1. Transitioning to Adulthood
Rashida A Ferrand
Reader in International Health
London School of Hygiene and Tropical Medicine
Rashida Ferrand has no financial relationships with commercial entities to disclose.

2. Timing and duration of ART
Context of addressing HIV in adolescence
HIV in adolescence
Chronic morbidity
Heart and lung
Bone
Neuro-cognitive
Mental health
Treatment experience
Timing and duration of ART
Social
Disclosure
Intense stigma
Familial pressure
Economic stress
Development
Sexual
Brain
Emotional
-identity and autonomy,
-mastering abstract thought,
-negotiating independent decision-making + additional burden of ownership of illness
-take risk
Lowenthal E et al Lancet Infect Dis 2015

3. Lost to follow-up after transition to next age-band: ZIMBABWE (n=3545)
Age at ART start
Rate of lost to follow-up per 100 person years (95% CI)
Adjusted RR* (95% CI),
p-value
Before transition to next age-band
After transition to next age-band
5 – 9y
4.9 (3.95, 5.98)
2.3 (1.47, 3.45)
0.7 (0.38, 1.11),
p = 0.113
10 – 14y
3.2 (2.44, 4.15)
4.9 (3.41, 7.07)
1.6 (0.96, 2.60),
p = 0.074
15 –19y
9.1 (7.12, 11.5)
16.7 (10.9, 25.6)
2.0 (1.19, 3.39),
p = 0.009
*Adjusted for gender, time on ART and calendar year
Kranzer K et al, manuscript in preparation

4. Challenges for transition
Burgeoning adolescent HIV epidemic
Outcomes worsen across this period
CARE PROVIDERS: lack of training, reluctance to transition
CAREGIVERS: lack of preparedness and involvement
ADOLESCENTS: lag in developmental readiness
A continuum not discrete process
Transition discourse from the point of view of medical providers
Lack of coordinated, multidisciplinary, evidence-based approaches
Ryscavage et al, AIDS Care 2016

5. Interventions Holistic model including clinical and psychosocial care
Encompass entire continuum
Volunteer co-providers at clinics and community
Dedicated transition programs + national guidelines
Group transition program using a phased approach
Identify and disclose
Joint staffing (time-line, checklists)
Respect readiness for transfer
Transition camps
Transition in groups
Life-skills camps: information, moral support and enjoyment
Hansudewechakul R et al JIAS 2015
Tulloch O et al Plos One 2014

6. Way forward Contexually appropriate and evidence-based approaches
Broader health system reform and policies to approach HIV from a dynamic and developmental and “comprehensive” perspective
Longitudinal studies to track program, physical and mental health outcomes across life-span
Social protection research
Use of novel technologies: eHealth and social media
Early engagement and participation of youth and families
grounded in local challenges and priorities
: address wider socioeconomic, structural and environmental constraints-cash trasnfers, life skills, parenting, educationalinterventions
Tassiopoulos et al BMJ 2016;
Judd A et al Curr Opin HIV and AIDS 2016