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


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.