article · HIV/AIDS - Research and Palliative Care
Adolescents in sub-Saharan Africa are frequently overlooked in strategies addressing advanced HIV disease, falling into a missing middle between paediatric and adult healthcare services. Although testing and antiretroviral therapy have advanced, young people face heightened vulnerabilities driven by treatment interruptions, fragmented healthcare delivery, psychosocial difficulties, and inadequate follow-up. To tackle these challenges, an adolescent-responsive care pathway centres on three main priorities. These comprise the early identification of individuals at risk of severe disease, the integration of clinical management with psychosocial support, and the provision of continuous care following hospital discharge or treatment breaks. Implementing this approach requires adaptation to local workforce limitations, financial resources, technology, and broader health-system capacity, ultimately aiming to curb preventable illness, lower mortality rates, and enhance long-term treatment retention and patient recovery.
Adolescents living with advanced HIV often fall through systemic cracks between child and adult healthcare systems. Addressing their unique clinical and emotional needs through integrated care models is vital for preventing avoidable deaths, maintaining treatment consistency, and ensuring that young people in sub-Saharan Africa survive and transition successfully into healthy adulthood.
The proposed care pathway represents an early-stage conceptual health-systems framework rather than a commercial product. Potential implementation pathways could involve public health authorities, non-governmental organisations, and clinical service providers seeking to adapt diagnostic tools, care integration protocols, and post-discharge tracking technologies to local health systems. However, the abstract does not indicate any immediate commercial application or market-ready solution.
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Abstract: Adolescents remain insufficiently addressed in the response to advanced HIV disease (AHD) in sub-Saharan Africa. Despite progress in HIV testing and antiretroviral therapy, gaps remain in early identification, integrated care, and continuity of care for adolescents at risk of severe disease. This commentary describes adolescents as a "missing middle” between pediatric and adult HIV services. It highlights how treatment interruption, fragmented services, psychosocial challenges, and weak follow-up can increase their vulnerability. We propose an adolescent-responsive AHD pathway focused on three priorities: early identification of adolescents at risk, integration of clinical and psychosocial care, and continuity after hospitalization or treatment interruption. The approach should be adapted to the available workforce, financing, technology, and health-system capacity. Strengthening these areas may help reduce preventable illness and deaths and improve retention and recovery among adolescents living with HIV in sub-Saharan Africa. Keywords: advanced HIV disease, adolescents, HIV, integrated care, sub-Saharan Africa, continuity of care
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DOI: 10.2147/hiv.s632486
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