Predictors of HIV positive status among 15-24 years old pregnant women attending antenatal care in South Africa

Abstract

Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) continues to be a significant public health problem. Women are disproportionately affected by the HIV epidemic. Adolescent Girls and Young Women (AGYW) (15-24 years) are at high risk of new HIV infections in South Africa. The burden of HIV among AGYW significantly varies by province, but the factors contributing to this difference are inadequately understood The aim of this study was to investigate the geographic distribution of HIV and socio-demographics characteristics associated with HIV among pregnant women aged 15-24 years old attending antenatal care (ANC) in public health facilities in South Africa in 2017 This was a secondary data analysis of data collected during the national antenatal survey in 2017. The antenatal survey is a cross-sectional survey conducted every 1-2 years among pregnant women aged 15-49 years in 1,595 sentinel sites selected from across all districts of South Africa. The survey was conducted between 1 October and mid-November, 2017. In the main (primary) study, consenting women eligible to participate in the study were consecutively enrolled and completed a nurse administered questionnaire. Following this, blood specimens were collected from the same women and sent to regional laboratories for HIV testing. The target population for the secondary analysis (i.e. for this study) was pregnant women aged 15-24 years who had an HIV test result (from the laboratory test done) and a complete survey questionnaire. Prevalence was estimated for each province and at district level. All estimates accounted for survey design and was weighted for midyear population size of reproductive age women at province level using the 2019 Statistics South Africa (STATSA) data. Multivariable logistic regression analysis was conducted to examine the association between socio-demographic characteristics and HIV positive status of pregnant women in the age 15-24 years. An age disparate relationship was defined as engagement in sexual partnership between AGYW and a man (father of the child) who is 5 or more years older.The survey enrolled 36 128 pregnant women aged 15-49 years old. Of this, 12 967 (35.9%) met the inclusion criteria for the current study. Of the total (12 967,35.9%) who met the inclusion criteria, about 87.3% (11 127) of participants were black African, 85.1% (10 821) were single and 79.3% (9 968) had completed secondary education. The median age of participants was 21 years (interquartile range (IQR): 19-23 years). About 35.6% (4 363) of the participants (i.e. AGYW) were engaged in age disparate relationship. HIV prevalence among AGYW was 18.5% (95% confidence interval (CI): 17.9–19.1%) nationally. HIV prevalence was 11.3% (95% CI: 10.5-12.1) among adolescents (15-19 years) and 21.9 (95% CI: 21.1-22.7) among young women aged 20-24 years. KwaZulu-Natal had the highest HIV prevalence (24%), followed by Mpumalanga (23.6%) and Eastern Cape (22.4%) respectively. Western Cape and Northern Cape had the lowest HIV prevalence at 8.4% and 8.9% respectively. In KwaZulu-Natal and Mpumalanga provinces, HIV prevalence ranged from 18.7% to 30.6% and 20.6% to 25.5% at district level respectively. In a multivariable analysis, young women in age disparate relationship had higher odds of being HIV positive [adjusted odds ratio, AOR 1.8 (95% CI:1.7 – 2.0)] compared with women not engaged in age-disparate relationship. Women in the age group 18-20 years and 21 – 24 years had higher odds of being HIV positive [AOR 1.7 (95% CI: 1.5 – 2.1) and 3.0 (95% CI: 2.6 – 3.6) respectively] compared to women aged 15–17 years. Single and cohabiting women were more likely to be HIV positive [AOR = 1.9 (95% CI: 1.6 – 2.2) and 1.8 (95% CI: 1.5 – 2.3) respectively]compared to married women. Women with no or primary education [AOR - 1.7 (95 % CI 1.5 - 2.0)] and women with secondary education [AOR = 1.9 (95% CI: 1.5 – 2.4)] had higher odds of being HIV positive compared to women with tertiary education.Despite efforts made to curb HIV in South Africa among AGYW, prevalence remains high in this age group. We found age disparate relationship, low education, older age, gravidity, marital status and geographic location to be strong predictors of HIV positive status. Interventions for curbing and reducing HIV infection should include targeting high burden provinces/districts and channeling more resources to such areas. Increasing ART coverage among older men, rapid expansion of pre-exposure prophylaxis (PrEP) among young women, and offering support, protection and empowerment strategies for vulnerable AGYW could reduce the risk of HIV infection in this age group. It is recommend prioritizing tertiary education among AGYW in order for them to be able to make informed decisions about their sexual life and be able to protect themselves against HIV infection.