A study of transmission risk behavior in a clinical population of adolescents with perinatally-acquired HIV in Soweto, South Africa

Wits Health Consortium (Pty), Ltd, Johannesburg

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Abstract

? DESCRIPTION (provided by applicant): This study will contribute to our scientific knowledge on an under-researched but growing population of perinatally-infected adolescents. Little is known about this population navigates important transitions to adulthood in the context of a highly stigmatized, chronic illness. As seropositive individuals they have grown up with significant adversity and psychosocial challenges that may contribute to high risk behavior, prevent them from disclosing their HIV status to potential partners, and reduce adherence to antiretroviral treatment (ART). These behavioral risks have long-term implications for both their own health (through poorly controlled HIV infection and clinical deterioration) and the public's health (through onward transmission). Thus, we are proposing a multi-disciplinary, collaborative project to develop this critical evidence base and initiate a long overdue focus on the distinct sexual health needs of perinatally-infected adolescents. The aims of this exploratory/developmental R21 are Aim 1: To describe the behavioral risk profiles (high risk sexual behaviors; HIV status disclosure; adherence to ART) of perinatally-infected adolescents attending a pediatric HIV clinic. This aim will assess the relative potential for onward HIV transmission, and enable practitioners to develop prevention strategies better tailored to the unique profile of perinatally-infected adolescents. Aim 2: To gather preliminary evidence on adverse childhood experiences among perinatally-infected adolescents and explore potential associations with the above high risk behaviors. This will help refine instruments and hypotheses for future study, and ultimately identify key childhood factors amenable to intervention. Aim 3: To develop the research procedures for a more extensive study contrasting the behavioral risk profiles of perinatally-infected, behaviorally-infected, and uninfected adolescents. Despite their very different life histories and needs, HIV prevention programs serving adolescents rarely distinguish between the above groups. This exploratory study will test the feasibility of recruitment and assessment procedures and inform sample size calculations for a larger study comparing risk profiles and childhood adversities among all three populations. To accomplish the above aims, we will collect exploratory data from perinatally-infected adolescents (age 15-19 years) receiving care at the Perinatal HIV Research Unit (PHRU) at the largest public hospital serving Soweto, South Africa. For Aim 3, patients who acquired HIV sexually or are HIV-negative will also be recruited from the Zazi Voluntary Counselling and Testing Programme, located within the PHRU. All patients will complete a survey privately using an Apple iPad; medical data will be abstracted separately from the charts of seropositive patients. The project was co- developed by investigators from the University of the Witwatersrand and Stony Brook University; the teams bring a long history of successful collaboration and complementary expertise.