| dc.description.abstract | Background: Whereas HIV Assisted Partner Notification (APN) is recommended by the World Health Organization for adolescents in SSA because of the high catch rate of new HIV positive cases among adults, no studies have been conducted among adolescents to evaluate APN service utilization, acceptability, and/or any potential social harm associated with this public health approach in the local setting. As such, there is a paucity of data on the utilization, factors associated, and the facilitators and barriers of APN among HIV positive sexually active adolescents aged 15-19 years.
Objectives: To determine the level of utilization, factors associated and, to explore barriers and facilitators of APN among HIV positive sexually active adolescents aged 15-19 years attending care at Baylor Uganda, Mulago clinic.
Methods: This was a cross-sectional study that employed both quantitative and qualitative data collections methods. The study was conducted at Baylor College of Medicine Children’s Foundation Mulago. A total of 372 HIV positive sexually active adolescents aged 15-19 years were enrolled. A questionnaire collecting information on individual, partner characteristics and outcome of partner notification was administered to study participants, as well as abstraction of medical and treatment history from the electronic database. Qualitative data consisted of in-depth interviews administered to 20 purposively selected sexually active HIV positive adolescents aged 15-19 years. Quantitative data was coded and entered into Epidata version 4.4.1 and then exported to STATA version 16 for analysis. Qualitative data was analyzed using the content thematic approach by Nvivo software and then mapped onto the COM -B behavior framework model.
Results: The median (IQR) age was 17 (16-19) years. Majority of participants were females (52.4%), 82% of the participants had completed secondary school, and the vast majority (92.7%) reported to be involved in boyfriend or girlfriend relationship. APN utilization in the study was 49%. Whereas APN was acceptable to the adolescents, their preferred modality of partner notification was client referral.
The factors associated with increased likelihood of utilization of APN services included relationship duration ≥ 2 years (Adj.PR = 1.3, p = 0.016), individuals without both parents alive (Adj.PR = 1.54, p = 0.009), and not watching pornography (Adj.PR = 2.16, p < 0.01). Factors associated with decreased likelihood of utilization of APN services included; not belonging to an HIV club(Adj.PR = 0.47, p < 0.01), residing in urban areas(Adj.PR = 0.51, p < 0.01), not having children(Adj.PR = 0.16, p < 0.01), inconsistent condom use (Adj.PR = 0.53, p = 0.001), those whose partners were aged >20 years (Adj.PR = 0.78, p = 0.031), abstaining from alcohol and recreational drugs (Adj.PR = 0.48, p < 0.01).
The major facilitators of APN utilization included desire for the partner to be tested for HIV and have access to early treatment initiation if positive whilst maintaining anonymity, access to professional counselling services and handling of adverse situations if they occurred, social support from family, fostering trust and improving adherence to ART.
The major barriers to APN utilization included fear of stigma and discrimination, intimate partner violence and other social harms including relationship dissolution, and short term/ transient relationships.
Conclusion: APN utilization among HIV positive adolescents at Baylor Uganda clinic was found to be low (49%) compared to rates reported among adults with HIV in Uganda. Nevertheless, APN was generally acceptable, and the adolescents preferred client referral as their modality for PN. Adolescents in stable sexual relationships (> 2 years), those not using pornography, and individuals without both parents alive were more likely to utilize PN services. In addition, we documented the fear of stigma and discrimination, intimate partner violence and non-committal sexual relationships as barriers to PN use, while facilitators included fostering trust, good ART adherence, family support, desire for enrolment into early HIV care if partner(s) was found positive and maintenance of anonymity of the referring adolescent.
Recommendations: We recommend integration of HIV PN services into youth friendly comprehensive services for adolescents living with HIV infection in Uganda. Passive referral is the adolescents’ preferred choice for PN. Provision of counselling about APN with emphasis on confidentiality should be provided for the adolescents and, peer mentors who have used APN services should be used to champion the use of APN services at the health facility. | en_US |
