As the number of vertically infected adolescents living with HIV (ALHIV) continues to grow, there is an increased need to support these individuals as they transition from pediatric to adult care. With the limited number of health and community care providers throughout much of sub-Saharan Africa, it is likely that many adolescents will not experience a physical transition from one clinic to another; however, all ALHIV undergo a mental transition to adulthood, and during this time self-care and self-management of HIV is key. Adolescence is a developmental phase between childhood and adulthood that is characterized by physical, psychological, and social changes at the individual level (World Health Organization [WHO] 2010). The WHO defines adolescence as the ages between 10 and 19, but many others consider adolescence to last until age 25. Transition is a “multifaceted, active process that attends to the medical, psychosocial, and educational or vocational needs of adolescents as they move from the child-focused to the adult-focused health-care system” (Reiss and Gibson 2002). Through provision of instruction and select tools created, the Toolkit for Transition of Care and Other Services for Adolescents Living with HIV provides
clear guidance to community care providers (CCPs) and health care providers (HCPs), the adolescent, and his or her family/caregiver to promote a smooth transition for the adolescent. The Toolkit is useful for both perinatally exposed adolescents as well as behaviorally exposed adolescents. It is anticipated that this Toolkit will be used in tandem with the Technical Brief, Transitioning of Care and Other Services for Adolescents Living with HIV in Sub-Saharan Africa, which provides a framework for transition and outlines essential care, support, and treatment services to best meet the multiple unique needs of this population. CCPs and HCPs who use this Toolkit can work with the adolescent and his or her family/caregiver to develop a package of services that are individually tailored to meet the needs of the adolescent in a developmentally appropriate manner.

Among children known to be living with HIV, the transition process should begin in preadolescence with a transition plan developed and reviewed—at minimum—annually. Included in this Toolkit is information and tools that CCPs and HCPs can use to develop a minimum package of services for their clients that includes psychosocial support; mental health; sexual and reproductive health (SRH); protection; alcohol and substance use; beneficial disclosure; loss, grief, and bereavement; positive living; clinical considerations; and linking health facilities and community programs. Utilization of these components will provide for a more holistic and smooth transition process. The Toolkit for Transition of Care and Other Services for Adolescents Living with HIV allows the adolescent and the family/caregiver to participate and guide the transition process based upon the adolescent’s readiness. In addition, it allows the HCP/CCP to support the adolescent during the transition process to maximize resiliency, minimize risk factors, and promote positive personal growth.