Globally, adolescents living with HIV (ALHIV) experience poor health outcomes such as low retention in care, ART non-adherence and viral non-suppression. These outcomes coincide with the period during and after their transition from pediatric to adult healthcare. This study aimed to systematically describe the compendium of transition interventions and synthesize the effects of such transition interventions on adherence to ART, retention in care and viral load suppression. Seven databases and Google Scholar were searched and the review findings were reported according to the Preferred Reporting Items Stipulated for Systematic Reviews and Meta-Analyses. The risk of bias and the strength of evidence were assessed using the National Institutes of Health quality assessment tool for observational cohort and cross-sectional studies. Seven studies (two cross-sectional, two retrospective cohort and three prospective cohort studies), with sample sizes ranging from 13 to 192, were included in the narrative synthesis. There was high-quality evidence that these interventions—Individualized care plans, communication, psychological support, and health and sexual education and mHealth—improved adherence, retention in care and viral load suppression at post-transition over the short and long term. In contrast, group transition intervention produced weak quality evidence. Hence, transition interventions including a combination of the high-quality evidenced interventions mentioned above can improve treatment outcomes for adolescents on ART.
Background: Adolescents living with HIV (ALHIV) experience poor health outcomes such as low retention in care, suboptimal adherence to ART, insufficient viral suppression, high morbidity and mortality. These outcomes coincide with the period during and after their transition from pediatric to adult healthcare. While some studies on transition interventions have reduced poor health outcomes among ALHIV, some have reported no significant reduction. There is a need to systematically describe, assess the quality and make recommendations regarding the effects of the transition interventions' compendium. The proposed study aims to systematically describe interventions that guide the transition of adolescents on ART from pediatric to adult care and synthesize evidence of the effects on adherence, retention in care and viral load suppression. Methods: A systematic review of interventions that guide the transition of adolescents on ART and report on treatment outcomes (adherence, retention in care and viral load suppression) will be conducted. Studies will be sourced from electronic databases (PubMed, Scopus, Web of Science, Ebscohost, CINAHL, Science Direct, Google scholar and the World Health Organization's (WHO's) library database). All studies will be exported to Mendeley, and two independent reviewers will screen the titles and abstracts and the full text according to the eligibility criteria. The risk of bias will be determined using Cochrane Collaboration tool RoB 2, the Newcastle–Ottawa Scale and the Risk of Bias in Non-randomized Studies - of Interventions checklists. The strength of evidence will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach. A narrative synthesis including the description of characteristics of studies, comparison of differences and similarities between studies and description of possible trends will be carried out. If possible, homogenous studies will be subjected to a meta-analysis.Discussion: the review findings will provide a robust knowledge base on transition interventions available to ALHIV. Assessing the strength and quality of studies will ascertain the magnitude of the effect of transition intervention outcomes and inform the development of protocols and treatment guidelines needed to achieve better health outcomes for ALHIV. Systematic review registration: Submitted to PROSPERO on the 12th of August 2021
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