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

Purpose of Review: An unprecedented number of youth living with HIV (YLHIV) are aging into adolescence and young adulthood, increasing concerns about the possibility of these youth being lost in the transition from supported care (sometimes in pediatric settings) to more independent healthcare settings. This could further the emerging disparities in outcomes between YLHIV and adults (e.g., higher nonadherence to treatment and increased viral loads, which may result in increased transmission of resistant HIV strains and increased morbidity and mortality). Recent Findings: In resource-rich settings where there is likely greater recognition of adolescent cognitive and developmental challenges, transitioning YLHIV to adult healthcare has emerged as a major challenge. In resource-limited settings (RLS), where the burden of HIV is significant and healthcare resources often stretched, the challenge to move toward healthcare independence and maintain a fluid continuum of care for YLHIV may be the greatest. Summary: We review key issues in transitioning YLHIV in RLS, highlighting steps in the transition process, examining evidence where available, and discussing challenges and opportunities to understanding and optimizing outcomes.