Predictors of secondary HIV transmission risk in a cohort of adolescents living with HIV in South Africa

Abstract

Objective: Preventing secondary HIV transmission from adolescents and young people living with HIV (AYPLHIV) to their partners and children is critical to interrupting the HIV infection cycle in sub-Saharan Africa. We investigated predictors of secondary HIV transmission risk (past-year sexual risk combined with past-year viremia) among AYPLHIV in South Africa. Design: A prospective cohort of AYLPHIV in South Africa recruited n = 1046 participants in 2014–2015, 93.6% of whom were followed up in 2016–2017 (1.5% mortality). Questionnaires used validated scales where available and biomarkers were extracted from n = 67 health facilities. Methods: Multivariate logistic regressions tested baseline factors associated with secondary HIV transmission risk, controlling for covariates, with marginal effect modelling combinations. Results: About 14.2% of AYPLHIV reported high secondary HIV transmission risk. High-risk AYPLHIV were more likely to be sexually infected [adjusted odds ratio (aOR) 2.79, 95% confidence interval (95% CI) 1.66–4.68, P < 0.001], and report hunger (aOR 1.93, 95% CI 1.18–3.14, P = 0.008) and substance use (aOR 2.19, 95% CI 1.19–4.02, P = 0.012). They were more likely to be in power-inequitable relationships (aOR 1.77, 95% CI 1.08–2.92, P = 0.025) and be parents (aOR 4.30, 95% CI 2.16–8.57, P < 0.001). Adolescents reporting none of these factors had a 4% probability of secondary transmission risk, rising to 89% probability with all five identified factors. Older age and early sexual debut were also strongly associated with a higher risk of secondary HIV transmission. Conclusion: It is essential to identify and support AYPLHIV at a high risk of secondary transmission. Screening for factors such as mode of infection and parenthood during routine healthcare visits could help identify and provide resources to the most at-risk adolescents.

The role of structural factors for preventing HIV risk practices among adolescents in South Africa: A three-wave analysis of caregiving, education, food security, and social protection

“…Our analysis applies rigorous statistical methods to three waves of data to investigate relationships between six structural factors and ve HIV risk practices simultaneously, further unpacking differential associations for males and females. In females, associations between education enrolment and age-disparate sex and condomless sex, respectively, are consistent with previous analyses and theories supporting this factor's promotion of safer sexual networks and adolescent girl's negotiating power [45][46][47][48][49][50]. The observed association between days with enough food at home and transactional sex is supported by the 'sex for basic needs' paradigm of transactional sex [51], and the concurrent relationship between this factor and both multiple sexual partnership and transactional sex is supported by qualitative reports of the in uence of poverty on sexual practices among adolescent girls [52].…”

Factors Associated with Preferences for Long-Acting Injectable Antiretroviral Therapy Among Adolescents and Young People Living with HIV in South Africa

“…AYLHIV, in particular, face significant challenges in ART adherence due to various complex and inter-related factors: the shift in personal responsibility when they transition into adult health services from paediatric health services [18], lack of disclosure [8], HIV-related stigma [2,19], relational factors, including caregiver/familial support and caregiver changes due to parental mortality [20], poor healthcare quality, and structural factors including stock outs and limited access to facilities [21]. Subsequently, AYLHIV have significant challenges in ART adherence and higher risk of viral failure, risk of HIV exposure among their sexual partners, and AIDS-related mortality and morbidity [22][23][24]. Interventions to improve ART adherence and long-term HIV outcomes among AYLHIV are vital to help advance progress to end AIDS by 2030 [25].…”

HIV prevalence and associated factors among orphaned adolescents and youth aged 12-24 years in South Africa

“…The mode of contracting HIV among young orphans is not only through risky sexual behaviour, but also through mother to child transmission [14][15][16]. Some HIV positive orphans are undiagnosed due to the challenge of connecting HIV positive orphans to universal test and treat programs because these programs are not targeted to orphans [17].…”

“…Improved understanding of factors associated with HIV in this population is important for developing tailored and targeted interventions. While there is a growing number of studies that looked at the factors associated with HIV among young people in the general population, fewer have focused on the orphan population [15]. This study aims to examine HIV prevalence and associated factors among reported orphaned adolescents aged 12-24 years in South Africa using the 2017 National HIV Prevalence, Incidence, Behaviour and Communication Survey.…”