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Patients transitioning from pediatric to adult HIV care have lower rates of retention in care and viral suppression. Health system interventions can improve outcomes in adolescents and young adults living with HIV (AYA-HIV). We designed and implemented an Adolescent Young Adult Healthcare Transition (AYAHCT) clinic in a U.S.-based healthcare system. We present a mixed-method (quantitative and qualitative) evaluation. The quantitative analysis included retrospective clinical outcomes between 2017-2023. Qualitative analysis included stakeholder interviews in pediatric, AYAHCT, and adult HIV clinics. The pilot cohort included 18 patients. Patients attended 4.4 visits/year, and retention in care was 100% in the first year in the AYAHCT clinic. However, only 70% of patients were virally suppressed. Seven patients (38.8%) transitioned to adult care, with 85.7% retention in care and 96.8% viral suppression. Stakeholders identified strengths including Ryan White funding, institutional support, and program adaptability. Stakeholders identified barriers, including HIV stigma and political climate in the Southern U.S., with resources needed for mental health, disclosure, and case management. We describe the initial outcomes of the AYAHCT cohort with a qualitative evaluation of clinical implementation. The pilot cohort demonstrated excellent retention across HIV care transitions but low viral suppression. Qualitative analysis revealed opportunities for program improvement.