Correlates of ART Use Among Newly Diagnosed HIV Positive Adolescent Girls and Young Women Enrolled in HPTN 068

Abstract

Despite expanded access to HIV treatment worldwide, poor HIV care outcomes persist among adolescent girls and young women (AGYW). This study was conducted among AGYW recruited from the HPTN 068 cohort who had sero-converted to HIV during the main trial between 2011 and 2014. The aim was to examine correlates of anti-retroviral treatment (ART) use. Log binomial regression was used to estimate the crude associations between social support, stigma, and HIV status disclosure and current ART use. Adjusted analyses were also conducted controlling for age and time since diagnosis. Seventy-nine AGYW were included in this analysis. Median age of participants was 20 (range: 17 to 24) and time since diagnosis ranged from 0.5 to 4.8 years (median = 2.1). Over 75% of AGYW (n = 60) had sought HIV care at some point, with the same number reporting previous disclosure of their sero-status. However, just 43% (n = 34) of participants were on treatment at the time of the interview. Over half of participants (n = 44; 55.7%) reported social support was available to them most or all of the time, and the median stigma score was 90 (range 80–113). Adjusted analyses found higher current ART use among those who had disclosed their status (adjusted prevalence ratio (aPR): 3.19; 95% confidence interval (CI) 1.09, 9.32; p = 0.0339) and those with lower scores on the disclosure concern sub-scale of the Berger HIV Stigma Scale (aPR: 0.88; 95% CI 0.79, 0.98; p = 0.0236). ART use among AGYW living with HIV and enrolled in HPTN 068 was low despite relatively high linkage to care during the trial. Interventions aimed at minimizing individuals’ concerns about disclosure and improving onward disclosure of one’s status could further improve ART utilization among AGYW living with HIV in South Africa.

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Acknowledgements

We thank all of the young women and their families who participated in HPTN 068 and made both the HPTN 068 and Engage studies possible. We thank Aimée Julien, Rushina Cholera, Laura McKinstry, Estelle Piwowar-Manning, Lynda Emel, Tamu Daniel, Tsundzukani Siwelana, Edwin Maroga, Menzi Hadebe, Simon Mijoli, Senamile Ndlovu Makhari, Mary Jane Hill, Lisa Albert, Erica Hamilton, Audrey Khosa, Simon Khoza, Jeffrey Tibane, Paul Mee, Myron Cohen, Wafaa El Sadr, Harsha Thirumurthy, Sudhanshu Handa, Cheryl Marcus, Joseph Eron, Tania Caravella, Diana Lynn, James Hargreaves, Sinead Delany-Moretlwe, Helen Rees, Michelle Adato, Suzanne Maman, Susannah Allison, Paul Sato, and Jenese Tucker. These individuals provided valuable insights and made important contributions to the study.

Funding

Funding support for the HPTN was provided by the National Institute of Allergy and Infectious Diseases (NIAID), the National Institute of Mental Health (NIMH), and the National Institute on Drug Abuse (NIDA) of the National Institutes of Health (NIH; award numbers UM1AI068619 [HPTN Leadership and Operations Center], UM1AI068617 [HPTN Statistical and Data Management Center], and UM1AI068613 [HPTN Laboratory Center]. The study was also funded under R01MH087118 and R24 HD050924 to the Carolina Population Center. Additional funding was provided by the Division of Intramural Research, NIAID, and NIH. The Agincourt Health and Socio-Demographic Surveillance System is supported by the School of Public Health University of the Witwatersrand and Medical Research Council, South Africa, and the UK Wellcome Trust (Grants 058893/Z/99/A; 069683/Z/02/Z; 085477/Z/08/Z; and 085477/B/08/Z). This project was also supported by NIH Research Training Grant # D43 TW009340 funded by the NIH Fogarty International Center, NINDS, NIMH, and NHBLI. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Filiatreau, L.M., Wright, M., Kimaru, L. et al. Correlates of ART Use Among Newly Diagnosed HIV Positive Adolescent Girls and Young Women Enrolled in HPTN 068. AIDS Behav 24, 2606–2615 (2020). https://doi.org/10.1007/s10461-020-02817-1

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Keywords

  • HIV/AIDS
  • Adolescents
  • Sub-saharan Africa
  • Anti-retroviral therapy
  • Linkage
  • Retention