A qualitative exploration of a memory from youth that shaped women's current relationship with food.

With increased access to antiretroviral therapy, children living with HIV are surviving into adolescence and young adulthood (; ). For young people living with HIV (YLHIV), the transition from pediatric to adult healthcare services is a high-risk time for care disengagement, due to operational and emotional challenges (; ). Healthcare transition is defined as a purposeful movement of young people with chronic diseases from child to adult-oriented care (). Care interruptions between pediatric to adult HIV clinics during this transition can lead to adverse health consequences like worsening CD4+ T cell and HIV viral load, poor retention in care, new AIDS events (e.g., candidiasis, tuberculosis, pneumocystis jiroveci pneumonia, progressive multifocal leukoencephalopathy, or HIV wasting syndrome) and mortality (; ; ). Some explanations for these outcomes have focused on the developmental period of adolescence, ages 10–24 years (), which predisposes them to engage in behaviors that increase transmission risk, poorer reasoning and decision-making, and a sense of invincibility (). Several studies reported better outcomes among those who remained in pediatric HIV care until older ages (i.e. until 18 or 20 years) when compared to those who were transitioned out sooner (i.e. at 12 or 15 years) (; ; ). In Thailand, as of 2024, there were 27,000 adolescents aged between 15–24 years living with HIV, including those with perinatal and behaviorally-acquired HIV, in which 257 of them died (). Those who start HIV treatment in pediatric care will transition to adult HIV clinics in their late teens or early 20s (). A previous study in Thailand documented a mortality rate of 1.76 per 100-person years among YLHIV with a median age of 21 years, with 71% of them were those who already transitioned to adult care (). Another study demonstrated decreased rates of retention and virologic suppression among adolescents who transitioned from pediatric to adult HIV clinics at a median age of 20 years (). There is a need for more intentional approaches to transition that offer support for YLHIV to help minimize attrition rates, and ensure favorable health outcomes. The Thai National Access Antiretroviral Program for people living with HIV/AIDS has provided antiretroviral treatment (ART) for more than two decades, with many YLPHIV included (). Additionally, multiple providers working within the Program have experience in handling healthcare transitions among YLHIV (). Some approaches have been successful as they demonstrated some benefits over the conventional approach (; ). We hypothesize some critical key considerations affecting the transition outcomes might be missing from regular practice. We used the modified Delphi method to develop a consensus around development appropriate standards for managing HIV clinical care transition for YLHIV. Through sharing lessons learned, we aimed to develop a consensus around standards in transition which would benefit future generations of pediatric and adolescent HIV care providers in Thailand and other similar settings.