7. HIV across the life course

Transition of care from paediatric to adult services

• All young adults and adolescents living with HIV should have an individualised transition plan in line with national guidance.

• Services caring for adolescents living with HIV require a named lead for transition in both paediatric and adult care.

• Adolescents living with HIV should meet their adult healthcare providers prior to transfer.

• Prior to transfer each adolescent requires a comprehensive medical and psychosocial summary.

Access to care

• Clinics providing care to young adults and adolescents living with HIV should meet ‘You’re Welcome’ accreditation standards.

• Clinics should be provided at convenient times, including clinics after school, college or work, and in easily accessible locations if possible.

• Feedback about the service should be actively sought and should be acted on.

• Young adults and adolescents living with HIV should have access to mental healthcare including psychological support.

• Young adults and adolescents living with HIV should have access to peer support, whether directly provided within clinic or through referral to external agencies.

Sexual health

• Young adults and adolescents living with HIV should have access to sexual health and contraception services within clinic or via agreed referral pathways to these services.

• Young adults and adolescents living with HIV should be assessed at least annually for signs of sexual exploitation and other vulnerabilities in line with above recommendations.

• Young adults and adolescents should be taught how to protect themselves and others from acquiring STIs. This should include discussions regarding ART as prevention, including discussion that a person living with HIV who is on ART and has achieved an undetectable viral load in their blood for at least 6 months cannot transmit HIV to their sexual partners (see Standard 1b).

• Young adults and adolescents should be informed about the indications for postexposure prophylaxis (PEP) and pre-exposure prophylaxis (PrEP) in sexual partners, for example, where adherence is suboptimal or viral load is detectable.

• Young adults and adolescents living with HIV should be made aware of the legal position in relation to HIV transmission, and how to protect themselves from prosecution, this should occur (and be documented) at the time of their initial diagnosis and subsequently as indicated.

Management of ART

• Young adults and adolescents living with HIV require optimisation of bone health with vitamin D measurement and supplementation and substitution of tenofovir with abacavir, if HLA-B*5701 and resistance assays allow, or with tenofovir alafenamide (TAF) as per NHS England guidance (www.england.nhs.uk/wp-content/uploads/2017/03/f03-taf-policy.pdf). Young adults and adolescents living with HIV require optimisation of mental health and avoidance of ARV agents associated with CNS toxicities is recommended.

• Regimens with high a genetic barrier to resistance should be considered for young adults and adolescents living with HIV initiating or restarting therapy.

• Young adults and adolescents living with HIV should have documented adherence assessment at each clinic and access to adherence support.