{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T04:35:16Z","timestamp":1789965316563,"version":"4.0.1"},"reference-count":33,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2021,7,8]],"date-time":"2021-07-08T00:00:00Z","timestamp":1625702400000},"content-version":"vor","delay-in-days":7,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000025","name":"National Institute of Mental Health","doi-asserted-by":"publisher","award":["K24MH114732"],"award-info":[{"award-number":["K24MH114732"]}],"id":[{"id":"10.13039\/100000025","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007301","name":"Harvard University Center for AIDS Research","doi-asserted-by":"publisher","award":["5P30AI060354\u201013"],"award-info":[{"award-number":["5P30AI060354\u201013"]}],"id":[{"id":"10.13039\/100007301","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["R21HD092132"],"award-info":[{"award-number":["R21HD092132"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Int AIDS Soc"],"published-print":{"date-parts":[[2021,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Adolescents living with perinatally acquired HIV have low rates of retention in care and viral suppression after the transition from paediatric to adult care. In this study, we developed and validated a tool to identify adolescent transition readiness.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We developed the HIV Adolescent Readiness for Transition Scale (HARTS) from June 2016 to May 2019 by iteratively adapting existing transition readiness scales for other chronic illnesses by conducting focus groups with 11 healthcare providers and 20 adolescents in South Africa. We administered a preliminary questionnaire to 131 adolescents to determine psychometric properties and assess test\u2013retest variability. We used confirmatory factor analysis to verify the proposed scale structure using the underlying variable approach. We correlated responses to self\u2010described transition readiness and age using linear regression. We subsequently validated the scale by prospectively administering it to 199 adolescents in a second South African setting before their transition. We then used multivariable logistic regression to assess the effects of the HARTS and relevant socio\u2010behavioural covariates on viral suppression one year after transition.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We identified four domains relevant to transition readiness: disclosure, health navigation, self\u2010advocacy and health literacy. Fifteen questions with a significant factor loading of 0.3 to 0.9 were identified. No significant test\u2013retest variability was seen among 10% of participants. Positive correlations with self\u2010described transition readiness were significant with the overall HARTS and domains of health navigation, self\u2010advocacy and health literacy. In the prospective analysis, for adolescents not using drugs, each 10\u2010point increase in the HARTS was associated with 0.62 odds of viral failure (95% CI 0.45 to 0.86; <jats:italic>p<\/jats:italic>\u00a0=\u00a00.004). The individual domains of self\u2010advocacy (AOR 0.56; 95% CI 0.33 to 0.94; <jats:italic>p<\/jats:italic>\u00a0=\u00a00.029), disclosure (AOR 0.02; 95% CI 0.01 to 0.25; <jats:italic>p<\/jats:italic>\u00a0=\u00a00.002), health navigation (AOR 0.51; 95%CI 0.25 to 1.02; <jats:italic>p<\/jats:italic>\u00a0=\u00a00.056) and health literacy (AOR 0.37; 95% CI 0.10 to 1.30; <jats:italic>p<\/jats:italic>\u00a0=\u00a00.121) were associated with viral failure adjusting for age at antiretroviral therapy initiation, ART regimen, sex, disclosure status, and alcohol use in both analyses.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The HARTS is a validated scale that can be used to identify which adolescents may require additional interventions prior to transitioning to adult care to improve viral suppression after transition.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.25767","type":"journal-article","created":{"date-parts":[[2021,7,8]],"date-time":"2021-07-08T07:14:58Z","timestamp":1625728498000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":26,"title":["Development and validation of the HIV adolescent readiness for transition scale (HARTS) in South Africa"],"prefix":"10.1002","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8640-7703","authenticated-orcid":false,"given":"Brian C","family":"Zanoni","sequence":"first","affiliation":[{"name":"Emory University Atlanta GA USA"},{"name":"Children\u2019s Healthcare of Atlanta Atlanta GA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3082-9234","authenticated-orcid":false,"given":"Moherndran","family":"Archary","sequence":"additional","affiliation":[{"name":"University of KwaZulu\u2010Natal Nelson Mandela School of Medicine Durban South Africa"},{"name":"King Edward VIII Hospital Durban South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thobekile","family":"Sibaya","sequence":"additional","affiliation":[{"name":"University of KwaZulu\u2010Natal Nelson Mandela School of Medicine Durban South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas","family":"Musinguzi","sequence":"additional","affiliation":[{"name":"Global Health Collaborative University of Science and Technology Mbarara Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary E","family":"Kelley","sequence":"additional","affiliation":[{"name":"Emory University Atlanta GA USA"},{"name":"Rollins School of Public health Atlanta GA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shauna","family":"McManus","sequence":"additional","affiliation":[{"name":"Emory University Atlanta GA USA"},{"name":"Rollins School of Public health Atlanta GA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica E","family":"Haberer","sequence":"additional","affiliation":[{"name":"Massachusetts General Hospital Boston MA USA"},{"name":"Harvard Medical School Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,7,8]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"South African National Department of Health.The 2012 national antenatal sentinel HIV and herpes simplex type\u20102 prevalence survey. 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