Background. In the United States, access to antiretroviral therapy has turned perinatal HIV infection from a terminal childhood illness into a manageable chronic condition. The first surviving cohort of perinatally infected children is now reaching young adulthood. There are many unknowns about how best to help these youths make successful transitions into healthy adulthood.

Methods. This study uses qualitative interview methods to explore facilitators of and barriers to the successful transition from pediatric to adult medical care for youths living with HIV. Interviews were conducted with a total of 47 individuals, including: 15 perinatally HIV-infected youths receiving their care at a pediatric HIV clinic in Baltimore, Maryland; 14 staff members at this pediatric clinic; 11 staff members at an adult HIV clinic in Baltimore; and 7 "transition leaders"—individuals with experience developing and implementing transition programs at other HIV clinics around the United States.

Results. Findings demonstrate the range of medical and social factors affecting transitions in care for the study population. Key findings highlight: (1) the pediatric clinic's role as a central component of the youths' otherwise weak social support networks; (2) youths' current skills deficits for succeeding in adult care; (3) the pediatric clinic's difficulty maintaining an ideal balance between providing adequate support for their high-needs patient population and simultaneously preparing the youths for the more rigid rules and demands of adult care; and (4) difficulties in cross-clinic coordination resulting from structural and cultural differences between the pediatric and adult clinics. Study findings provide the basis for recommendations about potential strategies for clinic-based programs to promote successful transitions to adult care.

Conclusions. A wide range of recommended clinic-based intervention strategies were derived from analysis of this study's findings. Potential strategies within four categories are discussed: (1) improving youths' emotional readiness and skills for adult medical care; (2) creating new transition policy and programming; (3) enhancing collaboration between pediatric and adult clinics; and (4) post-transfer planning. This dissertation represents one link in the long chain of formative research, evidence-based program development, implementation, and evaluation that will contribute to successful transitions from pediatric to adult care for HIV-positive youths.