Table 2.

Barriers and facilitators to transition and corresponding quotes

Themea	Quotes
Barriers to transition
Individual domain
Financial constraints	“It’s hard for me. When we were told [to move], we were told that, for those who don’t have insurance, one has to pay five thousand in the adult clinic. Many people stopped taking medication. They said that if life is a matter of paying five thousand, they would rather stay home.” (22 years, male, failed transition)
Family social support domain
Isolation/loss of peer network	“When I was required to move, meaning there are those who were my friends, who were seventeen [years old], maybe you are used to each other, you have stayed there maybe three or four years, and then you are required to move and leave one behind. So the friendship dies. So it could be that there are things that you thought about, you were helping each other, you can’t find them, because they come on Saturdays, you will be coming on Monday and that’s when there is a difference.”(22 years, female, failed transition) “Then I go to the adult CTC and meet grown ups I mean you won’t be comfortable as the way you stay with your fellow youths. You know grown ups are different from youths so I don’t know how it is going to be.” (20 years, female, transitioned to PMTCT)
Stigma	“Honestly when they were told to move to adult clinic most of them refused. They started saying from there that you will meet people who know you from the street who never knew you are infected and they start stigmatizing you. ‘Even a child of so and so,’[…] so from there is when most of the youth started refusing but they told them as per their age, ‘You will go there and receive care as you have been receiving from here.’ They accepted but after some time, the second month, the third, they met and later they got scattered, I don’t know where others went, I don’t know if they are here but they come on different days.” (27‐year‐old, female, successful transition)
Healthcare system domain
Manner of transition/lack of preparation	“It was announced. It was announced to all youth. There was no one who did not know about it. It was announced publicly and not in secret or via fliers. We were called and told if you have reached a certain age you will move to the adult clinic. And we were given a reason, it’s not like we were not given a reason. We were given more details about the reason for transition after inquiring more about why we were being moved. We were told it’s because of this, this and this. ‘So you mean we are moving because of that?’ We agreed with the decision because we were grown up and those were children and we would have taught them things they weren’t ready for.” (22 years, male, failed transition)
Quality of care in the adult clinic	“The number of people there is one of the factors that cause the time taken to be long” (21‐year‐old, male, pre‐transition) “Nurses and doctors should be added. Other times you can find a few doctors and a few people getting the files. They need to increase the doctors and nurses” (27‐year‐old, female, successful transition)
Unfavourable adult clinic days	“It is not good, it is not good at all, I mean I am thinking it was not a good idea, they should not make the clinic day during the week because many people are not free. They are in school, at work, everywhere. Weekends should be good.” (24‐year‐old, male, failed transition)
Lack of education seminars and social events in the adult clinic	“The adult CTC [adult clinic] is different somehow, I mean things that are done in the CTC are different. In the youth clinic there are things that we used to be taught, that used to help, but after transition to the adult clinic you just come give out your card and go to doctor, take your medicines and go home. So there is nothing about seminars, or what. There is none.” (26 year‐old‐female, transitioned to PMTCT)
Facilitators of transition
Individual domain
Maintenance of good physical, mental and emotional wellbeing.	“Another responsibility to my health is making sure that my health is stable because if it’s unstable I will take several steps back in life. I will not be able to go to work when I am ill, I wouldn’t be able to do anything when I am ill. I will go back on my progress and even economically.” (27‐year‐old, female, successful transition)
Positive perspective of HIV and self‐acceptance	“You see here I am HIV positive, this is not the end. I am not dying. There are accidents, there are those who get cancer, they die but when they adhere to medicine well, they get treated very well, and they live well, as long as you eat food and you check your CD4 on time.” (27‐year‐old female, transitioned to PMTCT) “I have accepted myself and I have not lost hope. Had I lost hope every time they speak that way, you may find that I would have already stopped taking my medicines and had died. But despite all these things that I face, it pains only at the time when they talk about me, but once I am out of there I forget about it.” (26 year old, female, transitioned to PMTCT)
Family social support domain
Family social support	“My parents are important especially my father is important because he is the one who looks after me and takes care of me even when I am sick .He is the one who supports me by paying the hospital charges, transport charges, food and other things and that’s why he is important. If it weren’t for him, maybe I wouldn’t be here talking to you right now.”(26 year old, female, transitioned to PMTCT)

^a A priori findings included financial constraints and loss of peer network as barriers to transition. Other themes were emergent findings.