Which aspects of HIV care matter most to keep young women on treatment?

New research has looked at how the type of HIV services being provided affects adolescent girls and young women’s engagement in care and their health. The findings suggest that young mothers with HIV are more likely to experience poor care and health outcomes than their peers.

What is the research about?

A total of 774 adolescent girls and young women with HIV (ages 12 to 24) took part in the research. They attended 60 clinics in Eastern Cape Province between 2018-2019. Around half (43%) were young mothers. (This means they had given birth before the age of 20.) Young mothers were more likely than their peers to have recently got HIV. They were also more likely to live in a poor household, have informal housing and experience food insecurity. 

Why is this research important?

Young women with HIV are less likely than older women to take antiretroviral treatment (ART) or be virally suppressed. This means they are more at risk of illness and AIDS-related death. They are also more likely to pass HIV on. Understanding how to improve HIV care for young women is essential to changing this.

What did they find out?

Researchers assessed five outcomes which show that HIV care is working. These were: past-week ART adherence, regular clinic attendance, uninterrupted treatment, not having TB symptoms and being virally suppressed. 

Many young women in the study were not experiencing these things. Young mothers were especially unlikely to experience them. Young mothers were more likely than their peers to have lower treatment adherence (74% compared to 81%). They were less likely to regularly attend clinics (76% compared to 84%) and have uninterrupted treatment (67% compared to 81%). Viral suppression was also lower (64% compared to 79%).

Researchers assessed seven health service provisions which show a high standard of HIV care. These were: no ART stockouts, kind and respectful providers, support groups, short travel time, short waiting time, confidentiality, and safe and affordable facilities.

Young mothers with HIV were less likely than non-mothers to encounter kind and respectful providers, short waiting times, and safe and affordable facilities. They were also less likely to attend support groups.

Three of the seven service provisions improved treatment outcomes among young women.

Not having ART stockouts was linked with improving one outcome: uninterrupted ART treatment.

Having kind and respectful providers and safe and affordable clinics were both linked with improvements across multiple outcomes. Researchers called these two factors ‘healthcare accelerators'. This means they were the service provisions that had the greatest impact.

Having kind and respectful providers was linked with improvements in adherence, clinic attendance, uninterrupted ART and viral suppression.

Having safe and affordable care was linked with improvements in clinic attendance, uninterrupted treatment and TB symptoms. 

These two accelerators improved outcomes whether young women were mothers or not.

What does this mean for HIV services?

Having safe and affordable care and kind and respectful health providers are the two things that will make the biggest difference to improving the health of adolescent girls and young women with HIV. Providing peer-led, community-based or mobile HIV care could help achieve these goals.

It is important to understand why it is that young mothers with HIV are less likely than their peers to experience respectful healthcare or safe and affordable clinics. 

Understanding what would make HIV care safe and affordable for young mothers and then meeting this need is important. Particularly given the finding that young mothers are more likely to be living in poverty. 

There is also an urgent need to ensure that health providers do not shame or judge young mothers for having children outside of marriage or for having HIV.