What is it going to take to move youth‐related HIV programme policies into practice in Africa?

Abstract

Introduction: HIV has been reported to be the leading cause of mortality amongst adolescents in Africa. This has brought attention to the changes in service provision and health management that many adolescents living with HIV experience when transferring from specialized paediatric- or adolescent-focused services to adult care. When transition is enacted poorly, adherence may be affected and the continuum of care disrupted. As the population of HIV-infected adolescents grows, effective and supported transition increases in significance as an operational imperative.Discussion: Considerable gaps remain in moving policy to practice at global, national, and local levels. Policies that give clear definition to transition and provide standard operating procedures or tools to support this process are lacking. National guidelines tend to neglect transition. Beyond transition itself, there has been slow progress on the inclusion of adolescents in national policies and strategies. Guidance often overlooks the specific needs and rights of adolescents, in particular for those living with HIV. In some cases, prohibitive laws can impede adolescent access by applying age of consent restriction to HIV testing, counselling and treatment, as well as SRH services. Where adolescent-focused policies do exist, they have been slow to emerge as tangible operating procedures at health facility level. A key barrier is the nature of existing transition guidance, which tends to recommend an individualized, client-centred approach, driven by clinicians. In low- and middle-income settings, flexible responses are resource intensive and time consuming, and therefore challenging to implement amidst staff shortages and administrative challenges. First, national governments must adopt transition-specific policies to ensure that adolescents seamlessly receive appropriate and supportive care. Second, transition policies must form part of a broader adolescent-centred policy landscape and adolescent-friendly orientation and approach at health system level. Third, national actors must ensure that transition policies are supported at implementation level. Fourth, youth involvement and community mobilization are essential. Finally, further implementation research is urgently needed to better understand how to support young people and providers in achieving smooth transitions.Conclusions: Only by moving from policy to practice through supportive policies and their implementation will we be closer to including adolescents in the 2030 goal of ending AIDS.

Trends Over Time for Adolescents Enrolling in HIV Care in Kenya, Tanzania, and Uganda From 2001–2014

“…Adolescent- focused services and staff that include peer and psychosocial support are likely required, and existing transition policies need to be implemented. 40–44 Reducing attrition among adolescents enrolling in HIV care in our region will also require a better understanding of LTFU (ie, as unidentified mortality, silent transfer, or complete disengagement from care), as well as a deeper grasp of the individual-, social-, and facility-level factors that influence attrition. 27,43…”

Tracking the transition of adolescents into adult HIV care: a global assessment

“…He notes that we are collectively responsible for helping adolescents achieve equal access to care to optimize treatment outcomes. In the final paper of this issue, Mark et al [ 13 ] outline five key strategies that will help us to move from policy to action on adolescent transition. The core of these efforts should be an adolescent-centred approach, without which we will continue to leave young people “lost in transition”, in between programs and policy agendas for children and adults.…”

Differing psychological vulnerabilities among behaviourally and perinatally HIV infected adolescents in South Africa – implications for targeted health service provision

“…In resource-poor settings, with fractured medical care and interrupted provisions, many adolescents who appear in clinics may be grouped together by age and gender rather than a clear understanding of their particular needs. There are clear barriers in policy implementation for this group and a general call to understand subgroups, drivers and promising practices if services of quality are to evolve (Mark et al 2017).…”