Table 2

Global themes with 12 subthemes

Overarching themeSubthemesRecommendations
Clinical milestones1. Puberty, reproductive health

  • (studies 9, 6 and 5).


2. Individualised transition timing

  • (studies 4 and 10).

HCT should be timed based on reaching appropriate clinical milestones from both the provider and patient perspectives, including physiological changes such as puberty, but also other clinical milestones including understanding of one’s disease.
Adolescent-Responsive Health System Chang3. Community adolescent-responsive health system

  • (studies 2, 5 and 8).


4. Transition timing

  • (studies 4 and 10).


5. Proximity to care

  • (study 6).


6. Poverty driven obstacles

  • (studies 1, 2, 6 and 8).


7. Need for health system strengthening, with unmet services

  • (studies 1, 6 and 5).

Successful HCT must address multiple structural barriers that adolescents have to care, including proximity to healthcare facilities, disparity in policy and funding in care, stigma, tribalism and racism.
Social and financial capital in transition8. Resilience tools and education

  • (studies 2, 3, 5 and 10).


9. Peer support

  • (study 4).


10. Mental health comorbidity

  • (study 1).


11. Financial empowerment and employment

  • (studies 2, 3, 6 and 8).

Successful HCT should have a holistic approach and should build social and emotional support, as well as address financial empowerment to aid adolescents in becoming self-sufficient.
Culturally sensitive measurement, evaluation and validation12. Language validation of surveys

  • (study 7).


13. Measurement and evaluation of programme implementation

  • (study 6).

In resource-denied settings, particularly with culturally and linguistically diverse patient populations, equitable approaches to data collection and analysis are necessary to capture all perspectives of vulnerable groups. Specific considerations to maximise diversity in sampling approaches, and the use of evaluation frameworks that allow for flexible exploration of context-specific nuances are important. More non-English language survey validation and rigorous RCTs are needed in LMICs, despite successful precedents.

  • HCT, healthcare transition; LMICs, low-income and middle-income countries; RCT, randomised controlled trial.