Pregnant adolescents living with HIV: what we know, what we need to know, where we need to go

Abstract

Introduction: HIV-infected pregnant and breastfeeding adolescents are a particularly vulnerable group that require special attention and enhanced support to achieve optimal maternal and infant outcomes. The objective of this paper is to review published evidence about antenatal care (ANC) service delivery and outcomes for HIV-infected pregnant adolescents in low-income country settings, identify gaps in knowledge and programme services and highlight the way forward to improve clinical outcomes of this vulnerable group.Discussion: Emerging data from programmes in sub-Saharan Africa highlight that HIV-infected pregnant adolescents have poorer prevention of mother-to-child HIV transmission (PMTCT) service outcomes, including lower PMTCT service uptake, compared to HIV-infected pregnant adults. In addition, the limited evidence available suggests that there may be higher rates of mother-to-child HIV transmission among infants of HIV-infected pregnant adolescents.Conclusions: While the reasons for the inferior outcomes among adolescents in ANC need to be further explored and addressed, there is sufficient evidence that immediate operational changes are needed to address the unique needs of this population. Such changes could include integration of adolescent-friendly services into PMTCT settings or targeting HIV-infected pregnant adolescents with enhanced retention and follow-up activities.

Reproductive aspirations, contraception use and dual protection among adolescent girls and young women: the effect of motherhood and HIV status

“…As new infections among adolescents persist, and as more ALHIV reach childbearing age [5], we need to better understand how to engage adolescent mothers in comprehensive, tailored health services to effectively reduce HIV-related morbidity and mortality [17]. Safe conception considerationsplanned pregnancies that coincide with viral suppression, but also socio-emotional readinessmust be integrated in HIV and SRH service provision for adolescent girls and young women living with HIV.…”

“…Nearly half of all unintended pregnancies among adolescent mothers end with terminations of pregnancy, most of which are unsafe [12,13]. Moreover, in several sub-Saharan African countries, many adolescent girls and young women report more than one pregnancy before age 20 [14], including adolescent girls living with HIV (ALHIV) [10,17,18]. Rapid repeat pregnancies within adolescence may pose further biological, developmental and economic risks for both the mother and her children.…”

“…The risks facing adolescent mothers are amplified for those living with HIV, who face additional vulnerabilities [17][18][19]. Adolescents living with HIV who become pregnant experience less consistent engagement in antenatal and HIV care, intermittent viral suppression [20][21][22], delayed initiation of antiretroviral therapy (ART) [23] and poorer access to infant HIV testing [24][25][26].…”

Decreasing incidence of pregnancy among HIV-positive adolescents in a large HIV treatment program in western Kenya between 2005 and 2017: A retrospective cohort study.

“…Multi-disciplinary adolescent antenatal and postnatal care has been shown in developed country settings to lead to increased clinic attendance, better birth outcomes (including decreased preterm birth and stillbirth rates), and increased post-partum uptake of contraception [38,39]. In this population, it may also enable increased engagement in PMTCT and, therefore, decreased rates of vertical transmission [40].…”

Understanding the uptake of prevention of mother-to-child transmission services among adolescent girls in Sub-Saharan Africa: a review of literature

“…Emerging data suggest that pregnant adolescents have lower uptake of PMTCT services and poorer maternal and infant HIV outcomes (Callahan, Modi, Swanson, Ng'eno, & Broyles, 2017) when compared to adult women; however, it is unclear whether these findings are consistent across the multiple countries/cultural contexts in SSA and what factors contribute to these findings. This article summarizes the findings of a review of the literature on the status of service utilization by PBALHIV along the PMTCT continuum of care compared to their adult counterparts, and highlights key programmatic gaps that should be targeted in order to improve outcomes of PBALHIV in PMTCT programs.…”