Healthcare provisions associated with multiple HIV-related outcomes among adolescent girls and young women living with HIV in South Africa: a cross-sectional study.

Journal: Journal of the International AIDS Society

Volume: 27

Issue: 2

Year of Publication: 2024

Affiliated Institutions:  Division of Social and Behavioural Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa. Institute for Global Health, University College London, London, UK. MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK. National Institute for Communicable Diseases, Johannesburg, South Africa. UNICEF Eastern and Southern Africa Office (UNICEF-ESARO), Nairobi, Kenya. Department of Social Policy and Intervention, University of Oxford, Oxford, UK. Centre for Social Science Research, University of Cape Town, Cape Town, South Africa. Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK. Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.

Abstract summary 

Adolescent girls and young women (AGYW) living with HIV experience poor HIV outcomes and high rates of unintended pregnancy. Little is known about which healthcare provisions can optimize their HIV-related outcomes, particularly among AGYW mothers.Eligible 12- to 24-year-old AGYW living with HIV from 61 health facilities in a South African district completed a survey in 2018-2019 (90% recruited). Analysing surveys and medical records from n = 774 participants, we investigated associations of multiple HIV-related outcomes (past-week adherence, consistent clinic attendance, uninterrupted treatment, no tuberculosis [TB] and viral suppression) with seven healthcare provisions: no antiretroviral therapy (ART) stockouts, kind and respectful providers, support groups, short travel time, short waiting time, confidentiality, and safe and affordable facilities. Further, we compared HIV-related outcomes and healthcare provisions between mothers (n = 336) and nulliparous participants (n = 438). Analyses used multivariable regression models, accounting for multiple outcomes.HIV-related outcomes were poor, especially among mothers. In multivariable analyses, two healthcare provisions were "accelerators," associated with multiple improved outcomes, with similar results among mothers. Safe and affordable facilities, and kind and respectful staff were associated with higher predicted probabilities of HIV-related outcomes (p<0.001): past-week adherence (62% when neither accelerator was reported to 87% with both accelerators reported), clinic attendance (71%-89%), uninterrupted ART treatment (57%-85%), no TB symptoms (49%-70%) and viral suppression (60%-77%).Accessible and adolescent-responsive healthcare is critical to improving HIV-related outcomes, reducing morbidity, mortality and onward HIV transmission among AGYW. Combining these provisions can maximize benefits, especially for AGYW mothers.

Authors & Co-authors:  Cluver Sherr Edun Sherman Armstrong Gulaid Jochim Banougnin Langwenya Wittesaele Rudgard Saal Laurenzi Zhou Toska

Study Outcome 

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Statistics
Citations :  UNAIDS . In Danger: UNAIDS Global AIDS Update 2022. 2022.
Authors :  15
Identifiers
Doi : e26212
SSN : 1758-2652
Study Population
Women,Girls,Mothers
Mesh Terms
Pregnancy
Other Terms
South Africa;adherence;adolescents;health services;motherhood;treatment
Study Design
Study Approach
Country of Study
South Africa
Publication Country
Switzerland