. A systematic review and meta-analysis was conducted. Electronic databases and grey literature were searched for relevant observational studies reporting retention or virological outcomes for adolescents post-transition in Blantyre. Data were extracted using a standardised form. Pooled estimates for retention and viral suppression were calculated using a random-effects model. Heterogeneity was assessed using the I² statistic. The analysis indicated suboptimal outcomes. The pooled proportion of adolescents retained in adult care one year post-transition was 68% (95% CI: 61–75%). The pooled proportion achieving viral suppression (VL <1000 copies/ml) at the same time point was 62% (95% CI: 55–69%). Significant heterogeneity was observed among the included studies. A substantial proportion of adolescents transitioning to adult HIV care in Blantyre are lost to care or do not achieve viral suppression within one year. This indicates weaknesses in the transition process and subsequent adult care provision. Implementation and evaluation of structured, adolescent-responsive transition protocols are required. These should include dedicated transition counselling, strengthened tracking systems, and tailored support within adult clinics to improve engagement and treatment outcomes. HIV, adolescents, transition, retention, viral suppression, Malawi, meta-analysis. This study provides consolidated evidence on post-transition outcomes for adolescents with HIV in a high-burden Malawian setting, informing the development of targeted interventions.