DSD in action: Adolescent transitioning clubs in Eswatini

To support adolescents who are ageing into adulthood, the Eswatini Ministry of Health included “transitioning clubs” in their 2022 guideline update. Transitioning clubs are for adolescents and young adults, aged 16-24 years, and have the same ART refill and clinical review frequency as clubs for adults.

We spoke with Florence Anabwani, Baylor Foundation Eswatini, Eswatini, about the Adolescent Transition Program supported by her organization. 

Florence, what is the overarching goal of the Adolescent Transition Program?

The objective of the programme is to ensure a seamless transition from paediatric to adult healthcare services for adolescents living with HIV. This is crucial because as adolescents grow older, their healthcare needs evolve and they must be prepared to manage their HIV independently. The successful implementation of an Adolescent Transition Program includes a multidisciplinary approach that addresses medical, psychosocial and educational needs of these clients.

Can you provide some detail on the composition of the team?

Our adolescent transition team comprises a team of paediatricians, general practitioners, HIV specialists, public health specialists, nurses, social workers, mental health professionals and adolescents living with HIV who have successfully navigated the transition themselves. This multidisciplinary team supports a comprehensive programme that covers all aspects of the transition, including medical, social, psychological and financial considerations. The team members collaborate to ensure a smooth transition process for each adolescent that is adapted according to their unique needs.

How do you identify clients for the transition programme and assess their service needs?

With our monitoring and evaluation team, we identify clients who are approaching the age where a transition to adult services will be necessary. These clients are then assessed to determine their readiness for transition, taking into account their cognitive maturity, full disclosure, emotional stability, adherence to medications, self-management skills, support systems and understanding of their diagnosis and the necessary management strategies. Further evaluations are done during teen club meetings and Camp Sibancobi.

Can you provide some detail on the education and skills-building activities of the programme?

Through peer educators, we provide age-appropriate education tailored to adolescents’ cognitive and emotional development, focusing on topics such as HIV management, sexual health and stigma. In addition, we offer skills training to help them manage their HIV as adults. This training includes information on the progression of HIV, the importance of medication adherence, potential side-effects of medications, and recognizing and managing symptoms of treatment failure. It involves skill-building sessions on making appointments, filling prescriptions, understanding health insurance (for those who can afford it) and advocating for oneself in a healthcare setting. Through our young adult support group, we also empower the adolescents with income-generating skills.

How does the programme facilitate the transition to adult services?

The programme is envisioned to gradually increase the adolescents’ independence (through attending appointments with a peer navigator, community adherence tracker, transition coordinator or nurse) to attending appointments alone but with the coordinator available for questions and, finally, attending appointments independently.

Once the multidisciplinary team feels that the adolescent or young adult is ready, the client selects a healthcare facility of their preference and the team facilitates linkage and transition to adult services. This involves a telephonic handover call during which the Baylor Clinic team introduces the client to the adult team and discusses their history and needs. We also mobilize resources to provide ongoing support or follow up to ensure that the transition is successful.

How do you evaluate the programme?

We continuously evaluate the programme by tracking key indicators such as appointment attendance, medication adherence and health outcomes. Through follow-up calls, we follow transitioned clients. Future evaluation could involve surveys or interviews with clients who have gone through the programme, as well as data analysis on outcomes such as medication adherence, HIV viral load and engagement with care.