©Kate Merrill/Johns Hopkins University

The issue
As adolescents and young adults living with HIV age into adulthood, they must navigate the transition to HIV self-management and adult care. This is a complex process, particularly for young people who must manage a chronic illness like HIV. As a result, many adolescents and young adults living with HIV have poor adherence to ART, leading to poor viral suppression and a greater risk of HIV-related mortality. Unfortunately, there is little data from the region on how to support youth in having a greater and more effective role in the management of their own care.

Our approach
This operational study responds to these challenges and evidence gaps by refining and testing a peer-mentoring strategy in Zambia to strengthen the capacity of health systems and families to support youth as they transition to, and engage in, self-management and adult HIV care and treatment. The study is a randomized controlled trial at the individual level that uses a stepped wedge design to assess a peer-mentoring strategy and toolkit to support youth living with HIV (ages 15–24 years) achieve a successful transition to self-management and adult care. The study team is testing a six-month peer-mentoring program among 144 youth in an intervention arm compared to 144 youth in a comparison arm. Participants are being systematically selected from two hospitals and two primary care clinics. Peer mentors are HIV-positive young adults who have successfully transitioned to self-management. Interactions with the youth participants take the form of one-on-one and youth group meetings. These interactions are being guided by tools in the Toolkit for Transition of Care and Other Services for Adolescents Living with HIV, developed by AIDSTAR One.

The impact
Results will offer evidence-based guidance and refined tools for youth living with HIV, their families, and their health care providers to improve the care transition process and related HIV outcomes.