{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T20:35:30Z","timestamp":1773434130870,"version":"3.50.1"},"reference-count":25,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2020,1,30]],"date-time":"2020-01-30T00:00:00Z","timestamp":1580342400000},"content-version":"vor","delay-in-days":29,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000071","name":"National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["R21HD089859"],"award-info":[{"award-number":["R21HD089859"]}],"id":[{"id":"10.13039\/100000071","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000025","name":"National Institute of Mental Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000025","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000026","name":"National Institute on Drug Abuse","doi-asserted-by":"publisher","award":["U01AI069924"],"award-info":[{"award-number":["U01AI069924"]}],"id":[{"id":"10.13039\/100000026","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Intern AIDS Soc"],"published-print":{"date-parts":[[2020,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>As adolescents and young people living with HIV (AYLH) age, they face a \u201ctransition cascade,\u201d a series of steps associated with transitions in their care as they become responsible for their own healthcare. In high\u2010income countries, this usually includes transfer from predominantly paediatric\/adolescent to adult clinics. In sub\u2010Saharan Africa, paediatric HIV care is mostly provided in decentralized, non\u2010specialist primary care clinics, where \u201ctransition\u201d may not necessarily include transfer of care but entails becoming more autonomous for one's HIV care. Using different age thresholds as proxies for when \u201ctransition\u201d to autonomy might occur, we evaluated pre\u2010 and post\u2010transition outcomes among AYLH.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We included AYLH aged &lt;16\u00a0years at enrolment, receiving antiretroviral therapy (ART) within International epidemiology Databases to Evaluate AIDS Southern Africa (IeDEA\u2010SA) sites (2004 to 2017) with no history of transferring care. Using the ages of 16, 18, 20 and 22\u00a0years as proxies for \u201ctransition to autonomy,\u201d we compared the outcomes: no gap in care (\u22652 clinic visits) and viral suppression (HIV\u2010RNA &lt;400\u00a0copies\/mL) in the 12\u00a0months before and after each age threshold. Using log\u2010binomial regression, we examined factors associated with no gap in care (retention) in the 12\u00a0months post\u2010transition.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 5516 AYLH from 16 sites were included at \u201ctransition\u201d age 16 (transition\u201016y), 3864 at 18 (transition\u201018y), 1463 at 20 (transition\u201020y) and 440 at 22\u00a0years (transition\u201022y). At transition\u201018y, in the 12\u00a0months pre\u2010 and post\u2010transition, 83% versus 74% of AYLH had no gap in care (difference 9.3 (95% confidence interval (CI) 7.8 to 10.9)); while 65% versus 62% were virally suppressed (difference 2.7 (\u22121.0 to 6.5%)). The strongest predictor of being retained post\u2010transition was having no gap in the preceding year, across all transition age thresholds (transition\u201016y: adjusted risk ratio (aRR) 1.72; 95% CI (1.60 to 1.86); transition\u201018y: aRR 1.76 (1.61 to 1.92); transition\u201020y: aRR 1.75 (1.53 to 2.01); transition\u201022y: aRR 1.47; (1.21 to 1.78)).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>AYLH with gaps in care need targeted support to prevent non\u2010retention as they take on greater responsibility for their healthcare. Interventions to increase virologic suppression rates are necessary for all AYLH ageing to adulthood.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.25447","type":"journal-article","created":{"date-parts":[[2020,1,31]],"date-time":"2020-01-31T02:09:53Z","timestamp":1580436593000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Characterizing the double\u2010sided cascade of care for adolescents living with HIV transitioning to adulthood across Southern Africa"],"prefix":"10.1002","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6637-5820","authenticated-orcid":false,"given":"Priscilla R","family":"Tsondai","sequence":"first","affiliation":[{"name":"Centre for Infectious Disease Epidemiology and Research School of Public Health and Family Medicine Faculty of Health Sciences University of Cape Town Cape Town South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0209-3285","authenticated-orcid":false,"given":"Annette H","family":"Sohn","sequence":"additional","affiliation":[{"name":"TREAT Asia\/amfAR \u2013 The Foundation for AIDS Research Bangkok Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sam","family":"Phiri","sequence":"additional","affiliation":[{"name":"Lighthouse Trust Clinic Lilongwe Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kombatende","family":"Sikombe","sequence":"additional","affiliation":[{"name":"Centre for Infectious Disease Research in Zambia Lusaka Zambia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3845-4863","authenticated-orcid":false,"given":"Shobna","family":"Sawry","sequence":"additional","affiliation":[{"name":"Harriet Shezi Children's Clinic Wits Reproductive Health and HIV Research Unit University of Witwatersrand Johannesburg South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cleophas","family":"Chimbetete","sequence":"additional","affiliation":[{"name":"Newlands Clinic Harare Zimbabwe"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6467-662X","authenticated-orcid":false,"given":"Geoffrey","family":"Fatti","sequence":"additional","affiliation":[{"name":"Kheth'Impilo Cape Town South Africa"},{"name":"Division of Epidemiology and Biostatistics Department of Global Health Faculty of Medicine and Health Sciences Stellenbosch University Cape Town South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael A","family":"Hobbins","sequence":"additional","affiliation":[{"name":"SolidarMed Luzern Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7367-7512","authenticated-orcid":false,"given":"Karl\u2010G\u00fcnter","family":"Technau","sequence":"additional","affiliation":[{"name":"Empilweni Services and Research Unit Department of Paediatrics &amp; Child Health Rahima Moosa Mother and Child Hospital Faculty of Health Sciences University of the Witwatersrand Johannesburg South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Helena","family":"Rabie","sequence":"additional","affiliation":[{"name":"Department of Paediatrics and Child Health Tygerberg Academic Hospital University of Stellenbosch Stellenbosch South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan","family":"Bernheimer","sequence":"additional","affiliation":[{"name":"M\u00e9decins Sans Frontiers Khayelitsha South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9887-0634","authenticated-orcid":false,"given":"Matthew P","family":"Fox","sequence":"additional","affiliation":[{"name":"Department of Global Health and Department of Epidemiology Boston University School of Public Health Boston MA USA"},{"name":"Health Economics and Epidemiology Research Office Faculty of Health Sciences University of Witwatersrand Johannesburg South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3176-5295","authenticated-orcid":false,"given":"Ali","family":"Judd","sequence":"additional","affiliation":[{"name":"MRC Clinical Trials Unit at UCL University College London (UCL) London United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2132-6037","authenticated-orcid":false,"given":"Intira J","family":"Collins","sequence":"additional","affiliation":[{"name":"MRC Clinical Trials Unit at UCL University College London (UCL) London United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8496-6475","authenticated-orcid":false,"given":"Mary\u2010Ann","family":"Davies","sequence":"additional","affiliation":[{"name":"Centre for Infectious Disease Epidemiology and Research School of Public Health and Family Medicine Faculty of Health Sciences University of Cape Town Cape Town South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"for the International epidemiology to Evaluate AIDS Southern Africa (IeDEA\u2010SA) Collaboration","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,1,30]]},"reference":[{"key":"e_1_2_9_2_1","unstructured":"UNAIDS.2018 Estimates.Geneva Switzerland:UNAIDS;2018[cited 2019 Jun 15]. 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