New advances in affordable antiretroviral therapy have enabled large cohorts of adolescents infected with HIV to enter adulthood for the first time in generalized epidemic settings. Yet, we know very little about the unique sexual and reproductive needs of HIV infected adolescents. This study explores the sexual and repro- ductive needs of HIV infected adolescents in Cape Town, South Africa and refines direction for future interven- tion design to promote sexual and reproductive health (SRH) as well as prevention of further HIV transmission to future partners and children. We will draw on lessons learned from other fields to develop intervention sci- ence to meet the needs of HIV-infected adolescents. South African adolescents are coming of age in a setting of both high HIV prevalence and frequent unintended pregnancy. Acquiring skills to protect against HIV trans- mission and pregnancy, coupled with maintenance of high levels of ART adherence, is the foundation of a comprehensive, evidence-based SRH prevention package for this high-risk population. Also important are tai- lored life skills for developing positive relationships, staying healthy, and for living productive lives with HIV to provide hope to HIV-infected adolescents regarding their futures. An evidence-based comprehensive SRH package also needs to provide required knowledge about planning for future safe childbearing and access to safer delivery options.
Aims 1 and 2 of this study are qualitative aims, and will inform Aim 3, an innovative us- er-responsive computerized survey designed to provide data to inform development of a future SRH interven- tion for adolescents living with HIV.
Aim 1 includes in-depth interviews (IDIs) with ~25 male and female HIV- positive adolescents sampled from a clinic setting, and will focus on SRH knowledge and needs, and perceived gaps related to interventions and services.
Aim 2 includes IDIs with ~25 clinicians and ~25 adult role models, who are influential adults including but not limited to parents and caregivers. The clinicians for IDIs will come from varied service capacities working with HIV positive adolescents, focused on adolescent needs, current services and broader needs.
Under Aim 3, the user-responsive computerized survey will be used to collect da- ta from ~100 adolescents regarding intervention needs and preferences. This survey integrates real-time com- puter analytics based on a conjoint analysis framework. This conjoint analysis approach will refine directions for future intervention design by including adolescents (future target users) in the process of identifying aspects of interventions that would engage them, including method of intervention delivery, modalities, venue, and oth- er strategies to meet the SRH needs of HIV-infected adolescents. This innovative research will be the first to identify potential interventions to improve sexual and reproductive health outcomes for adolescents living with HIV in the critically important setting of South Africa.
SIGNIFICANCE STATEMENT New advances in affordable antiretroviral therapy have enabled large cohorts of adolescents infected with HIV to enter adulthood for the first time in generalized epidemic settings. Yet, we know very little about the unique sexual and reproductive needs of HIV infected adolescents. This study explores the specific sexual and repro- ductive needs of HIV infected adolescents and refines direction for future intervention design to promote SRH as well as prevention of onwards vertical and horizontal transmission of HIV to partners and children.
