Low-transition rates in human immunodeficiency virus-infected adolescents: A cross-sectional mixed study of pediatric to adult care transition in Uganda

Abstract

BACKGROUND

Transition is a critical period for adolescents as they begin to assume responsibility for their own health. Similarly, the shift from pediatric to adult healthcare represents a vulnerable phase, marked by unique challenges in adolescent health care. Despite its importance, only a few studies have explored healthcare transition among adolescents in Uganda.

AIM

To identify factors associated with the transition to adult human immunodeficiency virus (HIV)-centered care among adolescents attending HIV/AIDS clinics in Uganda.

METHODS

A cross-sectional mixed-methods study was conducted among 265 adolescents, randomly selected from three antiretroviral therapy (ART) clinics, using a structured questionnaire. Focus group discussions and key informant interviews were conducted. Individuals aged 10-20 years who were actively enrolled in the ART program between January 4, 2022 and January 30, 2023 were recruited. The primary outcome of interest was the transition to adult care. Bivariate and multivariate analyses were performed for quantitative data, while content analysis was used to analyze qualitative data.

RESULTS

The prevalence of transition to adult care was 40.6%. Most participants were male (53.6%) and fell within the 13-15 age group (35.6%). Multivariate logistic regression analysis identified several factors significantly associated with transition to adult care: Age group 10-12 years [prevalence ratio (PR) = 2.525, 95%CI: 2.121-2.944, P = 0.002], Age group 13-15 years (PR = 1.900, 95%CI: 1.196-3.416, P = 0.001), successful viral load suppression (PR = 1.534, 95%CI: 1.173-1.648, P = 0.016), disclosure of HIV status to relatives (PR = 5.001, 95%CI: 3.411-3.611, P = 0.000), being prepared for transitioning (PR = 5.417, 95%CI: 3.468-7.135, P = 0.041) and having skilled pediatric caregivers (PR = 3.724, 95%CI: 2.084-4.105, P = 0.005).

CONCLUSION

Transition to adult care among adolescents was low. Improving transition outcomes may require strengthening individual support within the family context and integrating transition-focused care into existing specialized clinical settings to enhance the delivery of adolescent-friendly services.

Keywords: Human immunodeficiency virus-infected adolescents; Pediatric to adult care transition; Cross section study; Human immunodeficiency virus epidemiology; Multidisciplinary team; Uganda

Core Tip: Transitioning adolescents living with human immunodeficiency virus (HIV) to adult-centered care in Uganda remains a critical challenge, with transition rates remaining low. These findings have important implications for improving adolescent healthcare. Specifically: (1) Integrating transition care into existing clinical settings, and (2) Strengthening family support systems may enhance transition outcomes. Additionally, targeted interventions addressing the identified predictors of successful transition can further improve outcomes. These insights can guide policymakers and healthcare practitioners in Uganda and similar settings.