IntroductionAdolescents living with HIV (ALHIV) face unique psychosocial and structural challenges affecting ART adherence and engagement in care. Despite Zambia's expansion of adolescent-friendly HIV services, adolescents continue to experience poorer adherence and treatment outcomes than adults, including lower viral suppression and retention in care and limited understanding remains around the experiences of ALHIV and their caregivers. This study explored multilevel factors influencing ART adherence in Lusaka district from the perspectives of ALHIV and their caregivers.MethodsWe conducted an exploratory qualitative study on psychosocial, behavioral, and structural factors influencing ART adherence and experiences of HIV services among ALHIV in Lusaka, Zambia. Between February and July 2025, 35 in-depth interviews (20 ALHIV who were already aware of their HIV status and engaged in long-term care and 15 caregivers) were conducted across six health facilities (four PHC and two first-level facilities). Interviews were held in English or Nyanja, audio-recorded, transcribed, and analyzed using ATLAS.ti v24. A hybrid inductive-deductive approach, informed by the socioecological model, guided coding. Themes were organized in an analytical matrix showing multilevel influences on adherence, including emotional burden, stigma, support systems, and structural barriers. Trustworthiness was ensured through triangulation, peer debriefing, and iterative codebook development.ResultsThe themes identified spanned intrapersonal (individual), interpersonal, organizational/institutional, community, and structural/policy-level factors influencing ART adherence, alongside participant-generated cross-cutting recommendations to strengthen adolescent HIV service delivery. Many adolescents struggled with stigma, emotional distress, and challenges of consistent medication adherence, while others adapted through acceptance, spirituality, and counseling. Supportive relationships with family, peers, and healthcare workers fostered adherence, but stigma, school challenges, inconsistent caregiving, and limited privacy remained significant barriers. Socioeconomic issues, such as transport costs, hindered treatment continuity. Helpful strategies included routine-building, reminders, and increased health literacy. Participants recommended improving adolescent-friendly services by integrating mental health support, strengthening provider communication, expanding peer networks, and reactivating support groups to better support ART adherence among ALHIV.ConclusionAddressing psychological, social, service delivery, and structural barriers such as coordination between schools and the health system is vital to improving ART adherence among ALHIV in Zambia. A multilevel approach is needed to support sustainable treatment outcomes.

Adolescents living with HIV (ALHIV) in Zambia experience poorer treatment outcomes than adults, with lower viral suppression and higher loss to follow-up rates. Electronic medical record (EMR) systems such as SmartCare aim to strengthen patient monitoring, but their utility is contingent on high data quality. Accurate monitoring of ALHIV treatment outcomes is critical for improving patient care and supporting progress toward UNAIDS 95–95-95 targets. We conducted a retrospective cross-sectional review of EMR data for ALHIV on antiretroviral therapy in selected Lusaka facilities (January–December 2023). Data were extracted from SmartCare and assessed using the WHO Routine Data Quality Assessment framework across three dimensions: completeness, correctness, and consistency. Records from 3,978 ALHIV were analysed. Socio-demographic variables (gender, date of birth, age at ART initiation) and treatment data (ARV regimen) performed strongly, with ≥98% completeness, correctness, and consistency. In contrast, clinical variables showed substantial gaps. Completeness for baseline (n = 1,707) and current (n = 2,149) CD4 counts was 43% and 54%, respectively, though correctness and consistency exceeded 99%. Pregnancy and breastfeeding data among female adolescents (n = 2,177) were particularly poor, with completeness of 4% and 12%. By comparison, history of tuberculosis (100%) and current viral load results (91%) were reliably captured. Whereas SmartCare demonstrated strong reliability for demographic and treatment indicators, notable weaknesses in the completeness of key clinical variables, such as CD4 count and pregnancy/breastfeeding status were observed. These gaps may reflect variability in data entry workflows and system-level factors, including EMR upgrades, highlighting areas for targeted improvement. We recommend targeted training, system redesign to enforce mandatory entry of critical fields, and routine data quality monitoring to ensure EMR systems provide accurate and actionable data. Addressing these gaps would facilitate optimising HIV care and support progress toward achieving the UNAIDS 95–95-95 goals for ALHIV in Zambia.

Background:The coronavirus disease 2019 (COVID-19) pandemic disrupted healthcare systems, posing risks for adolescents living with HIV (ALHIV) in resource-limited, high HIV-prevalence settings. These disruptions threatened antiretroviral therapy (ART) adherence, viral load suppression (VLS) and retention in care (RiC). Aim:This study aimed to compare treatment outcomes of ALHIV on ART in the Khayelitsha and Eastern Substructure (KESS) before and during the COVID-19 pandemic. Setting:The study was performed in KESS, Cape Town, South Africa. Methods:A retrospective cohort analysis was conducted among ALHIV aged 10-19 years receiving ART at public health facilities, pre-COVID-19 (before 01 March 2020) and during COVID-19 (01 March 2020-31 December 2021). Sociodemographic, clinical, and treatment data were analysed. Descriptive and inferential statistics compared outcomes and determined factors associated with VLS (< 1000 copies/mL) using SPSS v.30. Results:Data from 1702 ALHIV (pre-COVID-19) and 2733 ALHIV (during COVID-19) were analysed. Viral load suppression declined from 82.1% to 64.8%, while full VLS (< 50 copies/mL) from 70.8% to 53.7% (p = 0.065). Antiretroviral therapy adherence fell from 96.4% to 70.0% (p < 0.001), and RiC 80.3% to 76.3% (p < 0.001). In multivariate analysis, higher CD4 count, and consistent ART adherence predicted VLS. Conclusion:Antiretroviral therapy adherence and VLS rates among ALHIV declined during COVID-19. Adolescent-centred healthcare delivery models are needed to ensure continuity of HIV treatment during public health emergencies. Contribution:This study provides local evidence on the pandemic's impact in a high-burden South African context. By quantifying declines in ART adherence, RiC, and VLS, it highlights ALHIV vulnerabilities and the need to strengthen adolescent-responsive, resilient healthcare systems.

Universal Health Coverage (UHC) is the cornerstone of equitable health systems and service delivery. Achieving UHC requires both "whole of government" and "whole of society" approaches that are vital for building resilient health systems that promote physical and mental wellness for all communities. In this paper, we review several theories of stakeholder engagement (SE) and argue that meaningful SE-as opposed to stakeholder management-is essential for fostering early participation and democratic decision-making in the transformation of health systems towards UHC. We recommend several key steps to promote early and inclusive SE that actively solicit input from diverse community members, establish open platforms for dialogue, and leverage the expertise and resources of various sectors. By creating a collaborative environment that includes each individual, whether an educator, policymaker, family member, or business leader, amongst others, we can advance the goals of UHC and build health systems that benefit everyone.

Background: Adolescents living with human immunodeficiency virus (HIV) face disproportionately poor treatment outcomes because of a combination of psychosocial, structural and health systems challenges. Despite efforts to implement adolescent-friendly and differentiated service delivery models in Zambia, gaps remain in the organisation and delivery of care. Aim: This study aimed to explore how HIV services for adolescents are delivered and experienced by healthcare workers and programme managers in Lusaka District. Setting: The study was conducted across six health facilities in Lusaka District, Zambia, representing different levels of the health system and providing HIV care to adolescents. Methods: A descriptive qualitative design was employed. Thirty purposively selected participants (24 healthcare workers and six HIV programme managers) participated in individual in-depth interviews (IDIs) conducted between 20 February 2025 and 30 April 2025 using a semi-structured interview guide. Data were audio-recorded, transcribed verbatim and analysed using inductive content analysis. Results: Inductive content analysis identified three themes: programmatic responses, highlighting strategic leadership, policy direction, adolescent-focused service delivery and workforce capacity building; implementation challenges, including inadequate infrastructure, health system limitations and individual-level barriers; and opportunities for improved programmatic response and service delivery, emphasising improvements in policy, health systems, infrastructure and service delivery. Conclusion: Although notable progress has been made in expanding adolescent HIV services in Lusaka, gaps in infrastructure, workforce and social support continue to affect programme effectiveness. Strengthening adolescent-responsive and sustainable care is essential to improve retention, viral suppression and Zambia’s progress towards the Joint United Nations Programme on HIV/AIDS (UNAIDS) 95-95-95 targets in the adolescent HIV cascade. Contribution: This study highlights barriers and opportunities in adolescent HIV programming in Lusaka, emphasising leadership, policy, service delivery and workforce capacity, while noting ongoing system and individual challenges. The findings can inform policy and practice to strengthen adolescent-responsive HIV care in Zambia and similar contexts.

Adolescents and youth living with HIV (AYLHIV) face increased health risks and need targeted support to optimally engage in treatment. The Supporting Adolescents to be Resilient and Thrive (S-SMART) programme is a digitally enabled, peer-supported self-management intervention designed to enhance psychosocial and treatment engagement outcomes among AYLHIV. This pilot study evaluated the feasibility and acceptability of S-SMART among AYLHIV aged 15-21 years who received HIV treatment at two public primary care clinics in the Cape Town Metropole, South Africa. Thirteen AYLHIV received smartphones, mobile data, and access to the S-SMART app from September to December 2024. The pilot programme for S-SMART included activities, peer group sessions, and coaching by four peers living with HIV. Focus groups were conducted before (n = 17) and after (n = 12), to assess usability and their user experiences. Activity and programme completion was > 95%. Participants found the app user-friendly overall, though some faced issues with navigation, language and understanding certain content. Engagement was strengthened through peer support and facilitation. While the programme promoted psychosocial empowerment, HIV-related challenges such as stigma and disclosure fears need ongoing support.

BACKGROUND/OBJECTIVES:Adolescents living with HIV (ALHIV) face compounded health and psychosocial challenges while managing lifelong antiretroviral therapy (ART). Mental health difficulties among ALHIV are strongly associated with suboptimal adherence and disengagement from care. While mental illness is well documented, limited empirical evidence exists on the influence of positive mental wellness on adherence self-efficacy among ALHIV. This study assessed mental wellness among ALHIV and identified key psychosocial predictors of adherence self-efficacy in public healthcare facilities in Cape Town, South Africa. METHODS:A cross-sectional survey was conducted among ALHIV (N = 251) aged 10-19 years who were receiving ART at public healthcare facilities across the Cape Town metropole. Participants completed an electronic questionnaire that assessed ten mental wellness domains and adherence self-efficacy. Descriptive statistics were calculated to summarise participant characteristics and mental wellness scores, while Pearson correlations and multiple linear regression were done to identify associations and independent predictors of adherence self-efficacy using SPSS v29. RESULTS:Most participants were aged 15-19 years (76.9%) and diagnosed with HIV at birth (68.9%). Mental wellness scores were high across all domains (M = 3.14-3.71). Hope (M = 3.71), spirituality (M = 3.58), and purpose in life (M = 3.52) were the highest-rated domains. All mental wellness domains were positively correlated with adherence self-efficacy (p < 0.001), with the strongest associations being purpose in life (r = 0.66), self-acceptance (r = 0.66) and resilience (r = 0.66). Hope (p < 0.001), resilience (p = 0.001), purpose in life (p = 0.03) and self-acceptance (p = 0.012) emerged as significant independent predictors. CONCLUSIONS:Positive mental wellness and adolescent-centred psychosocial support in routine HIV care may strengthen adherence self-efficacy and support adolescents' confidence in managing treatment.

Adolescents living with HIV (ALHIV) face ongoing challenges with treatment adherence and engagement in care, resulting in lower viral suppression rates compared to adults. Peer navigation has shown promise in supporting psychosocial well-being and adherence among adults, but evidence specific to adolescents in sub-Saharan Africa (SSA) remains limited. This qualitative evidence synthesis (QES) describes and assesses the quality of qualitative and mixed-methods studies on peer navigation and support interventions for ALHIV receiving antiretroviral therapy in SSA. Eligible studies, published in English between January 2015 and October 2025, were identified through a comprehensive search strategy in PubMed, Scopus, CINAHL, and APA PsycArticles. Data were extracted and analyzed thematically using Atlas.ti, and aligned with the Context-Intervention-Mechanism-Outcome (CIMO) framework. PNs in the studies were young people living with HIV who provided education, counselling and adherence support to their peers who were ALHIV. Effective programmes featured structured training, supportive supervision, and flexible delivery models adapted to adolescents' preferences. Mechanisms of change included trust-building, emotional support, disclosure coaching and empowerment. Reported outcomes included improved adherence, clinic attendance and various psychosocial indicators. However, challenges such as stigma, role ambiguity, limited remuneration, and lack of policy guidance constrained the sustainability and scalability of PN programs. Overall, peer navigation interventions appear effective in strengthening adolescent HIV care when PNs are adequately trained, supervised and contextually adapted. The variation in how peer navigation and support interventions for ALHIV are delivered and designed, along with the lack of standardization of the interventions, may affect the generalizability of the findings and the rollout of PN programs across SSA.

Background: Adolescents living with HIV (ALHIV) in low socio-economic contexts face challenges related to physical development and health, stigma, and economic instability. The onset of the COVID-19 pandemic exacerbated these vulnerabilities, impacting the physical, mental, and social well-being of ALHIV. ALHIV were positioned in a particularly precarious situation, requiring them to navigate the disruptions caused by the pandemic while simultaneously striving to maintain resilience and adherence to their antiretroviral treatment (ART). Objectives: To explore the resilience and vulnerability of ALHIV on ART in a peri-urban community in Cape Town, South Africa during the COVID-19 pandemic. Methodology: A participatory photovoice study was employed with 20 ALHIV aged 14 to 19 years. Participants received basic training on photography techniques and were asked to capture images representing their experiences during the COVID-19 pandemic. These photographs were shared and discussed in both individual interviews and group discussions. All interviews and discussions were audio-recorded, and the resulting transcripts were analysed using content analysis to identify key themes and insights. Results: Four key themes were identified: (1) disrupted routines and emotional strain, (2) support systems and coping mechanisms, (3) HIV treatment adherence facilitators and barriers, and (4) economic vulnerability and household stress. Despite the compounded challenges and significant hardships, ALHIV in this study demonstrated notable resilience, maintaining treatment adherence and a positive outlook despite economic struggles and social disruptions. Conclusions: This study highlights the resilience and vulnerability of ALHIV in resource-limited settings. Findings underscore the need for targeted mental health and social support interventions to address their unique vulnerabilities. Strengthening healthcare access, social support networks, and local community resources can improve the well-being and coping capacity of ALHIV in future crises.

Successful transition from paediatric to adult HIV care programme is a critical developmental milestone in the care trajectory of adolescents living with HIV (ALHIV). The transition process involves a shift from a structured, caregiver-supported healthcare model to one that requires independence and self-management. This process should be guided and supportive to ensure continued engagement in care and optimal adherence when ALHIV are transferred. This study utilised photovoice methods to explore the transition experiences of ALHIV in the Cape Town Metropole. Audio-recorded focus group data were transcribed verbatim and subjected to reflexive thematic analysis. Three distinctive patterns of behaviour from ALHIV were identified as themes. Type 1: socially reliant, dependent adolescent who heavily relies on family and peer support and struggles with adherence. Type 2: socially disconnected, hyper-independent adolescent , who is self-reliant, seeks solitude, and is generally resistant to external support. We configured a third (ideal) type, who is interdependent and able to self-manage their chronic condition, but within a supportive health care environment that provides positive healthcare and transition experiences. The findings underscore the need for supportive transition models promoting self-management skills, while facilitating a symbiotic relation with healthcare staff promoting sustained engagement in care well into adulthood. We recommend that adolescent or youth friendly services for ALHIV be expanded to support and monitor the transition process and outcomes in the adult HIV program.

Background: Research involving adolescents living with HIV (ALHIV) is challenging, as adolescents often struggle with articulating their experiences, a difficulty further compounded by HIV-related stigma, particularly in African contexts. Photovoice methods offer a valuable participatory approach, engaging and allowing participants to express and share their stories through visual representation, amplifying their voices in research. Aim: The aim of this review is to map out and synthesise evidence on the use of photovoice methods in research with ALHIV in African contexts. Setting: All countries in the African region were included. Method: Eight electronic databases (ERIC, Ebscohost, PubMed, SCOPUS, CINAHAL, PsycINFO, CABI Direct and Africa Index Medicus) were searched to identify articles that used photovoice methods with ALHIV in Africa to publish between 2000 and 2024. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) flowchart guided the screening and reporting of articles, with a narrative synthesis conducted. Results: Three key themes emerged in this review: resilience, personal challenges and environmental factors faced by ALHIV. Despite its strengths as a participatory approach, photovoice methods remain underutilised in research involving ALHIV in African contexts. Conclusion: This review demonstrates that high-quality photovoice studies can be effectively implemented in research with ALHIV in resource-constrained African settings with high HIV prevalence and stigma. Photovoice offers valuable insights to inform interventions aimed at improving the treatment outcomes and mental well-being of ALHIV, enhancing the relevance of such initiatives in these contexts. Contribution: These findings can further inform policies and interventions aimed at the care, well-being and treatment outcomes of ALHIV within African countries.

Background: In 2023, an estimated 39.9 million people globally were living with HIV, of which 1.55 million were adolescents aged 10–19 years. The 2021 Zambia HIV Impact Assessment revealed lower viral suppression rates in adolescents (15–24 years old) compared to adults on antiretroviral therapy (ART). Lusaka District, Zambia, has the highest number of adolescents on ART, with a 15.1% HIV prevalence in 2018. Objectives: To determine the prevalence and factors associated with viral suppression among adolescents living with HIV (10–19 years) on ART in Lusaka District, Zambia. Method: A retrospective cohort analysis was done of 3409 adolescents on ART at public health facilities in Lusaka from January 2023 to December 2023, and who had viral loads recorded. Socio-demographic, clinical, treatment and behavioural data were extracted from electronic health records and analysed using SPSS version 29. Results: The adolescent cohort in Lusaka achieved 91.8% viral suppression rate ( 1000 copies/mL), with 79% fully suppressed ( 50 copies/mL). In multivariate analysis, older adolescents (15–19 years) had lower odds of suppression compared to younger adolescents (10–14 years) (adjusted odds ratio [AOR] = 1.79; confidence interval [CI] : 1.32–2.43). Higher odds of viral suppression were linked to first-line dolutegravir regimen (AOR = 5.12; CI: 3.23–8.11) and optimal adherence (AOR = 1.89; CI: 1.03–3.47), while regimen switches reduced the odds of viral suppression (AOR = 0.60; CI: 0.45–0.80). Conclusion: Zambia reached the previous UNAIDS 90-90-90 targets with a viral suppression rate of 91.8%. However, to reach the revised 95% target by 2030, tailored interventions should be implemented to improve adherence and retention in care, particularly for older adolescents.

(1) Background: Globally, an estimated 1.7 million adolescents (aged 10–19 years) were living with HIV in 2023, with 82% residing in sub-Saharan Africa. For ALHIV, transitioning to adult care involves assuming responsibility for their own health and disease management, posing significant challenges to persistent engagement in care. There is a paucity in health policies guiding this transition in many sub-Saharan African countries. Overburdened and poorly functioning health systems struggle to provide optimal care for ALHIV amidst the rising HIV pandemic in this priority population. (2) Methods: This study employed a mixed-methods design, comprising a descriptive qualitative study with healthcare workers and managers and a cross-sectional survey to examine the practices and pathways in which the transition to adult HIV care occurs in the Cape Town Metropole, South Africa. (3) Results: We delineate three distinct ways in which transition occurs (transfer-only, adolescent-friendly, and supportive transition). A successful transition involves a sufficient level of self-management of their chronic condition and healthcare journey, which is preceded by adequate preparation pre-transition, and the monitoring of engagement post-transition. This ideally requires developing relevant health policies and implementing guidelines signaling political will and providing the impetus and agency of implementation at the service level in South Africa.

Despite significant advances in HIV treatment regimens, adolescents living with HIV (ALHIV) report lower rates of viral suppression compared to other age groups, reflecting sub-optimal adherence and lower engagement in care. In Zambia, adolescents lag behind in meeting the 95-95-95 targets for HIV care, when compared to adults. It is imperative that the specific needs of ALHIV are addressed in health policies that direct service delivery. This paper reports on Zambian health policies (policy documents and guidelines) that direct the provision of HIV care and treatment services for ALHIV, by assessing their alignment with recommendations for global best practice as presented in global health policies. We contextualize the policy review within the problem that exists in Zambia with respect to poor performance of the adolescents on the HIV cascade. We conducted a document review of national health policies and guidelines (N = 10) that relate to HIV service delivery for ALHIV in Zambia and assessed these against the global health policies (N = 6) of which Zambia is a signatory using the four-step READ methodology for document review in health policy research. We used thematic content analysis to develop key themes that describe the components of health service delivery according to the World Health Organization’s (WHO) health systems framework, and comparative analysis to map national health policy against global health policies. The Zambian policies are aligned with global recommendations for health service delivery for ALHIV by including psychosocial support, peer support, mental health services and sexual and reproductive health education in their offering. In addition, Zambian health legislation advocates for a change in the age of consent for health services and comprehensive sexual education in schools, as globally recommended. However, there is a lack of deliberate involvement of adolescents, caregivers and community stakeholders in policy development. With respect to health financing, the national policies promote the integration of HIV financing with other health financing mechanisms but lack dedicated funding for adolescent HIV services. While community involvement is emphasised through youth advisory boards, training, and support groups, there is a notable absence of intentional adolescent engagement at the high-level program design stage. Zambian health policies and guidelines align with global recommendations to optimize health service delivery for ALHIV in four of the six WHO Health Systems building blocks, as evidenced in the relevant global health policies. However, significant gaps remain in areas such as health legislation, financing and community engagement.

Background Retention in antiretroviral therapy (ART) is crucial for adherence, viral suppression, and preventing drug resistance. Adolescents (10-19 years) face retention challenges, affecting progress toward 95% viral suppression. Data on retention for this specific age bracket remains limited in Zambia.Methods A retrospective cohort analysis of 3978 adolescents on ART in Lusaka examined socio-demographic, clinical, treatment, and behavioral data. Kaplan-Meier estimates analyzed retention, and Cox regression identified associated factors using SPSS v29.Results Seventy percent remained in care, while 30% had interruptions, transfers, or death. Females (57.1%) had a higher non-retention risk (aHR: 1.21 [1.08-1.36]). Retention was lower in older adolescents (15-19 years, aHR: 0.11 [0.10-0.13]). Retention increased with early ART initiation with those starting ART at 15 to 19 years showed lowest retention (aHR: 578.50 [421.00-794.91]). Not changing ART regimens decreased retention (aHR: 0.88 [0.77-0.99]).Conclusions Targeted interventions should prioritize females, older adolescents, early ART initiation, and regimen changes.

Adolescents living with HIV (ALHIV) (10–19 years) make up approximately 4.2% (320,000) of people living with HIV in South Africa. Adolescence is a developmental period characterized by pervasive biological, social and psychological changes, which challenges adherence and retention in care for ALHIV on antiretroviral therapy (ART). Further, as ALHIV grow “older”, they are expected to transition to the adult HIV treatment programme, where they should assume greater responsibility for managing their chronic condition and healthcare pathway. Whereas it is imperative that ALHIV are transitioned when they are ready, little is known about the challenges and experiences of ALHIV before and during transition. The aim of this paper was to report on the experiences and challenges of transition for ALHIV who received ART at an adolescent-friendly service that is adjunct to a public primary healthcare facility in the Western Cape province of South Africa. Methods: Photovoice methods were employed to explore the transition experiences of ALHIV on ART at a “supportive transition” public health facility in the Cape Town Metro in South Africa. Participants took pictures that depict their experience pre- and during transition to adult care and discussed these in groups with peers. Audio data were digitally recorded and transcribed verbatim and subjected to thematic analysis using Atlas.Ti version 24. Results: The emergent themes described their apprehension to transitioning to adult care; self-management; challenges to adherence; the need for psychosocial support; and how adolescent-friendly services were filling the gap. Conclusions: We illuminate the “I-We-I” configuration, to reflect (the first “I”) individual ALHIV experiences as isolated before being transferred to the supportive facility; how they experience a sense of belonging and family (“we”) in the supportive facility; but face apprehension about transitioning to adult care in the local clinic, where they have to self-manage (final “I”).

Introduction Adolescents living with HIV (ALHIV) on antiretroviral therapy (ART) globally report lower rates of viral suppression because of challenges to remain adherent and engage in HIV treatment. Psychosocial support is critical to meet the unique needs of ALHIV. Peer navigation has been found to be effective in supporting adults in ART adherence, but the evidence for adolescents is scant. Given the large proportion of adolescents on ART in sub-Saharan Africa, peers hold promise to deliver psychosocial support. The aim of this qualitative evidence synthesis is to review qualitative and mixed-methods studies describing experiences of peer navigation and support interventions for ALHIV on ART in sub-Saharan Africa.Methods and analysis The population–concept–context configuration will be applied to identify suitable studies on ALHIV and on ART (population) and experiences of peer navigation and support (concept) and conducted in sub-Saharan African countries (context). The review will only include studies published in the English language. The following databases will be searched: PubMed, Wiley Library Online, EbscoHost (PsycArticles), MEDLINE, Scopus, CINAHL, WHO database and Google Scholar, for eligible qualitative studies published from January 2015 (to ensure relevance) to November 2025. Two-stage screening will be done by two reviewers independently. Extracted data will be thematically analysed with Atlas.Ti (v25) software. A narrative synthesis will be conducted to describe the reported outcomes, experiences and challenges with receiving and delivery of peer navigation and support interventions in sub-Saharan Africa. The review will adhere to Preferred Reporting Items for Systematic reviews and Meta-Analyses and Enhancing Transparency in Reporting the Synthesis of Qualitative Research reporting guidelines.Ethics and dissemination Ethics approval is not required for this qualitative evidence synthesis. The findings will be submitted to a peer-reviewed journal and disseminated to via conference proceedings.PROSPERO registration number CRD42024541951.

Background: Adolescents living with human immunodeficiency virus (HIV) aged 10–19 years account for 1.7 million globally, with 82% residing in sub-Saharan Africa. Older adolescents (15-19 years) assume greater responsibility for their own care, often leading to reduced adherence, lower retention, and poorer health outcomes. Understanding the role of healthcare workers (HCWs), key stakeholders in the HIV care continuum, is essential to strengthening transition practices and health system responses. Aim: To describe HCWs’ perspectives on transition practices for adolescents living with HIV in the Cape Town Metropole, South Africa. Setting: Six public primary health facilities in the Cape Town Metropole, South Africa. Methods: A descriptive qualitative design was used. Data were collected through in-depth, semi-structured interviews with 16 HCWs and analysed thematically. Results: Healthcare workers identified challenges to optimal transition (theme 1), including delayed disclosure, low adolescent readiness, and inconsistent transition processes. Health service responses (theme 2), such as youth clubs and provider-adolescent relationships, were supportive but unevenly applied. Gaps and recommendations (theme 3) included improving youth club management and ensuring system-wide support to enhance engagement and continuity of care. Conclusion: Successful transition to adult HIV care requires structural and psychosocial support mechanisms. Healthcare workers play a critical role and should be supported to consistently implement adolescent-friendly services during and post-transition. Contribution: This study offers system-level insights to inform policy, HCW training, and integrated models of care tailored to adolescents living with HIV in primary health settings in South Africa.

The national prevalence of HIV among adults in Zimbabwe was 10.4% in 2023, while the HIV prevalence in Bulawayo Metropolitan Province was 11.7%. The country achieved the UNAIDS Fast Track goals of 95-95-95 ahead of the 2030 target, by reporting an ART coverage of 97.0% and a viral suppression rate of 95.0%. As the number of people on ART continues to grow, it is expected that the number of patients failing current first-line non-nucleoside treatment will increase. However, access to second-line treatment regimens remains very limited in resource-poor settings such as Zimbabwe. It is therefore imperative to review treatment success for persons on second-line treatment. A retrospective cohort analysis was conducted using routinely collected clinical and demographic data from 315 participants who had been on a second-line ART regimen in Bulawayo for at least six months between 2015 and 2020. Statistical analyses were conducted to identify risk factors for viral suppression using SPSS version 28. Viral suppression (68.6%) for adults was far below the target of 95%. After accounting for all other variables, baseline CD4 count (>200 c/µL) [AOR = 1.94 (1.05-3.61)], having no history of non-adherence on first-line ART [AOR = 3.88 (1.91-7.85)], drug switch within 12 months of failure [AOR = 4.13 (1.98-8.60)] and retention in care at 5 years [AOR = 6.35 (2.56-15.76)] predicted viral re-suppression. The second-line (rescue) regimen has not achieved the expected success in reversing initial viral non-suppression (due to late presentation and poor adherence), despite enhanced adherence counselling. Timely switching is effective when done within 12 months and coupled with persistent engagement in care. We recommend improved methods, such as enhanced adherence counselling for behaviour change to improve viral re-suppression rates, especially for those on with a history of poor adherence and virologic non-suppression.

The successful roll-out and improved delivery of antiretroviral therapy (ART) services has led to paediatric HIV patients surviving to reach adolescence. Adolescents living with HIV (ALHIV) are challenged when transitioning to adult HIV care programmes where they must negotiate new care pathways, changes in healthcare providers and self-manage their chronic condition, in addition to dealing with the psychological and physiological developmental changes of adolescence. The transition process needs to be well guided, to ensure that ALHIV on ART maintain optimal adherence and remain engaged in care. Viral suppression and retention in care are significantly lower for older adolescents (15–19 years) compared to children and younger adolescents under 15 years – coinciding with the post-transition period. Comprehensive and structured transition protocols may have a significant impact on positive health outcomes. In sub-Saharan Africa, there is a dearth of policies and implementation guidelines for ALHIV who are transitioning to adult HIV care. The current review reports on policies and guidelines for transitioning ALHIV to adult HIV care in South Africa. Eight policies were identified, which were developed at global (n = 2), national (n = 2) and provincial levels (n = 1), and guided implementation (n = 3). Current national and provincial policies provide guidance on when to transition a patient clinically to facilitate the switch to adult ART regimens. Although global policies and implementation guidelines emphasise specific and comprehensive care for ALHIV on ART, these are not carried over to national and provincial policies in South Africa. Further development of policies is required to guide comprehensive, adolescent-friendly transition processes for ALHIV on ART in South Africa.