“ <i>I feel like a guest on the other side</i> ”: youth-identified challenges and solutions to transitioning from adolescent to adult HIV services in Western Kenya

Adolescents and young adults living with HIV (AYAH) face significant challenges when transitioning from adolescent to adult HIV services. Up to 50% of AYAH do not remain engaged in care after transition, which may result in virological failure. We sought to understand challenges to clinic transitions and youth-identified solutions to optimize health outcomes. We conducted three focus group discussions (FGDs) (<i>n</i> = 33) and a 4-day participatory, human-centered design (HCD) workshop as part of this qualitative sub study. AYAH recruited for FGDs between October and November 2020 were from health facilities in Kisumu County, Kenya. A subset of FGD participants and peer navigators were recruited for the HCD workshop. Participants were purposefully recruited to obtain diversity based on various demographic variables. We used a semi-structured guide covering HIV retention and clinic transition domains. The resultant audio files were transcribed, and transcripts analyzed inductively to identify emerging themes. During the HCD workshops, AYAH presented transition as a priority and engaged in journey mapping, story-telling and brainstorming to describe how transition happens, the challenges they experience and possible solutions. HCD analysis involved insight documentation, dialogue and rapid thematic analysis. AYAH who were between 14 and 24 years and were majority (56%) female, identified transition challenges including: limited knowledge about the transition process among providers; poor preparation for transition; complex organization and clinic flow in the adult HIV clinic; privacy and stigma concerns; challenging client-provider relationship dynamics; and concern for loss of relationships with peers. AYAH proposed approaches to improve the transition experience including early transition planning, peer transition support groups, peer-led transition, ongoing relevant health education during clinic visits and active support for acceptance of one's HIV status. AYA highlighted individual, provider and facility-level challenges with care transition. The solutions identified by AYAH can guide interventions to enhance HIV treatment engagement, including adherence and retention, during the critical transition period.<b>Trial registration:</b> ClinicalTrials.gov identifier: NCT04432571.