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Contrasting needs and vulnerabilities of adolescent females aged 15-19 years living with HIV according to likely mode of transmission in Mozambique

Title
Contrasting needs and vulnerabilities of adolescent females aged 15-19 years living with HIV according to likely mode of transmission in Mozambique
Presenter
Chloe A. Teasdale
Authors
C.A. Teasdale * (1,2,3), K. Brittain (4,5), A. Zerbe (2), C.A. Mellins (6), J. Falcao (2), A. Couto (7), E. Pimentel De Gusmao (2), M. Vitale (2), B. Kapogiannis (8), T.B. Simione (7), L. Myer (4,5), J.E. Mantell (6), C. Desmond (9), E.J. Abrams (2,3,10)
Institutions
(1) CUNY Graduate School of Public Health & Health Policy, Department of Epidemiology and Biostatistics, New York, United States, (2) Mailman School of Public Health, ICAP at Columbia University, New York, United States, (3) Mailman School of Public Health, Columbia University, Department of Epidemiology, New York, United States, (4) School of Public Health & Family Medicine, University of Cape Town, Division of Epidemiology & Biostatistics, Cape Town, South Africa, (5) School of Public Health & Family Medicine, University of Cape Town, Centre for Infectious Disease Epidemiology & Research, Cape Town, South Africa, (6) New York State Psychiatric Institute and Columbia University Irving Medical Center, HIV Center for Clinical and Behavioral Studies, Department of Psychiatry, New York, United States, (7) Ministry of Health, National STI, HIV/AIDS Control Program, Maputo, Mozambique, (8) Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, United States, (9) University of KwaZulu Natal, Centre for Rural Health, Durban, South Africa, (10) Vagelos College of Physicians and Surgeons, Columbia University, Department of Pediatrics, New York, United States

BACKGROUND: The population of adolescents living with HIV (ALHIV) includes those with vertically acquired HIV (AVH) and behaviorally acquired HIV (ABH). There have been few studies examining differences among ALHIV based on mode of transmission (MOT) in high prevalence settings.
METHODS: We conducted a survey of Mozambican ALHIV to measure sociodemographic characteristics, health history, and antiretroviral therapy (ART) adherence. The survey was conducted in 2019 at three health facilities in Nampula, Mozambique among a convenience sample of ALHIV 15-19 years (yrs), including females attending antenatal care. Classification of ALHIV by MOT was based on medical charts and survey data: those who initiated ART at <15yrs or reported no sexual history were considered AVH; all others were ABH. We compared female participants according to MOT, frequencies compared using Chi-square, Fishers exact and Wilcoxon rank-sum tests.
RESULTS: There were 208 ALHIV participants including 143 females, 50 (35%) AVH and 93 (65%) ABH. Female ABH were older at ART initiation compared to AVH, 18yrs (IQR: 17-19) vs 12yrs (IQR: 9-16) (p<0.001). Socioeconomic indicators were worse for ABH compared to AVH: lower proportions had an inside toilet (11% vs. 28%, p=0.008), running water (5% vs. 26%, p=0.001), ever accessed the internet (19% vs. 48%, p<0.001); more ABH vs AVH were not in school (67% vs 16%, p<0.001). Among ABH not in school, 49% reported no or incomplete primary school. Only 61% of ABH knew they should not miss any doses of ARVs compared to 78% of AVH (p=0.04). Only half of ABH (51%) and AVH (58%) had viral suppression <50 copies/mL. ABH were more likely to be in a relationship compared to AVH (85% vs. 36%; p<0.0001) and a higher proportion of ABH (75%) had disclosed to partners compared to AVH (44%) (p=0.01). Among ABH, 56 (60%) were pregnant or breastfeeding at the survey compared to 3 (6%) AVH (p<0.0001).
CONCLUSIONS: Our novel findings demonstrate diversity within the population of ALHIV by mode of transmission and highlight high levels of health, economic and social vulnerability and need especially among young women with ABH.