Persistently high incidence of HIV and poor service uptake in adolescent girls and young women in rural KwaZulu-Natal, South Africa prior to DREAMS

Abstract

BackgroundAdolescent girls and young women (AGYW) bear the brunt of the HIV epidemic in South Africa. ‘DREAMS’ aims to reduce HIV incidence through multi-level combination prevention. We describe HIV incidence and uptake of HIV and sexual reproductive health (SRH) by AGYW in KwaZulu-Natal (KZN), prior to DREAMS.MethodsLongitudinal and cross-sectional analysis of women (15–24 year old) in a population-based HIV incidence cohort within a demographic surveillance site in KZN. Observation time for HIV incidence was person-years at risk while resident. “Current use of contraceptives” and “having an HIV test in the past 12 months” was compared between 2011 and 2015.ResultsIn 2015, HIV prevalence was 11.0% and 34.1% and HIV incidence (2011–2015) was 4.54% (95%CI:3.89–5.30) and 7.45% (95%CI:6.51–8.51) per year in 15–19 and 20–24 year olds respectively, with no significant decline compared to 2006–2010. In 2015, 90.7% of 20-24-year-olds were unemployed, 36.4% and 51.7% of 15–19 and 20–24 year olds reported recent migration; 20.9% and 72.6% of 15–19 and 20–24 year olds had ever been pregnant. In 2015, less than 50% reported condom-use at last sex, 15.0% of 15–19 year olds and 48.9% of 20–24 year olds were currently using contraception and 32.0% and 66.7% of 15–19 and 20–24 year olds had tested for HIV in the past 12 months. There had been no improvement compared to 2011. Factors associated with AGYW testing for HIV in the past 12 months were, survey year—2011 more likely than 2015 (aOR = 0.50), number of partners (aOR = 3.25), ever been pregnant (aOR = 2.47) and knowing where to find ART (aOR = 1.54). Factors associated with contraception use were being older (aOR = 4.83); ever been pregnant (aOR = 12.62); knowing where to get ART (aOR = 1.79) and having had an HIV test in past 12 months (aOR = 1.74).ConclusionPrior to DREAMS, HIV incidence in AGYW was high. HIV and SRH service uptake did not improve and was suboptimal. Findings highlight the need for combination HIV prevention programmes for AGYW in this economically vulnerable area.

Findings from home‐based HIV testing and facilitated linkage after scale‐up of test and treat in rural South Africa: young people still missing

“…Additionally, all residents aged ≥ 15 years are invited to participate in an annual individual‐level survey, which includes collection of dried blood spots (DBSs) for anonymized HIV testing. HIV prevalence in the 2017 survey was 30% AHRI (unpublished data) and HIV incidence, although declining, remains extraordinarily high .…”

Antiretroviral Therapy Based Hiv Prevention Targeting Young Female-Sex Workers: A Mixed Method Approach to Understand the Implementation of Prep in a Rural Area of Kwazulu-Natal, South Africa

“…The targeted provision to FSW, excluding other groups at high risk of HIV limited the early effectiveness of a public-sector PrEP programme in this rural South African setting. In this setting where HIV prevalence is high, condoms are undesirable and use remains low, as seen across South Africa (3,29) there is a clear need for alternative HIV prevention methods. The introduction of PrEP through a sex worker programme was feasible, with PrEP awareness among AGYW rising over time, and PrEP was seen to be desirable for young men and women, discordant couples, and people with long distant sex partners.…”

“…South Africa has an estimated 7.2 million people living with HIV (1), the highest globally; HIV remains the leading cause of death (1,2). HIV incidence has remained high, with little movement over time, especially in KwaZulu-Natal with an annual incidence of 8% amongst females aged 20-24 in some communities (3). There has, however, been considerable progress in developing e cacious and cost-effective HIV prevention tools.…”

Thetha Nami: Participatory development of a peer-navigator intervention to deliver biosocial HIV prevention for adolescents and young men and women in rural South Africa

“…South Africa (SA) has an estimated 7.7 million people living with HIV -the highest number globally; HIV remains the leading cause of death. HIV incidence has remained stubbornly high, especially in KwaZulu-Natal (KZN) where we have shown an annual incidence of 8% amongst females aged 20-24 and 4% in males aged 25-29 [1]. This is despite highly e cacious and cost-effective HIV prevention tools.…”