HIV and adolescent girls and young women in sub-Saharan Africa: A call for expedited action to reduce new infections

Experiences of Young Women Living in Kibra, Kenya, on HIV Risk and Sexual Violence: A Descriptive Study

ABSTRACT

Before the COVID-19 pandemic, Kenya had seen a significant decline in new HIV infections among most age groups except for young people aged 15-24 years. Young women residing in urban areas are significantly affected by gender-based violence. Guided by the theory of gender and power and postcolonial theory, our descriptive qualitative study sought to understand young women's experiences with HIV risk and the impact of sexual violence before the COVID-19 pandemic. We conducted individual and focus group interviews with 73 young women residing in Kibra, Kenya. Using thematic analysis, interviews were recorded, transcribed, and coded. We identified six themes: financial insecurity, drug use, peer pressure, fear of condom use, physical environment, and disco matanga traditions. Findings revealed structural factors such as poverty and gender norms affect young women. Strategies for HIV risk prevention focused on young women in Kenya should include efforts for protecting young women from sexual violence.

Likelihood of Leveraging Augmented Reality Technology to Promote HIV Prevention and Treatment Among Adolescent Girls and Young Women in Cameroon: Cross-Sectional Survey

intro

Adolescent girls and young women in sub-Saharan Africa (SSA) represent 4 out of every 5 newly diagnosed HIV cases among adolescent girls and young women globally. Leveraging augmented reality (AR) technology for HIV prevention and treatment holds significant potential among young people. However, there is a knowledge gap regarding the acceptance of AR by adolescent girls and young women in SSA.

Objective

This study aimed to assess the likelihood of adolescent girls and young women in Cameroon using AR for HIV testing, prevention, and treatment. The study findings will lay the groundwork for developing AR-based interventions to prevent and treat HIV in Cameroon and beyond.

Methods

This was a cross-sectional survey conducted in Yaounde, Cameroon, in which 637 adolescent girls and young women were recruited using a combination of multistage cluster and snowball sampling techniques. We used an electronic survey to collect data on participants' knowledge, prior use of AR technology, and likelihood of using AR technology for HIV prevention and treatment, and associated factors. Multivariate ordinal regressions were used to analyze the factors associated with the likelihood of adolescent girls and young women using AR to prevent HIV.

Results

The study showed that 84% (536/637) of adolescent girls and young women had never heard of AR before this study, and only 8% (49/637) had prior experience using AR. Participants' median age was 22 (IQR 21-24) years, with the majority (362/637, 56.8%) aged between 21 and 25 years. Despite the low usage rate of AR among participants, there was a high likelihood of using AR to promote HIV prevention and treatment. Specifically, 72% (459/637) of participants reported that they were likely to use AR to visualize the HIV transmission process, while 73% (465/637) and 74% (471/637) reported the likelihood of using AR to learn about pre-exposure prophylaxis (PrEP) and how HIV medication lowers HIV viral load, respectively. More importantly, 54% (342/637) and 50% (319/637) of participants reported that they were extremely likely to use AR to learn the correct way of using condom and self-testing for HIV, respectively. The high likelihood of using AR to prevent and treat HIV was associated with a higher education level (P=.01), having ever tested for HIV (P=.03), and a history of previously using health apps or searching for health information on their phones (P<.001).

Conclusions

The likelihood of using AR technology to promote HIV prevention and treatment is high among adolescent girls and young women in Cameroon. Future research should focus on exploring the preferred features of AR-based digital health interventions and consider methods of implementing them in the context of Cameroon or SSA.

Intimate Partner Violence and Determinants of HIV Seroconversion among Female Caregivers in Kwazulu-Natal, South Africa: Insights from the Asenze Longitudinal Study

Intimate partner violence (IPV) has been associated with HIV seroconversion vulnerability, but few studies have examined multiple IPV types and HIV status. This study investigates exposure to various IPV types and HIV seroconversion among female caregivers in KwaZulu-Natal (KZN), South Africa, using longitudinal data (2008-2021) from the Asenze cohort study. We compared IPV exposure at baseline (Wave 1[W1]), sociodemographic, and psychosocial characteristics between women living with HIV (WLHIV) vs. HIV-negative at baseline; HIV-negative at baseline who seroconverted by Wave 3 (W3) vs. remaining HIV-negative, using chi-squared and t-tests. We also assessed seroconversion over time in the cohort. At W1, of 580 participants (WLHIV = 139, HIV-negative = 431), 42% reported any IPV. Considering both current and other partners, WLHIV reported higher exposure to threatening IPV (34% vs. 23%, p = .005) and multiple IPV types (32% vs. 23%, p = .029). From an other partner, WLHIV reported more physical IPV (32% vs. 21%, p = .010), any IPV (35% vs. 26%, p = .049), and multiple IPV types (23% vs. 15%, p = .029). No significant differences in IPV from a current partner were found between WLHIV and HIV-negative women. Those who seroconverted by W3 vs. remained HIV-negative at W3 did not differ on any IPV exposures. Women who seroconverted were younger (28.2 vs. 37.8, p <.001) and more likely to report hazardous drinking at W1 (13% vs. 3%, p <.001). The high levels of HIV seroconversion and IPV indicate a persistent HIV and IPV epidemic among female caregivers in KZN, necessitating expanded research and interventions.

Spatial and temporal trends in HIV/AIDS burden among South Asian countries from 1990 to 2021: A systematic examination of the Global Burden of Disease study 2021

BACKGROUND

HIV/AIDS remains a significant public health concern in South Asia, and trends in disease burden vary across the region. This study analyzed spatial and temporal trends in HIV/AIDS from 1990 to 2021 using data from the Global Burden of Disease (GBD) study 2021, focusing on incidence, prevalence, mortality, and disability-adjusted life-years (DALYs).

METHODS

We conducted a secondary analysis of GBD 2021 data, applying Joinpoint regression and auto-regressive integrated moving average models to assess trends in HIV/AIDS burden across South Asian countries. We calculated metrics such as average annual percentage change (AAPC), and estimated APC (EAPC) to evaluate temporal trends.

RESULTS

We found significant variations in HIV/AIDS trends across South Asia. India had the highest burden, with a sharp increase in DALYs between 1990 and 2000 with a percentage change (PC) of 184.09, followed by a decline (-0.73 in 2010-2021). Pakistan experienced the highest growth in DALYs and mortality (average PC 36.46; estimated PC 38.65), indicating severe ongoing public health challenges. In contrast, Nepal and Maldives showed notable reductions in both DALYs and mortality rates, reflecting successful intervention efforts. Afghanistan and Bangladesh exhibited fluctuating trends, with slight increases in the initial years followed by stabilization or modest declines. Auto-regressive integrated moving average projections suggested a slight increase in HIV/AIDS incidence by 2031, with mortality rates expected to decline more significantly.

CONCLUSION

The burden of HIV/AIDS in South Asia varies significantly, with some countries achieving reductions and others, particularly Pakistan, facing rising challenges. Continued and targeted public health interventions are crucial for managing and reducing the burden of HIV/AIDS across South Asia.

A longitudinal macro analysis of social determinants of health and their impacts on HIV prevalence and nutritional deficiencies in Sub-Saharan Africa

Sub-Saharan Africa faces a dual public health crisis of HIV and nutritional deficiencies driven by profound socio-economic disparities. Despite significant micro-study research, macro-level, longitudinal patterns and causal dynamics remain underexplored. This study employs Panel Auto-regressive distributed lags, Panel Granger causality, and Vector auto-correction model to examine the influence of social determinants on HIV prevalence and nutritional deficiencies across Sub-Saharan Africa. The study further carried out robustness diagnostics using Driscoll - Kraay standard error regression to confirm the reliability of the results. For HIV prevalence, income, education, and employment reduce rates over the long term, while healthcare access and housing quality show positive associations. Short-term effects show the benefits of income and healthcare access, with other factors showing limited impact. For nutritional deficiencies, income, education, employment, and housing quality significantly reduce malnutrition in the long term, while healthcare access correlates positively. Short-term effects show the immediate role of income and housing quality. The causal results show unidirectional links between income, education, employment, and housing quality to HIV. Housing quality and income exhibit bidirectional causality. No causal link exists between HIV and nutritional deficiencies. The study recommends the need for income support programs, expanded educational access, skill development, and strengthened healthcare systems.

A Disintegrin and Metalloprotease with Thrombospondin Motif, Member 13, and Von Willebrand Factor in Relation to the Duality of Preeclampsia and HIV Infection

Normal pregnancy is associated with multiple changes in the coagulation and the fibrinolytic system. In contrast to a non-pregnant state, pregnancy is a hypercoagulable state where the level of VWF increases by 200-375%, affecting coagulation activity. Moreover, in this hypercoagulable state of pregnancy, preeclampsia is exacerbated. ADAMTS13 cleaves the bond between Tyr1605 and Met1606 in the A2 domain of VWF, thereby reducing its molecular weight. A deficiency of ADAMTS13 originates from mutations in gene or autoantibodies formed against the protease, leading to defective enzyme production. Von Willebrand protein is critical for hemostasis and thrombosis, promoting thrombus formation by mediating the adhesion of platelets and aggregation at high shear stress conditions within the vessel wall. Mutations in VWF disrupts multimer assembly, secretion and/or catabolism, thereby influencing bleeding. VWF is the primary regulator of plasma ADAMTS13 levels since even minute amounts of active ADAMTS13 protease have a significant inhibitory effect on inflammation and thrombosis. VWF is released as a result of endothelial activation brought on by HIV infection. The SARS-CoV-2 infection promotes circulating proinflammatory cytokines, increasing endothelial secretion of ultra large VWF that causes an imbalance in VWF/ADAMTS13. Raised VWF levels corresponds with greater platelet adhesiveness, promoting a thrombotic tendency in stenotic vessels, leading to increased shear stress conditions.

Recruitment of Adolescent Girls and Young Women into an Early Oral PrEP Open- Label Study in Southern Africa: Lessons Learned from HPTN 082

Background

Adolescent girls and young women (AGYW) in southern Africa who are at high risk for HIV acquisition can mitigate this risk by using daily oral pre-exposure prophylaxis (PrEP) consistently. Using reflections from the community engagement teams in an early oral PrEP trial, this paper presents lessons learned from recruiting AGYW into the trial. It highlights experiences and strategies employed during the planning, readiness, and implementation phases of the trial.

Methods

The HIV Prevention Trials Network (HPTN) 082 was an open-label study of PrEP uptake and adherence conducted between October 2016 and October 2018 among 16- to 25-year-old women without HIV in Cape Town and Johannesburg, South Africa, and Harare, Zimbabwe. A joint community team meeting with team members from all three HPTN 082 sites garnered and synthesized team experiences by analysing fieldwork reflections, HPTN 082 study-led workshop summaries, project records, and Community Advisory Board (CAB) meeting minutes about lessons for stakeholder engagement that are relevant for PrEP introduction and service delivery.

Results

Using the Good Participatory Practice (GPP) framework, thighlighted the value of PrEP education, engagement with stakeholders during the formative phase, and the importance of peers and family as sources of information, support, and referral for adolescent study participants. In the first year of recruitment for HPTN 082, study participants reported they needed support for consistent daily oral PrEP use from parents and other adults, and efforts were intensified to engage parents and community stakeholders.

Conclusions

The introduction of daily oral PrEP, a novel HIV prevention for young African AGYW, required multiple strategies that were culturally sensitive, age-appropriate, and included peers, partners, parents, and other adults who influence health behaviours in AGYW.

Trial registration

Clinicaltrials.gov NCT02732730, 13 November 2018.

Optimising adolescents and young adults' utilisation of sexual and reproductive health and HIV services in Chad: a sensemaking approach

BACKGROUND

Adolescents and young adults (AYA) aged 15-24 years account for nearly half of all new HIV infections globally, with over 80% residing in sub-Saharan Africa, where AIDS is a leading cause of death. In Chad, HIV/AIDS significantly impacts AYA, despite a reduction in national prevalence from 1.6% in 2010 to 1.0% in 2022. AYA still contribute to 26.3% of new infections, with young women facing four times the risk compared with young men. Barriers throughout the care continuum, including transitions from paediatric to adult services, contribute to an overall antiretroviral therapy (ART) coverage of 47% in 2023, with only 27% of males compared with 58% of females receiving treatment. These challenges impact access to sexual and reproductive health services and effective help-seeking.

METHODS

This study used participatory action research with a sensemaking theoretical lens. From December 2021 to March 2024, data were collected from 52 AYA (aged 15-24, both HIV-positive and HIV-negative) in focus group discussions. Data were analysed using a modified grounded theory approach, with coding and category development guided by the constant comparison method.

RESULTS

Findings indicate that empowering AYA in health decision-making requires an adaptable approach considering individual experiences, interpersonal influences and systemic factors. Such an approach can enhance engagement with healthcare services, increase service utilisation and treatment adherence and inform policy redesign for more effective service delivery.

CONCLUSION

This study advances the understanding of sensemaking in healthcare, illustrating how AYA in Chad navigate and interpret the healthcare system. It highlights the need for AYA-friendly services that foster clear communication, trust and responsive care. Strengthening health systems through adolescent-responsive policies, workforce training and decentralised service delivery can enhance AYA engagement, service utilisation and retention in care. Aligning services with AYA perspectives through community-driven approaches and system reforms can improve healthcare accessibility and outcomes in similar contexts.

From pregnancy to beyond: renewed emphasis on comprehensive HIV prevention in South Africa

South Africa continues to document high HIV prevalence, particularly among pregnant women, highlighting significant prevention gaps. This viewpoint triangulates findings from the Sixth South African HIV Prevalence Survey, the 2022 Antenatal HIV Sentinel Survey, and our ongoing "Philani Ndiphile" trial, which is evaluating STI screening algorithms to improve pregnancy outcomes. Despite a recent national decline in antenatal HIV prevalence, the Philani trial recorded an HIV prevalence of 28.6% among pregnant women, mirroring high rates across the Eastern Cape Province. The trial cohort also revealed a significant increasing trend in HIV prevalence with age, from 6% at 18 years to 63% at 43 years, highlighting the need for age-targeted interventions in young women of childbearing age. National progress toward UNAIDS' targets for HIV status knowledge and ART initiation is evident; however, viral suppression remains a challenge, reflected in the 20% of Philani participants newly initiated or reinitiated on ART at their first antenatal visit. Efforts to reduce new HIV infections require strengthening, as high incidence rates persist among young women and during pregnancy and postpartum. Expanding access to oral and long-acting PrEP for pregnant and postpartum women is critical. Current coverage is low, and while new options show promise, implementation guidance remains limited. Socioeconomic factors, such as poverty and intimate partner violence, exacerbate HIV risk. Comprehensive interventions, including educational and vocational support, engaging male partners, and addressing STIs are essential. Continued support from global health partnerships and innovation in prevention strategies are vital to ending the epidemic and ensuring equitable outcomes.

Geographic variations and determinants of ever-tested for HIV among women aged 15-49 in Sierra Leone: a spatial and multi-level analysis

BACKGROUND

HIV testing among women in sub-Saharan Africa varies widely, with Sierra Leone having lower rates than other countries. This study explores geographic variations and determinants of HIV testing among women aged 15-49 in Sierra Leone.

METHOD

The study utilized data from the 2008, 2013, and 2019 Sierra Leone Demographic Health Surveys, comprising 39,606 women aged 15-49. Spatial autocorrelation and Moran's I were used to analyze the distribution of this outcome, while mixed-effect multi-level binary logistic regression assessed the factors associated with ever-tested for HIV. The findings were reported as adjusted odds ratios (aOR) with a 95% confidence interval (CI).

RESULTS

This study found that 21.47% of the study population comprised young women aged 15-19, and 53.62% had no formal education. Ever tested for HIV drastically increased from 13% in 2008 to 56% in 2019. HIV testing hotspots expanded from the Western urban and rural areas in 2008 to include districts like Port Loko, Kambia, and Bo by 2019, with a national testing pooled prevalence of 45.5% [44.2, 46.8]. The pooled regression analysis shows that women aged 20-34 had higher odds of testing than those aged 15-19, while those aged 40-49 had lower odds. Higher education, marriage/cohabitation, media exposure, parity, sexual activity, recent healthcare visits, condom use, STI history, larger households, female-headed households, and higher wealth indices were associated with higher odds of testing. Testing odds were higher during the 2013 and 2019 survey years compared to 2008. Conversely, Muslims, women with challenges accessing healthcare, and those in rural areas had lower odds of being tested.

CONCLUSION

From 2008 to 2019, the rate of women aged 15-49 years ever tested for HIV showed a significant increase. The expansion of HIV testing hotspots highlights progress in geographic coverage, but disparities remain, particularly in rural areas. Younger women (aged 20-34) and those with higher education, wealth, or access to healthcare services were more likely to be tested, underscoring the influence of socioeconomic and structural factors on testing uptake. The lower odds of testing among older women and Muslims point to the need for targeted interventions addressing cultural barriers. Media exposure, parity, and sexual activity emphasize the role of reproductive health and awareness in promoting testing. Efforts to improve access to healthcare in rural areas and address logistical challenges, such as distance to health facilities, are critical for equitable HIV testing coverage. Strengthening community-based outreach and culturally sensitive programs could further close the gaps in testing uptake. The sustained increase in testing prevalence from 2008 to 2019 reflects progress but also highlights the need for continuous investment in HIV testing programs.

How do social norms influence the sexual and reproductive health of very young adolescents in sub-Saharan Africa? A scoping review protocol

Introduction

Introduction Very young adolescents (VYAs, aged 10-14 years) in sub-Saharan Africa (SSA) have the worst sexual and reproductive health (SRH) outcomes of this age group worldwide due to structural, behavioural, socioeconomic and other factors. Social and gender norms have important consequences for the SRH and wellbeing of VYAs both now and over their life course. SRH programming often focuses on older adolescents (aged 15-19 years), overlooking younger ones. This scoping review sets out to explore how social and gender norms influence VYAs' SRH in SSA, in addition to exploring interventions that have been effective, to inform a context-specific intervention.

Methods

We will employ the methodology developed by Arksey and O'Malley to review the available literature. We will search online databases (PubMed/MEDLINE, CINHAL, EMBASE, PsycINFO, Cochrane Library, and African Index Medicus) for original studies published between 1 January 2000 and 31 December 2024. Further, we will perform a manual search to include relevant grey literature. The steps in the review are: 1) defining the research question, 2) identifying relevant studies, 3) selecting studies, 4) charting the data, and 5) collating, summarising, and reporting the results.

Results

Results We will report findings in accordance with the guidance provided in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) statement. We will analyse and summarise data about study characteristics using descriptive statistics. We will use thematic analysis to analyse and summarise key themes and issues. We will triangulate quantitative and qualitative findings.

Discussion

The review will map the breadth of studies focusing on social and gender norms, and SRH among VYAs, in addition to exploring interventions that have been effective. Findings will help us and others develop context-specific, bespoke interventions.

Human Immunodeficiency Virus Risk Perception, Condom Utilization, and Associated Factors Among Youths (15-24 Years of Age) in Gashena Town, Northeast Ethiopia: Community-Based Cross-Sectional Study

Background: Globally, an estimated 1.7 million people were newly infected with human immunodeficiency virus (HIV), and approximately 37.9 million people were living with the virus. The prevalence of HIV remains high in sub-Saharan African countries, including Ethiopia. Consequently, enhancing the awareness of HIV risk is crucial for prevention efforts, as studies have shown that increased risk perception is strongly linked to condom utilization among youths. Objective: This study aimed to assess HIV risk perception and condom utilization among youths and associated factors in Gashena town, Northeast Ethiopia. Method: Community-based cross-sectional study involving 422 youths (15-24 years old) was conducted from June 01 to 30, 2022. Participants were selected using a systematic random sampling technique, and data analysis was conducted using Statistical Package for the Social Sciences (SPSS) Version 25 software. Logistic regression analysis was employed to determine the odds ratios for variable associations, with statistical significance set at p < 0.05. Result: The present study revealed that 50% (95% CI: 42.7-57.3) of youths utilized condoms, while 19.4% (95% CI: 15.8-23.5) had a perception of being at risk for HIV. Factors significantly associated with both condom utilization and HIV risk perception included being 18 years old or older (AOR: 95% CI: 0.2 [0.10-0.40]), having completed primary education or higher (AOR: 95% CI: 6.23 [3.44-11.29]), and being employed (AOR: 95% CI: 1.96 [1.09-3.53]). Conclusion: This study found a low prevalence of condom utilization and HIV risk perception among youths. Being 18 years old or older, having completed primary education or higher, and being employed were factors significantly linked to both condom use and HIV risk perception. Therefore, raising awareness about the implications of unprotected sexual intercourse and HIV risk perception among youths of varying ages, educational status, and occupational statuses could potentially enhance condom utilization among this demographic group.

Acceptability of an annual tenofovir alafenamide implant for HIV prevention in South African women: findings from the CAPRISA 018 Phase I clinical trial

INTRODUCTION

Long-acting HIV pre-exposure prophylaxis promises to improve uptake, adherence and persistence challenges experienced with daily oral tablets. We assessed the acceptability of an annual tenofovir alafenamide (TAF) implant in South African women enrolled from 9 July 2020 until 31 May 2022 in a Phase I trial.

METHODS

Six women received one TAF implant for 4 weeks (Group 1), after which 30 women were randomized (4:1, TAF to placebo ratio) to receive 1 or 2 TAF or placebo implants for 48 weeks (Group 2), before trial discontinuation. Acceptability assessments were conducted pre- and post-implant removal. Implant attributes (size, quantity, insertion site, palpability, visibility) and physical experiences (insertion/removal procedures, implant site reactions [ISRs]) were rated on a scale of 1 (highly unacceptable) to 6 (highly acceptable), with 4 being the acceptability threshold. The mean (range) of the mean acceptability scores across all pre-removal visits were calculated, including stratification by removal timing (early vs. scheduled). Implant likes and dislikes were also assessed.

RESULTS

The median participant age was 26 years. Prior to implant removal, the mean (range) acceptability scores were 5.4 (3.6-6.0) for product attributes and 5.1 (1.7-6.0) for physical experiences. Eleven (31%) participants had early implant removals, occurring on average 19 weeks (range 2-27 weeks) after insertion. The proportion of study visits reporting adherence measure as unacceptable in early versus scheduled removals: ISRs (50% vs. 19%), visibility (30% vs. 15%), palpability (14% vs. 8%), pain (16% vs. 4%) and implant quantity (13% vs. 1%). Pre-removal acceptability scores for ISRs (p = 0.003) and physical experiences (p = 0.05) were significantly associated with early removal. Overall, mean (range) acceptability scores were 5.8 (4.0-6.0) and 5.9 (4.7-6.0) for lifestyle compatibility and likelihood of recommendation, respectively. After removal, 39% of participants found ISRs unacceptable, followed by 22% citing implant visibility. Potential for long-term HIV protection, followed by discreet and convenient use, were most liked, while ISRs were the most disliked aspect.

CONCLUSIONS

While implant attributes, physical experiences and insertion/removal procedures were largely acceptable, local ISRs significantly reduced tolerability and acceptability, resulting in higher-than-expected early removals. The potential benefits of an annual TAF implant may be undermined unless tolerability is improved.

HIV Vulnerability Typologies Among Adolescent Girls and Young Women in Lesotho: A Population-Based, Cross-Sectional, Latent Class Analysis

ABSTRACT

Adolescent girls and young women ages 15-29 years (AGYW) living in Lesotho experience a disproportionate HIV burden. Using a household-based national survey in Lesotho, we conducted a three-step latent class analysis to identify typologies of AGYW most vulnerable to HIV infection. We first classified AGYW into HIV vulnerability groups based on self-reported sexual behaviors, then identified associations between typology and HIV diagnosis. HIV vulnerability behaviors included early sexual debut, condomless sex, multiple sexual partners in the past year, sex with partners they do not know the status of or are living with HIV, age disparate sex, use of contraceptives, and having children. Across all age groups, we found that HIV vulnerability typologies could be described as low vulnerability, high vulnerability, and parous. As AGYW age, they engage in more types of higher vulnerability sexual behaviors; interventions to reduce this risk should start at a younger age. Our findings emphasize the importance of implementing and scaling up biomedical strategies such as pre-exposure prophylaxis.

A community-based study of intention to use HIV self-testing among young people in urban areas of southern Ethiopia

In sub-Saharan Africa, young people are at high risk of HIV infection, representing nearly 4 out of 5 new infections. HIV self-testing (HIVST), a new and proactive testing scheme that involves self-collection of a specimen and interpretation of results, is deemed potentially helpful for increasing testing amongst population groups like young people who do not frequently use routine testing services. This study assessed young people's intention to use HIVST in urban areas of southern Ethiopia drawing on the Theory of Planned Behaviour. A community-based cross-sectional study was conducted with 634 participants aged 15-24 years from six town administrations of two zones in January to February 2023. The participation rate was 634/636 yielding 99.7%. The OraQuick HIVST kit was demonstrated to young people recruited in a door-to-door survey with a face-to-face interview using an electronic questionnaire in a mobile phone-based application. Intention to use HIVST was measured from a 6-point Likert scale with scores of agreements ranging from 1 to 6. Descriptive statistics and ordinal logistic regression analysis were done using STATA version 18. Most of the participants agreed that they would use HIVST if it was available (86.3% agreeing or strongly agreeing). Interestingly, young people who perceived themselves at some to high risk were 0.51 times less likely to be in the higher order of intention to use when HIVST is available to them than those who perceived themselves at no to low risk. Intention to use HIVST increased by a factor of 1.29, 1.84 and 2.35 for every one-unit increase on the mean favourable attitude, perceived behavioural control, and acceptability scores, respectively. The majority of young people intended to use HIVST. Young people's perceived behavioural control, and acceptability of HIVST affected their intention to use. Intention and subsequent use of HIVST can be enhanced through an understanding of the role of risk perception and positive attitude, confidence to perform and acceptance of the test. Implementation studies are required to examine the actual uptake of HIVST among young people.

Adolescents and young adults with HIV and unsuppressed viral load: where do we go from here?

PURPOSE OF REVIEW

Adolescents and youth living with HIV (AYLHIV) have worse outcomes at all stages of the care cascade when compared with adults, yet adolescents and youth with unsuppressed viral load are typically excluded from phase 3 studies of novel HIV therapeutic agents and emerging strategies. Long-acting agents have the potential to radically change outcomes for young people struggling with adherence to daily oral HIV medications.

RECENT FINDINGS

1.5 million children aged less than 15 years live with HIV and more than 100 000 acquire HIV perinatally every year. Adolescents and youth aged 10-24 years comprise ∼40% of global incident HIV infections. Rates of viral suppression among AYLHIV vary markedly from 44 to 88%, resulting in morbidity and risks of transmission to partners and infants. Virological failure is mostly due to poor adherence, and AYLHIV express high levels of interest and acceptability of alternatives to oral daily medications, such as long-acting antiretroviral formulations. Emerging data regarding their use in populations with unsuppressed viral load are encouraging.

SUMMARY

AYLHIV, including populations without virologic suppression, must be prioritized for the programmatic implementation and research of long-acting HIV drugs and other therapeutic strategies to prevent morbidity and mortality and to ultimately end the HIV epidemic.

Realising agency: insights from participatory research with learners in a South African sexual and reproductive health programme

Background

Investing in the capabilities of adolescents is essential to achieving the United Nations Sustainable Development Goals, which focus on realising adolescent girls and young women's (AGYW) rights to education, health, bodily autonomy and integrity, sexual and reproductive health (SRH) and well-being. Despite significant scientific and programmatic progress in understanding and responding to their unique and intersecting vulnerabilities, AGYW continue to face disproportionate risk of STIs, HIV and early pregnancy. Health promotion and preventative interventions stand to be improved by early and meaningful engagement of AGYW in intervention design and delivery.

Methods

This study employed Youth Participatory Action Research (YPAR) to co-generate lessons for future school-based SRH programming. The 5-step YPAR process included: (1) youth investigator recruitment; (2) youth investigator training and co-design of YPAR methods; (3) youth investigator-led data collection; (4) collaborative analysis and interpretation; and (5) dissemination.

Results

Collaborative analysis revealed improvements in self-concept and bodily autonomy, understanding and formation of healthy relationships and demand for girl-centred health services and information at school. Additionally, the study highlights YPAR's positive influence on both the collaborative process and outputs of research. Further, it provides further insight into the quantitative biomedical and socio-behavioural findings of a larger experimental impact evaluation, in which it was nested.

Conclusion

Results from YPAR methods point to high programme acceptability and practical lessons to inform future school-based SRH programming. The inclusion of adolescent girls in the design, delivery and evaluation of intervention research that affects their lives is an important strategy for improving acceptability, and also has demonstrated value in building their health and social assets. Future recommendations include parental involvement, and employing quantitative measures for better evaluation of youth engagement, leadership and partnerships in the research process.

Leveraging behavioral economics strategies to close gaps in biomedical HIV prevention

Adolescent girls and young women (AGYW) in southern Africa face triple the HIV incidence of their male peers due to multiple factors, including economic deprivation and age-disparate relationships. A new study by Aurélia Lépine and colleagues has demonstrated that addressing healthcare costs among AGYW has the potential to reduce HIV incidence.

Influence of socio-contextual factors on the link between traditional and new media use, and young people's sexual risk behaviour in Sub-Saharan Africa: a secondary data analysis

BACKGROUND

Traditional and new media use links to young people's sexual risk behaviour. The social contexts of young people's daily lives that influence media use and sexual risk behaviour are often investigated as independent causal mechanisms. We examined the link between media use and young people's sexual risk behaviour, considering the intersecting socio-contextual factors in Sub-Saharan Africa.

METHODS

Age-adjusted bivariate logistic regression models tested the association between traditional media (TV, radio, and newspapers), and new media (mobile phone and online) use and sexual risk behaviour using the Demographic and Health Surveys from six Sub-Saharan African countries among unmarried sexually active youths, aged 15-24 years. Multivariate logistic regression models ascertained the media sources that had an additional influence on young people's sexual risk behaviour, after accounting for socio-contextual factors, and knowledge about HIV and other sexually transmitted infections.

RESULTS

Socio-contextual factors attenuated the association between media use and young people's sexual risk behaviour in many countries. However, those who did not have access to new and traditional media were more likely to use unreliable contraceptive methods or not use contraception. Adolescents in Nigeria who did not own phones were 89% more likely to use unreliable contraceptive methods or not use any methods [(AOR = 1.89 (1.40-2.56), p < .001)], those in Angola who did not read newspapers had higher odds of not using contraception or used unreliable methods [(aOR = 1.65 (1.26-2.15), p < .001)]. Young people in Angola (aOR = 0.68 (0.56-0.83), p < .001), Cameroon [(aOR = 0.66 (0.51-0.84), p < .001)], Nigeria [(aOR = 0.72 (0.56-0.93), p = .01)], and South Africa [(aOR = 0.69 (0.49-0.98), p = .03)] who did not own phones were less likely to have 2 or more sexual partners compared to those who owned phones. Lack of internet access in Mali was associated with lower odds of having 2 or more sexual partners (aOR = 0.45 (0.29-0.70), p < .001). Traditional media use was significantly associated with transactional sex in many countries.

CONCLUSIONS

Media use is linked to sexual risk behaviour among young people in Sub-Saharan Africa. Socioeconomic inequalities, levels of globalization, as well as rural-urban disparities in access to media, underscore the need to deliver tailored and targeted sexual risk reduction interventions to young people using both traditional and new media.

Knowledge and experiences of adolescent girls and young women in the use of sexual reproductive health and HIV services at health facilities in Maputo City, Mozambique

Background

Knowledge and use of sexual reproductive health and human immunodeficiency virus (SRH and HIV) services are crucial for the prevention of pregnancy and sexually transmitted infections (STIs) among adolescent girls and young women (AGYW). This study aims to assess the knowledge and perceptions of AGYW about the SRH and HIV services offered in health facilities in Maputo, Mozambique.

Material and methods

A cross-sectional descriptive study was conducted based on exit surveys with AGYW held at Zimpeto and 1° de Junho Health Facilities in Maputo City, between May 1, and June 9, 2023. Data were analyzed through descriptive statistics, t-test and ANOVA, using SPSS version 20.

Results

590 AGYW, aged 15-24 years of age, were included in the study. In general, knowledge of SRH and HIV services was fairly high, with knowledge of each specific service offered ranging between 38% and 97%. Knowledge about SRH and HIV services differed depending on the health facility where the AGYW sought SRH and HIV services; the participant's age; their occupation; their religion, and who they lived with. Counseling services were the most commonly reported services attended, with >90% of participants reporting having received counseling for each of the following: STI and HIV and pregnancy prevention, sexuality, and safer sex practices. The quality of SRH and HIV services, and attitudes of the providers were considered good by >90% of AGYW. Roughly 95% of AGYW at Zimpeto Health Facility were either "satisfied" or "very satisfied". Whereas at 1° de Junho Health Facility, only roughly 75% of AGYW were either "satisfied" or "very satisfied", and roughly 20% of AGYW were "little satisfied that their needs had been met that day.

Conclusions

Among AGYW there is high levels of knowledge about counseling services in contrast to diagnostics, treatment and clinical care. Specific attention should be given to ensuring appropriate physical infrastructure, such as dedicated adolescent friendly spaces and comfortable seating, and targeted interventions designed and implemented for those health facilities's identified. Targeted interventions should be designed and implemented for those HF's identified with lower AGYW perceived quality of service delivery.

Formalized peer referral to HIV pre-exposure prophylaxis supported with self-testing: a mixed-methods pilot study among young Kenyan women

Background

The uptake of daily oral HIV pre-exposure prophylaxis (PrEP)-a highly effective intervention-remains low among African adolescent girls and young women (AGYW) who could benefit. AGYW who initiate PrEP often do so through informal peer referral, which may be enhanced with formalized peer referral and peer-delivered HIV self-testing (HIVST). To understand the feasibility of this PrEP referral model among AGYW, we conducted a pilot study in Kenya.

Method

From March to May 2022, we recruited AGYW (≥16-24 years) using PrEP (i.e., "peer providers") from public healthcare clinics in Kiambu County and trained them on HIV prevention, HIVST use, and peer-supported linkage to clinic-based HIV services. Following training, peer providers received eight HIVST kits and were encouraged to refer four peers (i.e., "peer clients") to PrEP. We completed surveys with peer providers and clients one month following intervention delivery to assess PrEP initiation among peer clients. Later, we conducted focus group discussions (FGDs) with peer providers and clients to identify factors that facilitated or challenged intervention outcomes.

Results

We trained 16 peer providers (median age: 23 years, IQR 21-24) who reported delivering the intervention to 56 peer clients; 30 peer clients (median age: 21 years, IQR 19-22) contacted the study team and were enrolled. Most of the enrolled peer clients reported behaviors associated with HIV risk (e.g., condomless sex; 80%, 24/30) and were PrEP-naïve (87%, 26/30). At one-month, PrEP initiation among eligible PrEP-naïve peer clients was high, as reported by providers (78%, 43/55) and clients (85%, 22/26); recent HIVST use was also high among peer clients (provider report: 95%, 53/56; client report: 97%, 29/30). In the FGDs, participants reported that intervention outcomes were facilitated by close preexisting relationships, HIVST assistance, and being escorted to clinic-based HIV services by peer providers; intervention barriers included conflicting priorities and limited HIVST experience.

Conclusion

A formalized model of peer referral with HIVST delivery supported PrEP initiation among Kenyan AGYW. These findings demonstrate the potential for peer-delivered interventions to engage AGYW in HIV prevention services; however, more research is needed on the effectiveness and sustainability of this approach at scale.

Opportunistic Infections in HIV-Infected Children on Treatment in Southern Morocco: A 12-Years Retrospective Follow-up Study

BACKGROUND

Human immunodeficiency virus (HIV) infection in children is a significant public health concern, increasing the risk of infant mortality. Immunodeficiency caused by HIV favors the development of opportunistic infections (OIs), which are responsible for over 90% of HIV-related deaths. This study seeks to determine the primary OIs in children with HIV followed at the Hassan II Regional Hospital Center in Sous Massa, during the period from 2012 to 2023.

MATERIALS AND METHODS

This retrospective study is the first in Morocco to investigate OIs among HIV-infected children. It analyzed 76 complete medical records, using a data collection form designed based on existing literature.

RESULTS

This study revealed that 37% of participants were suffering from OIs, mainly diarrhea (11%), tuberculosis (9%) and pneumonia (7%).There was a significant correlation between OIs and HIV clinical stage (P=0.001), age (P=0.007), and anemia (P=0.001). Despite progress in management, the presence of OIs remains a risk factor for infant morbidity and mortality.

CONCLUSION

The study highlights the importance of early detection, prevention, and adherence to treatment in reducing this burden. Management of anemia is essential.

Adolescents' risky sexual behaviours and practices: Implications for sexuality education implementation in Zambia

BACKGROUND

 Adolescents' risky sexual behaviours (RSB) are detrimental to their sexual and reproductive health (SRH) well-being and present a serious public health threat, particularly in low- and middle-income countries (LMICs).

AIM

 This study aims to assess RSB among Grade 12 school-going adolescents after exposure to comprehensive sexuality education (CSE).

SETTING

 This study was conducted in Kitwe district, Zambia.

METHODS

 This cross-sectional study included 807 Grade 12 pupils at 13 selected secondary schools. Data were collected using a structured questionnaire. Proportionate probability sampling involving 13 schools was employed. Risky sexual behaviours binary outcome variables were based on transactional sex, sex while drunk, multiple sexual partners, age-disparate sexual relationships, and condomless sex. We conducted univariate and bivariate analyses to summarise sociodemographic factors and fitted binary and multivariable logistic regression models.

RESULTS

 The prevalence of RSB was 40.4%. Drinking alcohol (adjusted odds ratio [AOR] = 20.825; 95% CI [6.7-64.489]); ever had sex (AOR = 9.024; 95% CI [1.953-41.704]); school location (AOR = 6.50; 95% CI [1.61-26.24]); living with mother only (AOR = 4.820; 95% CI [1.328-17.493]); sex (male) (AOR = 2.632; 95% CI [1.469-4.713]), watching pornography (AOR = 1.745; 95% CI [1008-3.021]); religion (AOR = 0.472; 95% CI [0.250-0.891]) and attending religious functions (AOR = 0.317; 95% CI [0.118-0.848]) were significantly associated with RSB. Of the sexually active pupils, 221 (67.7%), 64 (19.6%) and 41 (12.5%) were in the low, medium and high-risk categories, respectively.

CONCLUSION

 Close to half of the respondents engaged in RSB. This is a significant number that needs intervention. The CSE programme needs to be linked with structural programmes that address the social drivers of RSB among adolescents.Contribution: The study provides a backdrop for evaluating current CSE strategies in LMICs.

Measuring HIV outcomes for adolescent girls and young women programs in Africa: Using the polling booth survey technique

INTRODUCTION

Adolescent girls and young women (AGYW) remain highly vulnerable to the risk of acquiring HIV (Human immunodeficiency virus). This study was conducted to measure behavioral, biomedical and structural outcomes for the Global Fund funded AGYW programmes in five African countries with high burden of HIV including Botswana, Cameroon. Lesotho, Malawi and Namibia.

METHODS

The study used a mixed methods approach to collect behavioral, structural and biomedical outcome data. Quantitative data were collected through 418 Polling Booth Survey (PBS) sessions from 4,581 AGYWs. Participants were recruited through a community-based multistage sampling technique using sampling weights for urban and rural communities. 23 Focus Group Discussions (FGD) were conducted to understand barriers to use of HIV prevention programme and community recommendations for improved coverage. Ethical approvals were obtained from the ethics review board in all five countries.

RESULTS

More than 50% of the respondents from all five countries reported to be sexually active, and at least 30% or more of those who were sexually active had multiple sex partners. There were wide variations between the countries in condom use with a non-marital sexual partner which ranged between 66% in Namibia to 42% in Cameroon. Cameroon (44%) had high percentage of AGYWs with independent income source while school drop-outs were higher in Malawi (55.5%) and Lesotho (46.6%). Nearly 1/4th of AGYWs in all countries, except Namibia, reported experiencing intimate partner violence. Nineteen percent of the respondents were pregnant in the last 12 months, and 50% of those pregnancies were unplanned. Lesotho had the highest proportion of AGYW (90.5%) ever tested for HIV, followed by Malawi (87.5%), Botswana (75%), Cameroon (69%) and Namibia (62.6%).

DISCUSSION

There is diversity across the countries, with country-wise and age-wise variations in results. In all countries, the AGYW programme will benefit from a more targeted approach to reach out to the most vulnerable AGYW, strengthening structural interventions, strengthening linkage to PrEP (Pre-Exposure Prophylaxis) and ART (Antiretroviral Therapy) for those who are living with HIV and a strong linkage with reproductive health services. The assessment helped countries to understand the gaps and opportunities to improve the HIV prevention programme with AGYW.

Feasibility, acceptability and preliminary effect of a community-led HIV self-testing model among adolescent girls and young women in Rural Northern Uganda: a quasi-experimental study protocol

BACKGROUND

Adolescent girls and young women (AGYW) in sub-Saharan Africa face a disproportionately higher HIV/AIDS burden despite the global decline in incidence. Existing interventions often fail to adequately address their unique social, economic, and cultural challenges, limiting access to essential HIV/AIDS services, including HIV testing. Emerging evidence indicates that HIV self-testing, a user-friendly and confidential method, enhances HIV diagnosis and linkage to care by targeting these barriers. This study aims to assess the feasibility, acceptability, and preliminary impact of a peer-delivered, community-health worker (CHW)-facilitated HIV self-testing intervention for AGYW in Northern Uganda.

METHODS

This mixed-methods quasi-experimental implementation science study will employ a three-fold approach. Firstly, we will conduct baseline formative qualitative research with 50 AGYW, 50 parents/partners to AGYW, 30 CHWs, 15 community leaders, and the district health office to inform the design of a peer-delivered CHW-facilitated HIV self-testing intervention tailored to AGYW's needs in Northern Uganda. Secondly, we will implement a mixed-methods pilot study to assess the intervention's feasibility and acceptability, involving 415 AGYW, 30 AGYW peer leaders, and 10 CHWs in selected parishes and villages in Omoro district, Northern Uganda. Lastly, we will evaluate the implementation outcomes and preliminary impact of the intervention on HIV self-testing rates and linkage to care by collecting and analyzing quantitative data pre- and post-intervention, laying the groundwork for a future robust randomized controlled trial.

DISCUSSION

Our intervention combines CHWs and peer-led strategies to address the unique challenges of AGYW in Northern Uganda, leveraging community resilience and peer influence. Successful completion of this project will provide a scalable model to be evaluated in a randomized trial and replicated in similar contexts.

TRIAL REGISTRATION NUMBER

PACTR202404851907736. Registered with the Pan-African Clinical Trials Registry on April 22, 2024.

Trend and principal components of HIV/AIDS among adults in SSA

This study aimed to identify the most important principal components (PCs) that contribute to the prevalence and change of HIV/AIDS in 44 SSA and data from different national and international datasets. The study estimated HIV prevalence, trend, and principal component analysis (PCA). Using the elbow method, the number of important PCs and contributions was identified. The quality of representation was checked, and more contributing variables for most important PCs were identified. Finally, the status by prevalence, the progress by trend, the more influenced component by PCA, and the more influenced variable with quality of representation by PCs were reported. The study found that HIV prevalence varied significantly, with 30 of the countries showed good progress/decline. Four PCs accounted for 51% of the total variance. Literacy, cohabitation, media exposure, and HIV status awareness are highly contributing factors. Based on these findings, a gap-based response will help reduce the burden of HIV.

The Feasibility and Acceptability of Using Mobile Applications for HIV Testing, Prevention, and Treatment Among Adolescent Girls and Young Women in Cameroon: A Cross-Sectional Study

ABSTRACT

Adolescent girls and young women (AGYW) are vulnerable populations to HIV/AIDS. We conducted a cross-sectional survey among 637 AGYW in Cameroon to study the feasibility and willingness to use mobile applications (apps) for HIV testing, prevention, and treatment. We found that phone ownership is high among AGYW, where 93.9% ( n = 598) of them (median age: 22 years, interquartile range: 21-24 years) had access to a smartphone, 49.5% ( n = 315) frequently searched for health information, and 48.9% ( n = 312) frequently used health-related apps. AGYW's willingness to use mobile apps for HIV testing, prevention, and treatment were 87.9% ( n = 560), 84.4% ( n = 538), and 84.9% ( n = 541), respectively. The high willingness to use apps was associated with older age, HIV testing, and searching for health information on a phone. Barriers to willingness included having no internet access, concerns about internet cost and privacy, and lack of consistent access to a smartphone.

Prevalence and factors associated with HIV testing among young women in Ghana

BACKGROUND

HIV/AIDS is a global health challenge and continues to threaten lives in sub-Saharan African countries such as Ghana. One of the important interventions for controlling its transmission is through testing and receiving medication. In this study, we present findings on the prevalence and factors associated with HIV testing among young women in Ghana.

METHODS

We used data from the 2014 Ghana Demographic and Health Survey comprising young women aged 15-24 years. We calculated the proportion of these young women who have ever been tested for HIV. The multivariable logistic regression analysis was used to assess the determinants of HIV testing at a 95% confidence interval (CI), and adjusted odds ratio (aORs) and p-values were reported. All analyses were adjusted using survey weights to account for unequal sampling probabilities.

RESULTS

The results showed that 31.4% (95% CI [29.63, 32.81]) of young women in Ghana had tested for HIV. The odds of HIV testing were likely to be higher among young women aged 20-24 (aOR = 2.24, 95% CI [1.75, 2.87]), those who were pregnant (aOR = 3.17, 95% CI [2.03, 4.95]) and those with one (aOR = 7.99, 95% CI [5.72, 11.17]), two (aOR = 10.43, 95% CI [6.47, 16.81]) or three or more children (aOR = 14.60, 95% CI [8.37, 25.48]) compared to their counterparts in the reference category. Women who had attained secondary education or higher (aOR = 2.66, 95% CI [1.67, 4.23]), were sexually active (aOR = 2.82, 95% CI [2.00, 3.97]), and in richer (aOR = 1.98, 95% CI [1.17, 3.34]) and richest wealth index (aOR = 1.99, 95% CI [1.10, 3.61]) were more likely to test for HIV than those with no formal education, who had not had sex before or in the poorest wealth index. Women from the Eastern (aOR = 1.69, 95% CI [1.04,2.72]) and Upper East regions (aOR = 2.62, 95% CI [1.44, 4.75]) were more likely than those in the Western region to get tested for HIV. However, the odds of testing for HIV were lower among women belonging to other religions (aOR = 0.43, 95% CI [0.23,0.82]) than Christians.

CONCLUSION

The findings show that HIV testing is low among young women in Ghana. To address this issue, it is recommended that both government and non-governmental organizations collaborate to create effective programmes and strategies. These may include continuous health education, regular sensitization programs and making HIV testing services much more accessible and affordable, taking into consideration the sociodemographic characteristics of young women.

Spatial mapping and predictors of ever-tested for HIV in adolescent girls and young women in Ethiopia

Background

Adolescent girls and young women (AGYW) are expected to be healthy in life. However, the unique health challenges faced by AGYW include unsafe sex practices and substance abuse. Only 46.3% of AGYW in Africa are aware of their HIV status, and difficulties are underlined in HIV testing among adolescents and young people. To demarcate the areas with low and high HIV testing, this study aimed to map predictors of ever-tested for HIV among adolescent girls and young women in Ethiopia.

Methods

Secondary data analysis was conducted using the dataset from the 2016 Ethiopia Demographic and Health Survey (EHDS). We conducted spatial autocorrelation and Moran's I statistics to investigate the regional variance of HIV being ever-tested in AGYW. In addition, spatial regression analyses such as ordinary least squares (OLS) regression and geographically weighted regression (GWR) were carried out to determine the predictors of being ever-tested for HIV among AGYW.

Results

Addis Ababa, some parts of Amhara, Dire Dawa, Gambela, and Tigray were the primary regions and city administrations for being ever-tested for HIV among AGYW. A lesser proportion of AGYW being ever-tested for HIV was found in Somalia, Afar, Benshangul Gumuz, and southern nations. Spatial regression analyses identified an age range of 15-19 years, being Muslim, having no formal education, having no knowledge about HIV, and experiencing severe stigma as predictors of being ever-tested for HIV among AGYW.

Conclusion

The proportion of AGYW being ever-tested for HIV was high in Addis Ababa, some parts of Amhara, Dire Dawa, Gambela, and Tigray. Spatial regression analyses identified that AGYW aged 15-19 years, having no formal education, having no knowledge about HIV, and experiencing severe community stigma as predictors negatively affecting the proportion of being ever-tested for HIV, while being Muslim was a predictor that positively affected the proportion of being ever-tested for HIV. The governments and other stakeholders should focus on increasing HIV testing among these special groups of the population.

Generalized and COVID related anxiety as risk factors for health outcomes among adolescents with HIV during COVID-19 in Tanzania

The COVID-19 pandemic and associated prevention strategies caused widespread interruptions to care and treatment for people living with HIV. Adolescents living with HIV (AWHIV) were particularly vulnerable to poor mental and physical health during COVID-19. We assessed the burden of generalized and COVID-19-related anxiety and associations with adherence to HIV care and treatment and viral load suppression (VLS) among AWHIV during the peak of the COVID-19 pandemic in Tanzania.

Methods

This cross-sectional study was conducted among AWHIV aged 15-19 years attending 10 clinics in Dar es Salaam from April 2022-February 2023. Study participants completed a self-administered questionnaire including Generalized Anxiety Disorder (GAD), COVID-19-related anxiety, and other psychosocial and physical health and support measures. HIV visit adherence, viral load and sociodemographic data were abstracted from patient health records.Analysis:: Multivariable (MV) quasibinomial and logistic regression models examined associations of Generalized and COVID-19-related anxiety with visit adherence and HIV virologic suppression (HIV VL < 50 copies/mL). Data were analyzed using R software.

Results

658 AWHIV (52% male) were included in this analysis. Most (86%) had been on antiretroviral treatment (ART) for at least four years, 55% attended at least 75% of their scheduled clinic visits, and 78% were HIV virologically suppressed. The median GAD and COVID-19-related anxiety scores were 2 (IQR: 0-5, and 26 (IQR: 13-43; respectively. Only 2% scored moderate-severe generalized anxiety (score 10-21). We found no significant associations between COVID-19-related anxiety or GAD and visit adherence. Higher GAD was inversely associated with VLS (adjusted odds ratio (AOR): 0.89 (95% CI 0.81, 0.98)). Female gender and higher quality of physical life were significantly associated with VLS.

Conclusion

Low levels of generalized and COVID-19 related anxiety were reported among Tanzanian AWHIV. Integrating screening and management of generalized anxiety screening into HIV care for AWHIV could improve VLS among this population.

Exploring perceptions of gender roles amongst sexually active adolescents in rural KwaZulu-Natal, South Africa

Traditional gender and social norms reinforce asymmetrical power relations, increase the risk of experiencing gender-based violence and mediate poor engagement with sexual and reproductive health services. This study explored gender norms and expectations amongst cisgender adolescents in rural KwaZulu-Natal, South Africa. A purposive sample of 29 adolescents aged 16-19 years old were enrolled as part of a longitudinal qualitative study. The current analysis reports on the first round of in-depth interviews, which focused on the role of men and women in their community. A theoretically informed thematic analysis identified three broad themes: 1) Adolescent interpretation and understanding of gender identity, 2) Gendered essentialism and Gender roles (two sub-themes: Young men: Power through providing, and Young women: The domestication process which highlighted that gender roles were defined by being the provider for men, and the successful fulfilment of traditional domestic behaviours amongst women), 3) Gender and fertility highlighted how participants highly valued fertility as affirming of manhood/womanhood. These norms reinforce gender roles that maintain asymmetrical power relations, carrying them over into adulthood. The subtle social pressure to prove fertility could have unintended consequences for driving teenage pregnancy. Structural, gender-based interventions emphasising positive gender-role development in early childhood are needed.

Access to adolescent sexual and reproductive health services in Accra, Ghana: An exploratory qualitative study

Nearly 31% of the Ghanaian population are adolescents, and these populations persistently face high rates of teenage pregnancies and unsafe abortions. This is despite sexual and reproductive health (SRH) being taught in the school curriculum. In this qualitative study, we explore the factors affecting adolescents' access to, and experiences of, SRH services in Accra, Ghana. We conducted 12 focus group discussions (FGDs) with adolescents and 13 key informant interviews (KIs) in Ghana. The FGDs were conducted with school-going and out-of-school adolescents. KIIs were conducted with various stakeholders working with adolescents or in SRH services. All interviews were conducted in English, audio recorded and transcribed verbatim. We applied the Dahlgren-Whitehead Rainbow model of health determinants and used a thematic analysis. Eight themes were identified, across micro, meso and macro levels, that influence adolescents' SRH access and experience in Accra. These included: family, social networks, the role of schools, health providers and services, the policy landscape, gender norms, cultural norms, and poverty. The findings highlight several factors that influence adolescents' access to appropriate SRH services in this context and demonstrate the need for a multisectoral effort to address structural factors such as harmful gender norms and persistent poverty.

HIV preexposure prophylaxis and postexposure prophylaxis in women: a comprehensive guide for healthcare providers

Great disparities and inequities in the delivery and acceptance of human immunodeficiency virus (HIV) prevention exist globally among women. Various barriers, such as societal stigma, low perceived risk, relationship dynamics, and lack of education on routes of HIV transmission can cause low utilization in HIV preexposure prophylaxis (PrEP) adoption and use. In addition, socioeconomic and structural factors, such as financial burden, lack of provider knowledge and willingness to prescribe, absence of insurance coverage, and limited access to healthcare services are additional barriers to PrEP use among cisgender women. The goal of this review is to highlight current and prospective PrEP options, attitudes, and views of PrEP use among cisgender women and healthcare providers, and the role of PrEP in special populations of cisgender women.

Pre-exposure prophylaxis access, uptake and usage by young people: a systematic review of barriers and facilitators

Background

Young people's sexual health decision-making, including decisions to access and adhere to HIV prevention strategies such as Pre-Exposure Prophylaxis (PrEP), are influenced by a range of internal and external factors. Synthesizing these factors is essential to guide the development of youth-focused PrEP health promotion strategies to contribute to international goals of ending HIV transmission.

Objective

To understand the individual, interpersonal, sociocultural and systemic barriers and facilitators to PrEP access, uptake and use experienced by young people 24 years and younger.

Design

A systematic review that adhered to the Preferred Reporting Items of Systematic Review and Meta-Analysis Protocols.

Data Sources and Methods

Eight databases (PubMed, Scopus, Cochrane, Medline, CINAHL, JBI, EMBASE, Web of Science) were systematically searched using terms related to young people, HIV and PrEP use. A narrative synthesis approach was used to delineate key barriers and facilitators to PrEP access, uptake and use.

Results

Of 11,273 returned articles, 32 met the eligibility criteria for inclusion: 18 from the United States, 10 from African nations and two from Brazil. Barriers and facilitators to PrEP access, uptake and use experienced by young people were identified across intrapersonal, interpersonal, community and systems levels. These factors are described under four overarching themes that relate to knowledge, side effects and perceptions of risk; attitudes and perceptions of family and partners; community attitudes and stigma; and negative healthcare provider experiences and difficulties navigating complex costly healthcare systems.

Conclusion

Findings suggest individual-level factors need consideration alongside the impacts of healthcare systems and broader systemic sociocultural structures within young people's relationships when developing PrEP health promotion strategies and services. Without considering these wider external implications to access, uptake and use of PrEP, global targets towards the elimination of HIV transmission will likely remain out of reach.

Registration

This review was registered with Prospero (CRD42022296550).

Female Genital Mutilation and Sexual Risk Behaviors of Adolescent Girls and Young Women Aged 15-24 Years: Evidence From Sierra Leone

PURPOSE

Considering the high levels of female genital mutilation (FGM) in Sierra Leone with over 83% of girls and young women aged 15-24 years having undergone the practice, the study explores the potential influence of FGM on sexual behaviors of adolescent girls and young women (AGYW) in Sierra Leone.

METHODS

Cross-sectional data from the 2019 Demographic Health Survey were utilized to examine the association between FGM and three sexual behaviors; sexual debut before 18 years, child marriage and adolescent motherhood. To model this association, a generalized estimation equation technique was employed, while controlling for socio-demographic characteristics. Additionally, the study corrected for multiple-hypothesis testing using the Benjamini-Hochberg procedure with a specified false discovery rate of 0.05. Finally, percentage predicted probabilities of occurrence of the sexual risk behaviors in the presence of FGM were also calculated.

RESULTS

Of the 5524 AGYW, 76% had undergone FGM. FGM was associated with all three sexual risk behaviors. Sexual debut before 18 years had the highest predicted probability increase (+18.00 ppt, 95% CI: 14.41 to -21.59), followed by adolescent motherhood (+13.38 ppt, 95% CI: 10.16-16.60) and child marriage (+12.61 ppt; 95% CI: 10.22-15.01). Education was found to be protective against all three sexual risk behaviors.

DISCUSSION

The findings of this study demonstrate that FGM remains a prevalent practice in Sierra Leone, even among the younger generation. This practice is strongly associated with sexual behaviors that pose a significant risk to the health outcomes of AGYW. Investments in education by removing barriers to access for AGYW could lead to multiple gains.

Prevalence of risk factors for human immunodeficiency virus among sexually active women in Rwanda: a nationwide survey

BACKGROUND

The Human Immunodeficiency Virus (HIV) remains a global health burden, and despite the advancements in antiretroviral therapy and various strategies employed to curb HIV infections, the incidence of HIV remains disproportionately high among women. Therefore, this study aimed to determine the prevalence of the risk factors for the acquisition of HIV among sexually active women in Rwanda.

METHODS

Secondary data from the 2020 Rwanda Demographic Health Survey, comprising 10,684 sexually active women, was used. Multistage stratified sampling was employed to select the study participants. Multivariable logistic regression was conducted to determine the associated risk factors using the SPSS (version 25).

RESULTS

Of the 10,684 sexually active women, 28.7% (95% confidence interval (CI): 27.5-29.4) had at least one risk factor for HIV acquisition. Having no education (AOR = 3.65, 95%CI: 2.16-6.16), being unmarried (AOR = 4.50, 95%CI: 2.47-8.21), being from female-headed households (AOR = 1.75, 95%CI: 1.42-2.15), not having health insurance (AOR = 1.34, 95%CI: 1.09-1.65), no HIV test history (AOR = 1.44, 95%CI: 1.01-2.08), being from the poorest wealth quintile (AOR = 1.61, 95%CI: 1.14-2.27) and lack of exposure to mass media (AOR = 1.30, 95%CI: 1.07-1.58) were associated with higher odds of exposure to at least one HIV acquisition risk factor. In contrast, age groups of 25-34 (AOR = 0.56, 95%CI: 0.44-0.71) and 35-44 years (AOR = 0.62, 95%CI: 0.48-0.80), rural residence (AOR = 0.63, 95%CI: 0.49-0.81) and being from the western region (AOR = 0.67, 95%CI: 0.48-0.94) were associated with less odds of exposure to at least one HIV acquisition risk factor.

CONCLUSION

More than a quarter of sexually active women in Rwanda had exposure to at least one risk factor for HIV acquisition. There is a need to maximize the use of mass media in disseminating HIV prevention and behavioral change messages. Engagement of religious leaders and promotion of HIV testing, especially among the never-testers, may be vital strategies in successful HIV prevention programs.

Model-based predictions of protective HIV pre-exposure prophylaxis adherence levels in cisgender women

Most human immunodeficiency virus (HIV) infections occur in cisgender women in resource-limited settings. In women, self-protection with emtricitabine/tenofovir disoproxil fumarate pre-exposure prophylaxis (FTC/TDF-PrEP) constitutes a major pillar of HIV prevention. However, clinical trials in women had inconsistent outcomes, sparking uncertainty about adherence requirements and reluctance in evaluating on-demand regimens. We analyzed data from published FTC/TDF-PrEP trials to establish efficacy ranges in cisgender women. In a 'bottom-up' approach, we modeled hypotheses in the context of risk-group-specific, adherence-efficacy profiles and challenged those hypotheses with clinical data. We found that different clinical outcomes were related to the proportion of women taking the product, allowing coherent interpretation of the data. Our analysis showed that 90% protection was achieved when women took some product. We found that hypotheses of putative male/female differences were either not impactful or statistically inconsistent with clinical data. We propose that differing clinical outcomes could arise from pill-taking behavior rather than biological factors driving specific adherence requirements in cisgender women.

Access to sexual and reproductive health services among South African young people living with and without HIV during the COVID-19 pandemic

OBJECTIVE

To examine sexual and reproductive health (SRH) service access among South African young people during the COVID-19 pandemic.

STUDY DESIGN

We utilized cross-sectional data collected from February to October 2021 in Cape Town among young people 13-24 years of age living with and without HIV.

RESULTS

Two hundred and fifteen young people living with HIV (YPLWH) and 320 young people living without HIV were included. Young people reported an unmet need for SRH services during COVID-19, and 28% of YPLWH reported missing an HIV care appointment during the COVID-19 lockdowns.

CONCLUSIONS

Expanding access to SRH services for young people during disruptive events is critical to reduce disparities in HIV and other SRH outcomes.

Synthesis of protective oral PrEP adherence levels in cisgender women using convergent clinical- and bottom-up modeling

Globally, most HIV infections occur in heterosexual women in resource-limited settings. In these settings, female self-protection with generic emtricitabine/tenofovir disoproxil fumarate pre-exposure prophylaxis (FTC/TDF-PrEP) may constitute a major pillar of the HIV prevention portfolio. However, clinical trials in women had inconsistent outcomes, sparking uncertainty regarding risk-group specific adherence requirements and causing reluctance in testing and recommending on-demand regimen in women. We analyzed all FTC/TDF-PrEP trials to establish PrEP efficacy ranges in women. In a 'bottom-up' approach, we modeled hypotheses corroborating risk-group specific adherence-efficacy profiles. Finally, we used the clinical efficacy ranges to (in-)validate hypotheses. We found that different clinical outcomes could solely be explained by the proportion of enrolled participants not taking the product, allowing, for the first time, to unify clinical observations. This analysis showed that 90% protection was achieved, when women took some of the product. Using 'bottom-up' modelling, we found that hypotheses of putative male/female differences were either irrelevant, or statistically inconsistent with clinical data. Furthermore, our multiscale modelling indicated that 90% protection was achieved if oral FTC/TDF was taken at least twice weekly.

Nurse-facilitated preexposure prophylaxis delivery for adolescent girls and young women seeking contraception at retail pharmacies in Kisumu, Kenya

OBJECTIVE

We evaluated preexposure prophylaxis (PrEP) uptake, initiation, and continuation within a nurse-facilitated pharmacy-based delivery model for Kenyan adolescent girls and young women (AGYW) seeking contraception at retail pharmacies.

METHODS

From October 2020 to March 2021, PrEP-trained nurses were stationed at three retail pharmacies in Kisumu, Kenya. AGYW (aged 15-24 years) purchasing contraception (emergency contraception, oral contraceptive pills, injectables, implants, condoms) were counseled on PrEP, completed HIV testing, and offered a free 1-month supply of PrEP pills per national guidelines by nurses under supervision of a remote physician. We evaluated uptake among all AGYW offered PrEP. At 30 days after uptake, we evaluated PrEP use initiation and plans for continuation.

RESULTS

We enrolled 235 AGYW clients who were HIV-negative and purchasing contraception at pharmacies. Emergency contraception was the most frequently purchased contraceptive (35%). Median age was 22 years (IQR 19-23), 44% were currently in school, and 33% currently had multiple sexual partners. One-fourth (24%) exchanged sex for money or favors and 14% had sex while intoxicated in the prior 6 months. Overall, PrEP uptake was 85%; at 1 month, 82% had initiated PrEP use and 68% planned to continue use. Among those initiating PrEP, 69% were willing to pay for PrEP at retail pharmacies (median KES 150, IQR 100-200) even if available for free at public sector facilities.

CONCLUSION

In this evaluation of nurse-facilitated PrEP delivery at pharmacies in Kenya, a substantial proportion of AGYW who purchased contraception subsequently initiated PrEP, planned to continue use, and were willing to pay for PrEP.

Mental health and psychosocial interventions integrating sexual and reproductive rights and health, and HIV care and prevention for adolescents and young people (10-24 years) in sub-Saharan Africa: a systematic scoping review

Background

Interventions targeting combined sexual and reproductive health, Human Immunodeficiency Virus (HIV) management and mental health care in sub-Saharan Africa (SSA) are few. There is a need to address common determinants of poor mental, psychosocial and sexual and reproductive health and rights (SRHR) through multimodal and multipronged interventions for adolescents. The main objective of this study was to identify whether and how interventions targeting adolescent SRHR and HIV with a focus on pregnant and parenting adolescents in SSA include mental health components and how these components and their outcomes have been reported in the literature.

Methods

We carried out a two process scoping review approach between 01.04.2021 and 23.08.2022. In the first stage, we searched the PubMed database to identify studies focusing on adolescents and young people aged 10 to 24 from 2001 to 2021. We identified studies focusing on HIV and SRHR that had mental health and psychosocial aspects to the interventions. Our search yielded 7025 studies. Of these 38 were eligible based on our screening criteria that covered interventions, and on further scrutiny, using PracticeWise, an established coding system, we identified select problems and practices to provide a more granular assessment of how interventions developed for this context mapped on to specific problems. At this second stage process, we selected 27 studies for inclusion as actual interventional designs for further systematic scoping of their findings and we used the Joanna Briggs Quality Appraisal checklist to rate these studies. This review was registered within the International Prospective Register of Systematic Reviews (PROSPERO), number CRD42021234627.

Findings

Our first set of findings is that when coding problems and solutions, mental health concerns were the least common category of problems targeted in these SRHR/HIV interventions; nevertheless, psychoeducation and cognitive behavioral strategies such as improved communication, assertiveness training, and informational support were offered widely. Of the 27 interventional studies included in the final review, 17 RCTs, 7 open trials, and 3 mixed designs, represented nine countries of the 46 countries in SSA. Intervention types included peer, community, family, digital, and mixed modality interventions. Eight interventions focused on caregivers and youth. Social or community ecology associated problems (being an orphan, sexual abuse, homelessness, negative cultural norms) were the most common risk factors and were more frequent than medical issues associated with HIV exposure. Our findings highlight the relevance and centrality of social issues related to adolescent mental and physical health along with the need to strengthen multimodal interventions along the lines of problems we have identified in our review.

Interpretation

Combined interventions jointly addressing adolescent SRHR, HIV, and mental health have been relatively understudied, despite evidence that adverse social and community factors are rampant in this population.

Funding

MK was funded by Fogarty International CenterK43 TW010716-05 and lead the initiative.

Women for science and science for women: Gaps, challenges and opportunities towards optimizing pre-exposure prophylaxis for HIV-1 prevention

Preventing new HIV infections remains a global challenge. Young women continue to bear a disproportionate burden of infection. Oral pre-exposure prophylaxis (PrEP), offers a novel women-initiated prevention technology and PrEP trials completed to date underscore the importance of their inclusion early in trials evaluating new HIV PrEP technologies. Data from completed topical and systemic PrEP trials highlight the role of gender specific physiological and social factors that impact PrEP uptake, adherence and efficacy. Here we review the past and current developments of HIV-1 prevention options for women with special focus on PrEP considering the diverse factors that can impact PrEP efficacy. Furthermore, we highlight the importance of inclusion of female scientists, clinicians, and community advocates in scientific efforts to further improve HIV prevention strategies.