Transition from paediatric to adult HIV care is associated with a decline in virological suppression among adolescents and young adults

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HIV medicine Published June 4, 2026 Medically reviewed June 4, 2026 Study authors: Joseph Petra E, Itaeli Annabel M, Amour Maryam, Bwire George Msema PubMed ↗ DOI ↗ By Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

Key Takeaway

Consider implementing targeted strategies to sustain virological suppression after adolescents transition to adult HIV care.

This systematic review and meta-analysis evaluated the impact of transitioning from paediatric to adult HIV care on virological suppression in adolescents and young adults aged 10 to 26 years. The analysis focused on patients receiving antiretroviral therapy within the sub-Saharan Africa setting. Researchers compared virological outcomes before and after the transition to adult services.

The main results indicated a notable reduction in viral suppression following the transition. While suppression rates were high prior to the move to adult care, they decreased after the transition occurred. This decline highlights a potential vulnerability in the continuity of care during this specific life stage.

The authors noted significant heterogeneity between the included studies and explored sources of variability through subgroup analyses. They emphasized that future large-scale longitudinal studies should utilize standardized transition age definitions and consistent follow-up durations. Uniform virological suppression thresholds are also recommended to ensure robust and comparable evidence across different contexts.

The practice relevance of these findings points to the urgent need for targeted strategies to sustain viral suppression post-transition. Clinicians should be aware that the transition process itself may disrupt treatment efficacy in this population.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedJun 2026

PMID41822955

View Original Abstract ↓

BACKGROUND: HIV remains a major global burden, with 2.4 million children and adolescents affected, 84% living in sub-Saharan Africa. As adolescents age, transitioning from paediatric to adult HIV care represents a critical period that may significantly affect antiretroviral therapy (ART) adherence, retention in care and virological suppression. A systematic evaluation of evidence from sub-Saharan Africa is essential to quantify the effects of healthcare transition on virological outcomes, especially viral suppression. METHODS: We systematically searched three electronic databases: PubMed, Scopus and Embase for studies published between January 1, 2015, and March 5, 2025, using keywords HIV, adolescents, transition to adult care and virological outcome. A narrative synthesis was used to summarize the findings, and meta-analyses were conducted using random-effects models to estimate pooled proportions with corresponding 95% confidence intervals. Heterogeneity between studies was quantified using the I statistic, and potential sources of variability were explored through subgroup analyses based on study characteristics. The risk of bias for the included studies was assessed according to the study design using the Newcastle-Ottawa Scale. This review was registered with PROSPERO (CRD420251005361). RESULTS: The systematic search identified 1324 articles, of which 8 met the predefined inclusion criteria and were included in the final analysis. These studies consisted of 13 819 adolescents and young adults aged between 10 and 26 years. The pooled proportions of viral suppression were 75% (95% confidence interval [CI]: 68%-81%, I: 89.2%, p < 0.0001) before transition and 67% (95% CI: 44%-84%, I: 95.7%, p < 0.0001) after transition. CONCLUSION: There is a decline in viral suppression following the transition from paediatric to adult HIV care in sub-Saharan Africa, indicating the need for targeted strategies to sustain suppression post-transition. Future large-scale longitudinal studies should use standardized transition age definitions, consistent follow-up durations and uniform virological suppression thresholds to ensure robust and comparable evidence.