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. 2022 Feb 1;36(2):267-276.
doi: 10.1097/QAD.0000000000003044.

Predictors of secondary HIV transmission risk in a cohort of adolescents living with HIV in South Africa

Elona Toska  1   2   3 , Siyanai Zhou  1 , Christina A Laurenzi  4 , Roxanna Haghighat  3 , Wylene Saal  1 , Laurie Gulaid  5 , Lucie Cluver  3   6
Affiliations

Predictors of secondary HIV transmission risk in a cohort of adolescents living with HIV in South Africa

Elona Toska et al. AIDS. .

Abstract

Objective: Preventing secondary HIV transmission from adolescents and young people living with HIV (AYPLHIV) to their partners and children is critical to interrupting the HIV infection cycle in sub-Saharan Africa. We investigated predictors of secondary HIV transmission risk (past-year sexual risk combined with past-year viremia) among AYPLHIV in South Africa.

Design: A prospective cohort of AYLPHIV in South Africa recruited n = 1046 participants in 2014-2015, 93.6% of whom were followed up in 2016-2017 (1.5% mortality). Questionnaires used validated scales where available and biomarkers were extracted from n = 67 health facilities.

Methods: Multivariate logistic regressions tested baseline factors associated with secondary HIV transmission risk, controlling for covariates, with marginal effect modelling combinations.

Results: About 14.2% of AYPLHIV reported high secondary HIV transmission risk. High-risk AYPLHIV were more likely to be sexually infected [adjusted odds ratio (aOR) 2.79, 95% confidence interval (95% CI) 1.66-4.68, P < 0.001], and report hunger (aOR 1.93, 95% CI 1.18-3.14, P = 0.008) and substance use (aOR 2.19, 95% CI 1.19-4.02, P = 0.012). They were more likely to be in power-inequitable relationships (aOR 1.77, 95% CI 1.08-2.92, P = 0.025) and be parents (aOR 4.30, 95% CI 2.16-8.57, P < 0.001). Adolescents reporting none of these factors had a 4% probability of secondary transmission risk, rising to 89% probability with all five identified factors. Older age and early sexual debut were also strongly associated with a higher risk of secondary HIV transmission.

Conclusion: It is essential to identify and support AYPLHIV at a high risk of secondary transmission. Screening for factors such as mode of infection and parenthood during routine healthcare visits could help identify and provide resources to the most at-risk adolescents.

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Conflict of interest statement

The project has been funded by the International AIDS Society through the CIPHER grant (155-Hod; 2018/625-TOS). The views expressed in written materials or publications do not necessarily reflect the official policies of the International AIDS society; the Claude Leon Foundation [F08 559/C]; Evidence for HIV Prevention in Southern Africa (EHPSA), a UK aid programme managed by Mott MacDonald; Janssen Pharmaceutica N.V., part of the Janssen Pharmaceutical Companies of Johnson & Johnson; Nuffield Foundation, but the views expressed are those of the authors and not necessarily the Foundation (Visit www.nuffieldfoundation.org); the Oak Foundation grants [R46194/AA001] and [OFIL-20–057]; the Regional Inter-Agency Task Team for Children Affected by AIDS - Eastern and Southern Africa (RIATT-ESA); the John Fell Funds [161/033] and [103/757]; the Leverhulme Trust (PLP-2014–095); University of Oxford's ESRC Impact Acceleration Account (IAA) [1602-KEA-189] and [K1311-KEA-004]; UNICEF Eastern and Southern Africa Office (UNICEF-ESARO); UKRI GCRF Accelerating Achievement for Africa's Adolescents (Accelerate) Hub (Grant Ref: ES/S008101/1). E.T. was supported by the Fogarty International Center, National Institute on Mental Health, National Institutes of Health under Award Number K43TW011434. The content is solely the responsibility of the authors and does not represent the official views of the National Institutes of Health. Funding was also provided for the research team by the European Research Council (ERC) under the European Union's Seventh Framework Programme [FP7/2007-2013]/ ERC grant agreement no. 313421, the European Union's Horizon 2020 research and innovation programme/ERC grant agreement no. 737476). E.T. was supported by the Oxford University Clarendon-Green Templeton College Scholarship in 2012-2016.

The views expressed in written materials or publications do not necessarily reflect the official policies of the International AIDS society; the Claude Leon Foundation [F08 559/C]; Evidence for HIV Prevention in Southern Africa (EHPSA), a UK aid programme managed by Mott MacDonald; Janssen Pharmaceutica N.V., part of the Janssen Pharmaceutical Companies of Johnson & Johnson; Nuffield Foundation, but the views expressed are those of the authors and not necessarily the Foundation. Visit www.nuffieldfoundation.org; the Oak Foundation grants [R46194/AA001] and [OFIL-20–057]; the Regional Inter-Agency Task Team for Children Affected by AIDS - Eastern and Southern Africa (RIATT-ESA); the John Fell Funds [161/033] and [103/757]; the Leverhulme Trust (PLP-2014–095); University of Oxford's ESRC Impact Acceleration Account (IAA) [1602-KEA-189] and [K1311-KEA-004]; UNICEF Eastern and Southern Africa Office (UNICEF-ESARO); UKRI GCRF Accelerating Achievement for Africa's Adolescents (Accelerate) Hub (Grant Ref: ES/S008101/1). Research reported in this publication was supported by the Fogarty International Center, National Institute on Mental Health, National Institutes of Health under Award Number K43TW011434. The content is solely the responsibility of the authors and does not represent the official views of the National Institutes of Health.

Figures

Fig. 1
Fig. 1
Probability of high secondary HIV transmission risk (controlling for covariates).
See this image and copyright information in PMC

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