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Rousseau E, Wu L, Heffron R, Baeten JM, Celum CL, Travill D, Delany-Moretlwe S, Bekker LG, Bukusi E, Omollo V, van der Straten A, O’Malley G, Haberer JE, Morton JF, Johnson RE, Roberts ST. Association of sexual relationship power with PrEP persistence and other sexual health outcomes among adolescent and young women in Kenya and South Africa. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 5:1073103. [PMID: 37325240 PMCID: PMC10266091 DOI: 10.3389/frph.2023.1073103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 05/16/2023] [Indexed: 06/17/2023] Open
Abstract
Introduction Gendered power inequalities impact adolescent girls' and young women's (AGYW) sexual and reproductive health (SRH) outcomes. We investigated the influence of sexual relationship power on AGYW's SRH outcomes, including HIV pre-exposure prophylaxis (PrEP) persistence. Methods The POWER study in Kisumu, Kenya, and Cape Town and Johannesburg, South Africa provided PrEP to 2,550 AGYW (aged 16-25). AGYW's perceived power in their primary sexual relationship was measured among the first 596 participants enrolled using the Sexual Relationship Power Scale's (SRPS) relationship control sub-scale. Multivariable regression was used to test for (1) key sociodemographic and relationship characteristics associated with relationship power; and (2) the association of relationship power with SRH outcomes including PrEP persistence. Results In this cohort, the mean SRPS score was 2.56 (0.49), 542 (90.9%) initiated PrEP; 192 (35.4%) persisted with PrEP at 1 month of which 46 (24.0% of 192) persisted at 6 months. SRPS were significantly lower among AGYW who cohabited with their sex partner (-0.14, 95% CI: -0.24 to -0.04, p = 0.01), or had ≥1 sex partner (-0.10, 95% CI: -0.19 to -0.00, p = 0.05). AGYW with lower SRPS were more likely to not know their partner's HIV status (aOR 2.05, 95% CI: 1.27 to 3.33, p < 0.01), but SRPS was not associated with PrEP persistence, STI infection, condom, or hormonal contraception use. Discussion AGYW's reasons for initiating PrEP and reasons for continuously using PrEP may be different. While low relationship power was associated with perceived HIV vulnerability, AGYW's PrEP persistence may be influenced by more than relationship power.
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Affiliation(s)
- Elzette Rousseau
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Linxuan Wu
- Departments of Global Health, Medicine and Epidemiology, University of Washington, Seattle, WA, United States
| | - Renee Heffron
- Departments of Global Health, Medicine and Epidemiology, University of Washington, Seattle, WA, United States
| | - Jared M. Baeten
- Departments of Global Health, Medicine and Epidemiology, University of Washington, Seattle, WA, United States
- Gilead Sciences, Inc., Seattle, WA, United States
| | - Connie L. Celum
- Departments of Global Health, Medicine and Epidemiology, University of Washington, Seattle, WA, United States
| | - Danielle Travill
- Wits RHI, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | | | | | - Ariane van der Straten
- Department of Medicine, Centre for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA, United States
- Astra Consulting, Kensington, CA, United States
| | - Gabrielle O’Malley
- Departments of Global Health, Medicine and Epidemiology, University of Washington, Seattle, WA, United States
| | - Jessica E. Haberer
- Harvard Medical School, Harvard University, Boston, MA, United States
- Centre for Global Health, Massachusetts General Hospital, Boston, MA, United States
| | - Jennifer F. Morton
- Departments of Global Health, Medicine and Epidemiology, University of Washington, Seattle, WA, United States
| | - Rachel E. Johnson
- Departments of Global Health, Medicine and Epidemiology, University of Washington, Seattle, WA, United States
| | - Sarah T. Roberts
- RTI International, Women’s Global Health Imperative (WGHI), Berkeley, CA, United States
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Bhushan NL, Shangase N, Kimaru LJ, Gomez-Olive FX, Kahn K, Pettifor AE. HIV Related Behaviors Among Male Partners of Adolescent Girls and Young Women in Rural South Africa. AIDS Behav 2023; 27:1469-1477. [PMID: 36318420 PMCID: PMC10485811 DOI: 10.1007/s10461-022-03882-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2022] [Indexed: 05/16/2023]
Abstract
Improving men's engagement in HIV prevention is not only essential for reducing their own HIV risk but also the risk of transmitting HIV to their female partners. We conducted a cross-sectional survey using a population-based sample of men (age 18-30) who reported being a partner of an adolescent girls and young women (AGYW) in South Africa (N = 2827). We used logit-binomial regression models to examine associations among men's partnership characteristics, HIV risk perceptions, and HIV-related behaviors and examine differences by male partner age (younger men (18-24) vs. older men (25-30)) and age difference between partners (age-concordant (< 5 years) vs. age-disparate (≥ 5 years)). Most men reported inconsistent condom use (85%) and nearly half reported engaging in transactional sex (48%). Older men were just as likely as younger men, and men with age-disparate and age-concordant partners, to inconsistently use condoms, engage in transactional sex, and perpetrate intimate partner violence. Most men also reported a very high interest in pre-exposure prophylaxis (PrEP) (77%) and half reported having an HIV test in the past year (50%). There were no differences by male partner age or age difference between partners in PrEP interest but older men and men in age-discordant relationships were more likely than younger men and men in age-concordant relationships to have an HIV test in the past year. Male partners of AGYW in South Africa are engaging in HIV-related behaviors and need HIV prevention interventions to reduce risk for themselves and their female partners.
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Affiliation(s)
- Nivedita L Bhushan
- RTI International, 3040 Cornwallis Road, 27709, Research Triangle Park, NC, USA.
| | - Nosipho Shangase
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Linda Jepkoech Kimaru
- University of Arizona, Tucson, AZ, USA
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - F Xavier Gomez-Olive
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Audrey E Pettifor
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
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Bhushan NL, Stoner MCD, Groves AK, Kahn K, Pettifor AE. Partnership Dynamics and HIV-Related Sexual Behaviors Among Adolescent Mothers in South Africa: A Longitudinal Analysis of HIV Prevention Trials Network 068 Data. J Adolesc Health 2022; 71:63-69. [PMID: 35370076 PMCID: PMC9232891 DOI: 10.1016/j.jadohealth.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 01/26/2022] [Accepted: 02/03/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE In South Africa, adolescent mothers have a three times higher risk of HIV acquisition than nonadolescent mothers. Yet, limited evidence exists regarding how early childbearing may affect HIV risk. A better understanding of adolescent mothers' partnership dynamics and sexual behaviors is critical to tailoring interventions to prevent new infections. METHODS Data are from HIV Prevention Trials Network 068, a longitudinal study of adolescent girls and young women (AGYW) aged 13-20 in South Africa who were followed annually for up to 6 years. Log-binomial regression models were used to assess whether adolescent motherhood was associated with partnership dynamics (intimate partner violence, gender inequitable norms, low relationship power, no HIV prevention communication) and if the association between partnership dynamics and sexual behaviors (unprotected sex and transactional sex) varied by adolescent motherhood. Generalized estimating equations, with an exchangeable correlation structure, were used to account for nonindependence. RESULTS Adolescent mothers were more likely than nonadolescent mothers to be in partnerships characterized by intimate partner violence, low relationship power, gender inequitable norms, and no HIV prevention communication. A higher proportion were also more likely to experience these dynamics, as well as engage in transactional sex, after giving birth. Poor partnership dynamics put AGYW at a higher risk for unprotected sex and transactional sex, regardless of adolescent motherhood status. DISCUSSION Engaging adolescent mothers in interventions post birth and developing interventions that address power imbalances in AGYW's sexual partnerships have the potential to reduce engagement in HIV-related sexual behaviors and HIV risk in the long term.
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Affiliation(s)
- Nivedita L Bhushan
- Center for Communication Science, RTI International, Research Triangle Park, North Carolina.
| | - Marie C D Stoner
- Women's Global Health Imperative, RTI International, San Francisco, California
| | - Allison K Groves
- Department of Community Health and Prevention, Drexel University, Philadelphia, Pennsylvania
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Audrey E Pettifor
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa; Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Milovanovic M, Jewkes R, Matuludi M, Dunkle K, Hlongwane K, Vanleeuw L, Slingers N, Jaffer M, Mbowane V, Abdullah F, Otwombe K, Gray G, Coetzee J. Sex work and young women: a cross sectional study to understand the overlap of age and sex work as a central tenet to epidemic control in South Africa. AIDS Care 2022; 35:555-563. [PMID: 35373670 DOI: 10.1080/09540121.2022.2057908] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Adolescent girls and young women (AGYW) engaging in sex-for-money transactions are at risk of HIV infection. A better understanding of the demographic, socio-economic factors and risks of HIV acquisition is required to guide appropriate public health interventions targeting young sex workers in South Africa. A cross-sectional survey of Female Sex Workers (FSWs), using a chain referral sampling method, was conducted across 12 sites in South Africa in 2019. Three thousand and five participants were enrolled and interviewed assessing demographic characteristics, sexual behaviour, substance use and HIV testing and treatment. Of 3005 women, 13.3% were ≤24 years old (young FSWs); of these, 60.0% entered sex work aged ≤19 years. Economic factors were the primary drivers of entry into sex work. HIV prevalence amongst young FSWs was 40.4%, with 12.4% recently infected. Younger FSWs were significantly less likely to know they were HIV positive (87.6% versus 92.1%), to report any ART exposure (75.2% versus 87.6%) and to be virally suppressed (58.1% versus 75.2%) compared to older FSWs. Our findings highlight that many FSWs enter sex work at a young age. It is essential to develop tailored services and interventions that improve access to HIV prevention and treatment services addressing specific needs.
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Affiliation(s)
- Minja Milovanovic
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa.,African Potential Management Consultancy (APMC), Johannesburg, South Africa
| | - Rachel Jewkes
- Gender & Health Research Unit, South African Medical Research Council, Pretoria, South Africa
| | - Mokgadi Matuludi
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa
| | - Kristin Dunkle
- Gender & Health Research Unit, South African Medical Research Council, Pretoria, South Africa
| | - Khuthadzo Hlongwane
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa
| | - Lieve Vanleeuw
- Office of AIDS and TB Research, South African Medical Research Council, Pretoria, South Africa
| | - Nevilene Slingers
- Office of AIDS and TB Research, South African Medical Research Council, Pretoria, South Africa
| | - Maya Jaffer
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa
| | - Venice Mbowane
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa
| | - Fareed Abdullah
- Office of AIDS and TB Research, South African Medical Research Council, Pretoria, South Africa
| | - Kennedy Otwombe
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Glenda Gray
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa.,Office of the President, South African Medical Research Council, Tygerberg, South Africa
| | - Jenny Coetzee
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa.,African Potential Management Consultancy (APMC), Johannesburg, South Africa.,Gender & Health Research Unit, South African Medical Research Council, Pretoria, South Africa
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What's in a Name? A Mixed Method Study on How Young Women Who Sell Sex Characterize Male Partners and Their Use of Condoms. J Acquir Immune Defic Syndr 2021; 87:652-662. [PMID: 33507013 DOI: 10.1097/qai.0000000000002623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 12/01/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Young women who sell sex (YWSS) are at disproportionate risk of HIV. Reducing YWSS' vulnerability requires engaging their male sexual partners. To achieve this, we need to understand the characteristics and dynamics of their sexual partnerships to inform effective interventions. METHODS We conducted a mixed-methods study to compare YWSS' qualitative descriptions of male partners with categories reported in a behavioral survey. Data were drawn from enrollment into an evaluation of the DREAMS initiative in Zimbabwe in 2017. As part of a respondent-driven sampling survey, we recruited 40 seed participants from 2 intervention and 4 comparison sites. We conducted semistructured interviews with 19 "seeds," followed by a behavioral survey with 2387 YWSS. We interpreted quantitative and qualitative data together to understand how YWSS perceived male sexual partners, assess how well survey variables related to narrative descriptions, and describe patterns of risk behavior within partnerships. RESULTS Qualitative data suggest survey categories "husband" and "client" reflect YWSS' perceptions but "regular partner/boyfriend" and "casual partner" do not. In interviews, use of the term "boyfriend" was common, describing diverse relationships with mixed emotional and financial benefits. More than 85% of male partners provided money to YWSS, but women were less likely to report condomless sex with clients than regular partners (11% vs 37%) and more likely to report condomless sex with partners who ever forced them to have sex (37% vs 21%). CONCLUSIONS Reducing HIV risk among YWSS requires prevention messages and tools that recognize diverse and changing vulnerability within and between sexual relationships with different male partners.
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Filiatreau LM, Giovenco D, Twine R, Gómez-Olivé FX, Kahn K, Haberland N, Pettifor A. Examining the relationship between physical and sexual violence and psychosocial health in young people living with HIV in rural South Africa. J Int AIDS Soc 2021; 23:e25654. [PMID: 33340267 PMCID: PMC7749553 DOI: 10.1002/jia2.25654] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 10/16/2020] [Accepted: 11/19/2020] [Indexed: 12/12/2022] Open
Abstract
Introduction Experiences of violence during youth contravene young people’s rights and increase the risk of depression and poor human immunodeficiency virus (HIV) care outcomes among youth living with HIV (YLWH). Intervention targets for mitigating the negative psychosocial effects of violence are needed, particularly in areas like rural South Africa where violence remains pervasive and mental healthcare is limited. This study aims to quantify the associations between physical and sexual violence and depressive symptoms in YLWH in rural South Africa and explore the modification of these associations by key measures of psychosocial well‐being. Methods We conducted a cross‐sectional survey among 362 YLWH ages 12 to 24 in rural South Africa to ascertain participants’ history of physical and sexual violence, current depressive symptoms (Center for Epidemiological Studies‐Depression Scale) and levels of social support (Medical Outcomes Social Support Scale), resilience (Conner‐Davidson Resilience Scale) and self‐esteem (Rosenberg Self‐Esteem Scale). Log‐binomial regression was used to estimate the association between history of physical or sexual violence and clinically meaningful depressive symptoms (scores ≥16). Effect measure modification by high versus low resilience, social support and self‐esteem was assessed using likelihood ratio tests (α = 0.20). Results A total of 334 individuals with a median age of 21 (interquartile range: 16 to 23) were included in this analysis. Most participants were female (71.3%), single (81.4%) and attending school (53.0%). Ninety‐four participants (28.1%) reported a history of physical or sexual violence and 92 individuals (27.5%) had clinically meaningful depressive symptoms. Meaningful depressive symptoms were significantly higher among participants with a history of physical or sexual violence as compared to those with no history of violence (adjusted prevalence ratio: 2.01; 95% CI: 1.43, 2.83). However, this association was significantly modified by social support (p = 0.04) and self‐esteem (p = 0.02). Conclusions In this setting, the prevalence of meaningful depressive symptoms was significantly higher among YLWH with a history of physical or sexual violence as compared to those without a history of violence. However, higher levels of self‐esteem or social support appeared to mitigate this association. Programmes to improve self‐esteem and social support for youth have the potential to minimize depressive symptoms in YLWH who have experienced physical or sexual violence.
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Affiliation(s)
- Lindsey M Filiatreau
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Danielle Giovenco
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rhian Twine
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | - F Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Audrey Pettifor
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
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Atkins K, Rucinski K, Mudavanhu M, Holmes L, Mutunga L, Kaufman MR, Bassett J, Van Rie A, Schwartz SR. Sexual Relationship Types, Partner HIV Self-Testing, and Pre-Exposure Prophylaxis Among South African Adolescent Girls and Young Women: A Latent Class Analysis. J Acquir Immune Defic Syndr 2021; 86:413-421. [PMID: 33196552 PMCID: PMC10358829 DOI: 10.1097/qai.0000000000002569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 09/28/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sexual relationships among adolescent girls and young women (AGYW) are influenced by social, economic, and gender dynamics. Understanding AGYW's different relationship types and their implications for HIV risk is important for development of tailored interventions. We sought to identify relationship typologies among AGYW and their impact on uptake of HIV prevention interventions. METHODS From May 2018 to February 2019, 2200 HIV-negative AGYW (ages 16-24) in Johannesburg, South Africa, participated in an HIV prevention intervention involving distribution of HIV self-test kits to their male partners. AGYW were also offered pre-exposure prophylaxis. At baseline, AGYW completed a questionnaire, and outcomes were assessed for 3 months. We used latent class analysis to identify relationship types and mixture modeling to estimate the impact of relationship type on engagement in prevention interventions. RESULTS We identified 3 relationship types: "stable, empowered relationships with older partners" (class 1, n = 973); "shorter, empowered relationships with peer partners" (class 2, n = 1067); and "shorter relationships with risky partners" (class 3, n = 160). Compared with AGYW in class 1 relationships, AGYW in class 2 and 3 relationships were less likely to complete partner testing alongside HIV results sharing (class 2 adjusted risk ratio: 0.89, 95% confidence interval: 0.85 to 0.95; class 3 adjusted risk ratio: 0.84, 95% confidence interval: 0.73 to 0.94). Pre-exposure prophylaxis uptake was highest in class 3 (11.2%) compared with class 2 (3.8%) and class 1 (1.0%; P < 0.001). CONCLUSIONS Relationship type impacts uptake of HIV prevention interventions among South African youth. Intervention effectiveness could be optimized by using tailored approaches to HIV risk mitigation among AGYW.
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Affiliation(s)
- Kaitlyn Atkins
- Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Katherine Rucinski
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | | | - Leah Holmes
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | | | - Michelle R. Kaufman
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | | | - Annelies Van Rie
- Department of Epidemiology and Social Medicine, University of Antwerp, Antwerp, Belgium
| | - Sheree R. Schwartz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Mody A, Sikombe K, Beres LK, Simbeza S, Mukamba N, Eshun-Wilson I, Schwartz S, Pry J, Padian N, Holmes CB, Bolton-Moore C, Sikazwe I, Geng EH. Profiles of HIV Care Disruptions Among Adult Patients Lost to Follow-up in Zambia: A Latent Class Analysis. J Acquir Immune Defic Syndr 2021; 86:62-72. [PMID: 33105396 PMCID: PMC7722465 DOI: 10.1097/qai.0000000000002530] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 09/28/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients report varied barriers to HIV care across multiple domains, but specific barrier patterns may be driven by underlying, but unobserved, behavioral profiles. METHODS We traced a probability sample of patients lost to follow-up (>90 days late) as of July 31, 2015 from 64 clinics in Zambia. Among those found alive, we ascertained patient-reported reasons for care disruptions. We performed latent class analysis to identify patient subgroups with similar patterns of reasons reported and assessed the association between class membership and care status (ie, disengaged versus silently transferred to a new site). RESULTS Among 547 patients, we identified 5 profiles of care disruptions: (1) "Livelihood and Mobility" (30.6% of the population) reported work/school obligations and mobility/travel as reasons for care disruptions; (2) "Clinic Accessibility" (28.9%) reported challenges with attending clinic; (3) "Mobility and Family" (21.9%) reported family obligations, mobility/travel, and transport-related reasons; (4) "Doubting Need for HIV care" (10.2%) reported uncertainty around HIV status or need for clinical care, and (5) "Multidimensional Barriers to Care" (8.3%) reported numerous (mean 5.6) reasons across multiple domains. Patient profiles were significantly associated with care status. The "Doubting Need for HIV Care" class were mostly disengaged (97.9%), followed by the "Multidimensional Barriers to Care" (62.8%), "Clinic Accessibility" (62.4%), "Livelihood and Mobility" (43.6%), and "Mobility and Family" (23.5%) classes. CONCLUSION There are distinct HIV care disruption profiles that are strongly associated with patients' current engagement status. Interventions targeting these unique profiles may enable more effective and tailored strategies for improving HIV treatment outcomes.
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Affiliation(s)
- Aaloke Mody
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO
| | - Kombatende Sikombe
- Centre for Infectious Diseases Research in Zambia, Lusaka, Zambia
- Department of Public Health Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Laura K. Beres
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Sandra Simbeza
- Centre for Infectious Diseases Research in Zambia, Lusaka, Zambia
| | - Njekwa Mukamba
- Centre for Infectious Diseases Research in Zambia, Lusaka, Zambia
| | - Ingrid Eshun-Wilson
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO
| | - Sheree Schwartz
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Jake Pry
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO
- Centre for Infectious Diseases Research in Zambia, Lusaka, Zambia
| | - Nancy Padian
- Division of Epidemiology, University of California, Berkeley, Berkeley, CA
| | | | - Carolyn Bolton-Moore
- Centre for Infectious Diseases Research in Zambia, Lusaka, Zambia
- Division of Infectious Diseases, University of Alabama, Birmingham, AL
| | - Izukanji Sikazwe
- Centre for Infectious Diseases Research in Zambia, Lusaka, Zambia
| | - Elvin H. Geng
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO
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Risk of HIV infection among adolescent girls and young women in age-disparate relationships in sub-Saharan Africa. AIDS 2020; 34:1539-1548. [PMID: 32443063 DOI: 10.1097/qad.0000000000002582] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the association between age-disparate relationships and risk of HIV infection among adolescent girls and young women (AGYW) aged 15-24 years. DESIGN Systematic review and meta-analysis of published studies until January 5, 2020 in sub Saharan Africa (SSA). METHODS We searched several electronic databases, grey literature, and hand searched reference list of included studies to identify eligible studies for data abstraction. We assessed the quality of included studies using Newcastle-Ottawa Scale for nonrandomized studies. The DerSimonian-Laird random effects model was used to pool the overall results using risk ratios (RR), presented in a forest plot with 95% confidence interval (CI) and predictive interval. Heterogeneity was assessed with Cochrane's Q-test and quantified with I values. Publication bias was checked with funnel plots and Egger's test. RESULTS We included 24 studies with an overall sample size of 33 390. Data show that age-disparate relationships were significantly associated with unprotected sexual intercourse (pooled RR, 1.57; 95% CI, 1.34-1.83; 95% predictive interval, 1.22-2.02), and higher risk for HIV infection (pooled RR, 1.39; 95 CI, 1.21-1.60; 95% predictive interval, 0.80-2.42). Studies included in pooling risk of unprotected sexual intercourse were largely homogeneous (I-value= 0.0, P = 0.79) whereas those for HIV infection were heterogeneous (I- value = 89.0%, P < 0.01). We found no publication bias and no study influenced the meta-analytic results. CONCLUSION Age-disparate relationships among AGYW are associated with increased risk of unprotected sexual intercourse and HIV infection in SSA. HIV prevention interventions should target this sub-population.
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Parmley LE, Rosen JG, Nuh O, Venegas M, Sunday A, İ Nergiz A, Thiim A. Nothing about us without us: considerations for ensuring rights-affirming index case testing for young people. J Int AIDS Soc 2020; 23:e25595. [PMID: 32779384 PMCID: PMC7417867 DOI: 10.1002/jia2.25595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/07/2020] [Accepted: 07/15/2020] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Joseph G Rosen
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - Oğuzhan Nuh
- Social PolicyGender Identity, and Sexual Orientation Studies AssociationIstanbulTurkey
| | - Manuel Venegas
- defeatHIV Community Advisory BoardFred Hutch Cancer Research CenterSeattleWAUSA
| | - Aaron Sunday
- African Network of Adolescents and Young Persons Development (ANAYD)KadunaKaduna StateNigeria
- Association of Positive Youth Living with HIV in Nigeria (APYIN)AbujaNigeria
| | - Ali İ Nergiz
- Cerrahpasa Medical SchoolIstanbul University‐CerrahpasaIstanbulTurkey
| | - Aron Thiim
- Program RISEJustice Resource InstituteFraminghamMAUSA
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11
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Gottert A, Pulerwitz J, Heck CJ, Cawood C, Mathur S. Creating HIV risk profiles for men in South Africa: a latent class approach using cross-sectional survey data. J Int AIDS Soc 2020; 23 Suppl 2:e25518. [PMID: 32589340 PMCID: PMC7319107 DOI: 10.1002/jia2.25518] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 04/10/2020] [Accepted: 04/22/2020] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Engaging at-risk men in HIV prevention programs and services is a current priority, yet there are few effective ways to identify which men are at highest risk or how to best reach them. In this study we generated multi-factor profiles of HIV acquisition/transmission risk for men in Durban, South Africa, to help inform targeted programming and service delivery. METHODS Data come from surveys with 947 men ages 20 to 40 conducted in two informal settlements from May to September 2017. Using latent class analysis (LCA), which detects a small set of underlying groups based on multiple dimensions, we identified classes based on nine HIV risk factors and socio-demographic characteristics. We then compared HIV service use between the classes. RESULTS We identified four latent classes, with good model fit statistics. The older high-risk class (20% of the sample; mean age 36) were more likely married/cohabiting and employed, with multiple sexual partners, substantial age-disparity with partners (eight years younger on-average), transactional relationships (including more resource-intensive forms like paying for partner's rent), and hazardous drinking. The younger high-risk class (24%; mean age 27) were likely unmarried and employed, with the highest probability of multiple partners in the last year (including 42% with 5+ partners), transactional relationships (less resource-intensive, e.g., clothes/transportation), hazardous drinking, and inequitable gender views. The younger moderate-risk class (36%; mean age 23) were most likely unmarried, unemployed technical college/university students/graduates. They had a relatively high probability of multiple partners and transactional relationships (less resource-intensive), and moderate hazardous drinking. Finally, the older low-risk class (20%; mean age 29) were more likely married/cohabiting, employed, and highly gender-equitable, with few partners and limited transactional relationships. Circumcision (status) was higher among the younger moderate-risk class than either high-risk class (p < 0.001). HIV testing and treatment literacy score were suboptimal and did not differ across classes. CONCLUSIONS Distinct HIV risk profiles among men were identified. Interventions should focus on reaching the highest-risk profiles who, despite their elevated risk, were less or no more likely than the lower-risk to use HIV services. By enabling a more synergistic understanding of subgroups, LCA has potential to enable more strategic, data-driven programming and evaluation.
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Affiliation(s)
| | | | | | - Cherie Cawood
- Epicentre Health ResearchPietermaritzburgSouth Africa
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12
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Comins CA, Rucinski KB, Baral S, Abebe SA, Mulu A, Schwartz SR. Vulnerability profiles and prevalence of HIV and other sexually transmitted infections among adolescent girls and young women in Ethiopia: A latent class analysis. PLoS One 2020; 15:e0232598. [PMID: 32407394 PMCID: PMC7224533 DOI: 10.1371/journal.pone.0232598] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 04/17/2020] [Indexed: 12/02/2022] Open
Abstract
Background Adolescent girls and young women (AGYW) aged 15–24 years have among the highest risk for HIV and other sexually transmitted infections (STI) across sub-Saharan Africa. A latent class analysis (LCA) was conducted to identify intersecting social- and structural-level determinants of HIV/STI acquisition among AGYW in Ethiopia. Methods AGYW were recruited from venues using time-location sampling, completing an interviewer-administered behavioral survey and biological testing for HIV, syphilis, and chlamydia. LCA was used to identify distinct groups, defined by social- and structural-level determinants of HIV/STI risk, among AGYW. Prevalence ratios (PR) and 95% confidence intervals (CI) compared differences in HIV/STI prevalence by group. Results A total of 1,501 AGYW were enrolled across Addis Ababa (March–May 2018) and Gambella (June–July 2019). We identified three patterns of vulnerability defined by schooling status, migration history, food insecurity, orphan status, social support, and employment. We labeled these groups as “highly vulnerable” (representing ~21% of the population), “stable, out-of-school, migrated” (~42%), and “stable, in-school, never migrated” (~37%). STI prevalence was nearly two-fold higher among AGYW in the “highly vulnerable” group compared to AGYW in the “stable, in-school, never migrated” group (PR 1.93; 95% CI 1.33, 2.80). Conclusions Characterizing patterns of vulnerability among AGYW that reflect higher-level social and structural factors can help facilitate early identification of AGYW at the highest risk of HIV/STI acquisition, thus differentiating groups of AGYW who may most benefit from targeted HIV prevention interventions during adolescence and early adulthood.
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Affiliation(s)
- Carly A. Comins
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- * E-mail:
| | - Katherine B. Rucinski
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | | | | | - Sheree R. Schwartz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
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13
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Geng EH, Holmes CB, Moshabela M, Sikazwe I, Petersen ML. Personalized public health: An implementation research agenda for the HIV response and beyond. PLoS Med 2019. [PMID: 31891581 DOI: 10.1371/journal.pmed.1002809,16,5,(e1002809)] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Affiliation(s)
- Elvin H Geng
- Division of Infectious Diseases, Department of Medicine and Center for Dissemination and Implementation, Institute for Public Health, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Charles B Holmes
- Center for Global Health and Quality, Georgetown University Department of Medicine, Washington, DC
- Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Mosa Moshabela
- School of Nursing and Public Health, University of KwaZulu Natal, Republic of South Africa
| | - Izukanji Sikazwe
- Center for Infectious Diseases Research in Zambia, Lusaka, Zambia
| | - Maya L Petersen
- Division of Biostatistics, School of Public Health, University of California Berkeley, Berkeley, California, United States of America
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14
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Geng EH, Holmes CB, Moshabela M, Sikazwe I, Petersen ML. Personalized public health: An implementation research agenda for the HIV response and beyond. PLoS Med 2019; 16:e1003020. [PMID: 31891581 PMCID: PMC6938296 DOI: 10.1371/journal.pmed.1003020] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Elvin H. Geng
- Division of Infectious Diseases, Department of Medicine and Center for Dissemination and Implementation, Institute for Public Health, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Charles B. Holmes
- Center for Global Health and Quality, Georgetown University Department of Medicine, Washington, DC
- Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Mosa Moshabela
- School of Nursing and Public Health, University of KwaZulu Natal, Republic of South Africa
| | - Izukanji Sikazwe
- Center for Infectious Diseases Research in Zambia, Lusaka, Zambia
| | - Maya L. Petersen
- Division of Biostatistics, School of Public Health, University of California Berkeley, Berkeley, California, United States of America
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