HIV-Infected Adolescent Mothers and Their Infants: Low Coverage of HIV Services and High Risk of HIV Transmission in KwaZulu-Natal, South Africa

Abstract

ObjectivesRates of pregnancy and HIV infection are high among South African adolescents, yet little is known about rates of mother-to-child transmission of HIV (MTCT) in this group. We report a comparison of the characteristics of adolescent mothers and adult mothers, including HIV prevalence and MTCT rates.MethodsWe examined patterns of health service utilization during the antenatal and early postnatal period, HIV prevalence and MTCT amongst adolescent (<20-years-old) and adult (20 to 39-years-old) mothers with infants aged ≤16 weeks attending immunization clinics in six districts of KwaZulu-Natal between May 2008 and April 2009.FindingsInterviews were conducted with 19,093 mothers aged between 12 and 39 years whose infants were aged ≤16 weeks. Most mothers had attended antenatal care four or more times during their last pregnancy (80.3%), and reported having an HIV test (98.2%). A greater proportion of HIV-infected adult mothers, compared to adolescent mothers, reported themselves as HIV-positive (41.2% vs. 15.9%, p<0.0001), reported having a CD4 count taken during their pregnancy (81.0% vs. 66.5%, p<0.0001), and having received the CD4 count result (84.4% vs. 75.7%, p<0.0001). Significantly fewer adolescent mothers received the recommended PMTCT regimen. HIV antibody was detected in 40.4% of 7,800 infants aged 4–8 weeks tested for HIV, indicating HIV exposure. This was higher among infants of adult mothers (47.4%) compared to adolescent mothers (17.9%, p<0.0001). The MTCT rate at 4–8 weeks of age was significantly higher amongst infants of adolescent mothers compared to adult mothers (35/325 [10.8%] vs. 185/2,800 [6.1%], OR 1.7, 95% CI 1.2–2.4).ConclusionDespite high levels of antenatal clinic attendance among pregnant adolescents in KwaZulu-Natal, the MTCT risk is higher among infants of HIV-infected adolescent mothers compared to adult mothers. Access to adolescent-friendly family planning and PMTCT services should be prioritised for this vulnerable group.

Adolescent and young pregnant women at increased risk of mother-to-child transmission of HIV and poorer maternal and infant health outcomes: A cohort study at public facilities in the Nelson Mandela Bay Metropolitan district, Eastern Cape, South Africa

“…[21] An additional contributory factor may have been decreased adherence to antiretrovirals, as has been found among adolescents receiving lifelong ART. [22] A recently published crosssectional survey from KwaZulu Natal also found increased MTCT among adolescent mothers, [23] but did not analyse young women as a separate group. Further research should be conducted to establish the relative contribution of factors resulting in vertical transmission among young women.…”

Seeking wider access to HIV testing for adolescents in sub-Saharan Africa

“…To date, only two studies, both from South Africa, have specifically evaluated HTC among pregnant adolescents accessing prevention of mother-to-child transmission of HIV (PMTCT) services (46,47). One study was a cross-sectional survey in Kwazulu Natal (KZN) (46); the other was a cohort study with follow-up, in Eastern Cape (47).…”

“…One study was a cross-sectional survey in Kwazulu Natal (KZN) (46); the other was a cohort study with follow-up, in Eastern Cape (47). Ever-tested for HIV rates were similar (≥ 98%) between adolescent and adult mothers in the KZN study (46), likely facilitated by legislation supporting HTC for adolescents 12 y and older in South Africa (33). In the Eastern Cape study, adolescents were 1.4 times less likely to have tested for HIV prior to booking (47).…”

“…In the Eastern Cape study, adolescents were 1.4 times less likely to have tested for HIV prior to booking (47). Compared to adult women, adolescents experienced later entry into care, lower ART uptake or inappropriate ART administration, lower early infant diagnosis rates, and increased mother-to-child transmission of HIV (MTCT), stillbirth, and mortality (46,47). These studies highlight gaps in PMTCT service delivery for adolescents and higher risk of MTCT among adolescent HIVpositive mothers, even in the setting of optimized legal access to HTC.…”

“…However, beyond 14 y, female adolescents have much higher HIV incidence and prevalence as compared to males (7,8,(59)(60)(61) ( Table 1). Pregnant adolescent females (46,47), adolescents with early sexual debut, married, or partnered but living separately, engaging in transactional sex, especially in rural areas (62,63), having multiple or older sexual partners (59,60,64), and those experiencing high mobility and labor migration (65,66), have also been identified to be at increased risk of HIV infection and unfavorable outcomes. Lastly, the significant proportions of perinatally-infected individuals surviving into young adolescence and young adulthood should not be overlooked (51,61,67).…”