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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Statistics South Africa. Mortality and causes of death in South Africa, 2015: Findings from death notification. Pretoria; 2017. 132 p
Human Sciences Research Council (HSRC). The Fifth South Africa National HIV Prevalence, Incidence, Behavioral and Communication Survey, 2017 Overview Presentation. 2018 Jul 17; Pretoria: HSRC Press; 2018
Human Sciences Research Council (HSRC). The Fifth South Africa National HIV Prevalence, Incidence, Behavioral and Communication Survey, 2017: HIV Impact Assessment Summary Report. Cape Town: HSRC Press; 2018.
Gómez-Olivé FX, Angotti N, Houle B, et al. Prevalence of HIV among those 15 and older in rural South Africa. AIDS Care. 2013;25(9):1122–8.
Pillay Y, Pillay A. Implementation of the Universal Test and Treat strategy for HIV positive patients and differentiated care for stable patients. Pretoria: Department of Health, Republic of South Africa; 2016.
Human Sciences Research Council. South African National HIV prevalence, incidence, behavior and communication survey, 2017. Cape Town: HSRC Press; 2019.
Wong VJ, Murray KR, Phelps BR, Vermund SH, McCarraher DR. Adolescents, young people, and the 90–90-90 goals: a call to improve HIV testing and linkage to treatment. AIDS. 2017;31(3):S191–S194194.
Millstein S, Petersen A, Nightingale E. Promoting the health of adolescents: new directions for the twenty-first century. New York: Oxford University Press; 1994.
Davies MA, Pinto J. Targeting 90-90-90: don’t leave children and adolescents behind. J Int AIDS Soc. 2015;18(7 6):20745.
Fortenberry JD, Martinez J, Rudy BJ, Monte D. Linkage to care for HIV-positive adolescents: a multisite study of the adolescent medicine trials units of the adolescent trials network. J Adolesc Health. 2012;51(6):551–6.
Acree ME. Transition of care for youth with HIV. Pediatr Ann. 2017;46(5):e198–e202.
Murphy DA, Belzer M, Durako SJ, Sarr M, Wilson CM, Muenz LR. Longitudinal antiretroviral adherence among adolescents infected with human immunodeficiency virus. Arch Pediatr Adolesc Med. 2005;159(8):764–70.
Naswa S, Marfatia YS. Adolescent HIV/AIDS: Issues and challenges. Indian J Sex Transmitted Dis. 2010;31(1):1–10.
Lee SJ, Detels R, Rotheram-Borus MJ, Duan N. The effect of social support on mental and behavioral outcomes among adolescents with parents with HIV/AIDS. Am J Public Health. 2007;97(10):1820–6.
Cluver L, Pantelic M, Toska E, et al. STACKing the odds for adolescent survival: health service factors associated with full retention in care and adherence amongst adolescents living with HIV in South Africa. J Int AIDS Soc. 2018;21(9):e25176.
Camara M, Bacigalupe G, Padilla P. The role of social support in adolescents: are you helping me or stressing me out? Int J Adolesc Youth. 2017;22(2):123–36.
Lall P, Lim SH, Khairuddin N, Kamarulzaman A. Review: An urgent need for research on factors impacting adherence to and retention in care among HIV-positive youth and adolescents from key populations. J Int AIDS Soc. 2015;182(1):19393.
Pettifor A, Stoner M, Pike C, Bekker LG. Adolescent lives matter: preventing HIV in adolescents. Curr Opin HIV AIDS. 2018;13(3):265–73.
Patel V, Flisher AJ, Hetrick S, McGorry P. Mental health of young people: a global public-health challenge. Lancet. 2007;369(9569):1302–13.
UNAIDS. Miles to go: Closing gaps, breaking barriers, righting injustices. Geneva UNAIDS; 2018. 264 p.
Mark D, Armstrong A, Andrade C, et al. HIV treatment and care services for adolescents: a situational analysis of 218 facilities in 23 sub-Saharan African countries. J Int AIDS Soc. 2017;20(3):21591.
Pettifor A, MacPhail C, Selin A, et al. HPTN 068: a randomized control trial of a conditional cash transfer to reduce HIV infection in young women in South Africa—study design and baseline results. AIDS Behav. 2016;20(9):1863–82.
Kahn K, Collinson MA, Xavier Gómez-Olivé F, et al. Profile: agincourt health and socio-demographic surveillance system. Int J Epidemiol. 2012;41(4):988–1001.
MRC/Wits Agincourt Research Unit. Key Research Findings and Research Translation [Internet]. 2014. Available from: https://www.agincourt.co.za/?page_id=1911
Pettifor A, MacPhail C, Hughes JP, et al. The effect of a conditional cash transfer on HIV incidence in young women in rural South Africa (HPTN 068): a phase 3, randomised controlled trial. Lancet Glob Health. 2016;4(12):e978–e988988.
Sherbourne CD, Stewart AL. The MOS social support survey. Soc Sci Med. 1991;32(6):705–14.
Gjesfjeld CD, Greeno CG, Kim KH. A confirmatory factor analysis of an abbreviated social support instrument: the MOS-SSS. Res Soc Work Pract. 2008;18(3):231–7.
Berger B, Estwing Ferrans C, Lashley F. Measuring stigma in people with HIV: psychometric assessment of the HIV stigma scale. Res Nurs Health. 2001;24(6):518–29.
Wright K, Naar-King S, Lam P, Templin T, Frey M. Stigma scale revised: reliability and validity of a brief measure of stigma for HIV+ youth. J Adolesc Health. 2007;40(1):96–8.
Yehia BR, Rebeiro P, Althoff KN, et al. Impact of age on retention in care and viral suppression. J Acquir Immune Defic Syndr. 2015;68(4):413–9.
Hadland SE, Milloy MJ, Kerr T, et al. Young age predicts poor antiretroviral adherence and viral load suppression among injection drug users. AIDS Patient Care STDS. 2012;26(5):274–80.
Babatunde O, Ojo OJ, Atoyebi OA, et al. Seven-year review of retention in HIV care and treatment in federal medical centre Ido-Ekiti. Pan Afr Med J. 2015;22:139.
Langebeek N, Gisolf EH, Reiss P, et al. Predictors and correlates of adherence to combination antiretroviral therapy (ART) for chronic HIV infection: a meta-analysis. BMC Med. 2014;12(1):142.
McInerney PA, Ncama BP, Wantland D, et al. Quality of life and physical functioning in HIV-infected individuals receiving antiretroviral therapy in KwaZulu-Natal. South Africa Nurs Heal Sci. 2008;10(4):266–72.
Drain PK, Losina E, Coleman SM, et al. Social support and mental health among adults prior to HIV counseling and testing in Durban, South Africa. AIDS Care. 2015;27(10):1231–40.
Nöstlinger C, Bakeera-Kitaka S, Buyze J, Loos J, Buvé A. Factors influencing social self-disclosure among adolescents living with HIV in Eastern Africa. AIDS Care. 2015;27(Suppl 1):36–46.
Maman S, Groves AK, Mcnaughton Reyes HL, Moodley D. Diagnosis and disclosure of HIV status: Implications for women’s risk of physical partner violence in the postpartum period. J Acquir Immune Defic Syndr. 2016;72(5):546–51.
National Department of Health. National consolidated guidelines for the prevention of mother-to-child transmission of HIV (PMTCT) and the management of HIV in children, adolescents and adults. Pretoria: Department of Health; 2015. p. 126.
Evangeli M, Foster C. Who, then what? The need for interventions to help young people with perinatally acquired HIV disclose their HIV status to others. AIDS. 2014;28(3):S343–S346346.
Sithole Z, Mbizvo E, Chonzi P, et al. Virological failure among adolescents on ART, Harare City, 2017: a case-control study. BMC Infect Dis. 2018;18(1):469.
Bikaako-Kajura W, Luyirika E, Purcell DW, et al. Disclosure of HIV status and adherence to daily drug regimens among HIV-infected children in Uganda. AIDS Behav. 2006;10(7):85–93.
Snyder K, Wallace M, Duby Z, et al. Preliminary results from Hlanganani (Coming Together): a structured support group for HIV-infected adolescents piloted in Cape Town, South Africa. Child Youth Serv Rev. 2014;45:114–21.
Grainger C. Understanding disclosure behaviours in HIV-positive young people. J Infect Prev. 2017;18(1):35–9.
Kennedy CE, Fonner VA, Armstrong KA, O’Reilly KR, Sweat MD. Increasing HIV serostatus disclosure in low and middle-income countries: A systematic review of intervention evaluations. AIDS. 2015;29(1):S7–S23.
Logie CH, Lacombe-Duncan A, Wang Y, et al. Pathways from HIV-related stigma to antiretroviral therapy measures in the HIV care cascade for women living with HIV in Canada. J Acquir Immune Defic Syndr. 2018;77(2):144–53.
Valenzuela C, Ugarte-Gil C, Paz J, et al. HIV stigma as a barrier to retention in HIV care at a general hospital in Lima, Peru: a case–control study. AIDS Behav. 2015;19(2):235–45.
Katz IT, Ryu AE, Onuegbu AG, et al. Impact of HIV-related stigma on treatment adherence: systematic review and meta-synthesis. J Int AIDS Soc. 2013;16(3):18640.
Butts SA, Parmley LE, Alcaide ML, et al. Let us fight and support one another: adolescent girls and young women on contributors and solutions to HIV risk in Zambia. Int J Womens Health. 2017;9:727–37.
Ammon N, Mason S, Corkery J. Factors impacting antiretroviral therapy adherence among human immunodeficiency virus-positive adolescents in Sub-Saharan Africa: a systematic review. Public Health. 2017;157:20–31.
Pantelic M, Boyes M, Cluver L, Thabeng M. ‘They say HIV is a Punishment from God or from Ancestors’: cross-cultural adaptation and psychometric assessment of an HIV stigma scale for South African adolescents living with HIV (ALHIV-SS). Child Indic Res. 2018;11(1):207–23.
Heestermans T, Browne JL, Aitken SC, Vervoort SC, Klipstein-Grobusch K. Determinants of adherence to antiretroviral therapy among HIV-positive adults in sub-Saharan Africa: a systematic review. BMJ Glob Health. 2016;1(4):e000125.
Bogart LM, Chetty S, Giddy J, et al. Barriers to care among people living with HIV in South Africa: contrasts between patient and healthcare provider perspectives. AIDS Care. 2013;25(7):843–53.
Beer L, Fagan JL, Valverde E, Bertolli J. Health-related beliefs and decisions about accessing HIV medical care among HIV-infected persons who are not receiving care. AIDS Patient Care STDS. 2009;23(9):785–92.
Zanoni BC, Archary M, Buchan S, Katz IT, Haberer JE. Systematic review and meta-analysis of the adolescent HIV continuum of care in South Africa: the Cresting Wave. BMJ Glob Health. 2016;1:e000004.
Kuruc JD, Cope AB, Sampson LA, et al. Ten years of screening and testing for acute HIV infection in North Carolina. J Acquir Immune Defic Syndr. 2016;71(1):111–9.
Sharma M, Ying R, Tarr G, Barnabas R. Systematic review and meta-analysis of community and facility-based HIV testing to address linkage to care gaps in sub-Saharan Africa. Nature. 2015;528(7580):S77–85.
Gardner LI, Metsch LR, Anderson-Mahoney P, et al. Efficacy of a brief case management intervention to link recently diagnosed HIV-infected persons to care. AIDS. 2005;19(4):423–31.
WHO. Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV. Geneva, Switzerland: WHO Press; 2015. 78 p.
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 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
- Sub-saharan Africa
- Anti-retroviral therapy