Preparation should start early and be multidisciplinary so as to incorporate individuals’ cognitive development and mental health, medication adherence, sexual and reproductive health, socioeconomic issues, stigma and disclosure. The Thai paediatric HIV programme is a highly evolved model,Synta66 in which providers have longer experience of providing ART to children than in most other resource-limited settings. There is a need for contextual understanding and a holistic approaches to HIV care that are grounded in service providers’ and service users’ experiences, and the local challenges and priorities. The perspectives of participants in this study illustrated where gaps in the continuity of a paediatric HIV treatment and care continuum are likely to arise and the need to continually reassess the needs of HIV positive children in a changing epidemic. We found that the concept of a holistic approach was supported by service-providers and appreciated by service-users, but needed clearer policy backing. In 2013 69% of paediatric patients registered at the three sites at the time of this study would have reached the age at which transition to adult services should occur; there is an urgent need to make provision for these cases. A wellcoordinated team comprising hospital staff and volunteers can help to overcome human resources constraints and UVI3003 provide the continuity that children and adolescents will need as a new generation of HIV positive adults. The need for additional guidance for the care of adolescents is now being recognized in Thailand and some recommendations have been incorporated into ART guidelines. Child- and adolescent-specific elements of HIV policy were considered a low priority and may contribute to the gaps in service provision that were visible at both ends of the care continuum in this study. Our study has several limitations. Data was collected at a single point in time and therefore only provides a superficial sense of important changes over time. Respondents only included only those who are enrolled in care, the perspectives of those who have poorer access to services or avoid HIV services are important if the system is to be responsive to their needs.