Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health & Health Policy, New York, New York, United States of America.
ICAP at Columbia University, Mailman School of Public Health, New York, New York, United States of America.
PLoS One. 2021 Apr 26;16(4):e0250218. doi: 10.1371/journal.pone.0250218. eCollection 2021.
Adolescents living with HIV (ALHIV) 15-19 years of age are a growing proportion of all people living with HIV globally and the population includes adolescents with vertically acquired HIV (AVH) and behaviorally acquired HIV (ABH).
We conducted a survey to measure sociodemographic characteristics, educational status, health history, and antiretroviral therapy (ART) adherence among a convenience sample of ALHIV at three government health facilities in 2019 in Nampula, Mozambique. ALHIV 15-19 years on ART, including females attending antenatal care, were eligible. Routine HIV care data were extracted from medical charts. Classification of ALHIV by mode of transmission was based on medical charts and survey data. ALHIV who initiated ART <15 years or reported no sex were considered AVH; all others ABH. Frequencies were compared by sex, and within sex, by mode of transmission (AVH vs. ABH) using Chi-square, Fishers exact tests and Wilcoxon rank-sum tests.
Among 208 ALHIV, 143 (69%) were female and median age was 18 years [interquartile range (IQR) 16-19]. Just over half of ALHIV (53%) were in or had completed secondary or higher levels of education; the most common reason for not being in school reported by 36% of females was pregnancy or having a child. Of all ALHIV, 122 (59%) had VL data, 62% of whom were <1000 copies/mL. Almost half (46%) of ALHIV reported missing ARVs ≥ 1 day in the past month (62% of males vs. 39% of females; p = 0.003). Just over half (58%) of ALHIV in relationships had disclosed their HIV status: 13% of males vs. 69% of females (p<0.001). Among sexually active males, 61% reported using a condom at last sex compared to 26% of females (p<0.001). Among female ALHIV, 50 (35%) were AVH and 93 (65%) were ABH, 67% of whom were not in school compared to 16% of ABH, (p<0.001).
Data from our study underscore the high level of deprivation among ALHIV enrolled in HIV care in Mozambique, as well as important disparities by sex and mode of transmission. These data can inform the development of effective interventions for this complex and important population.
15-19 岁的青少年艾滋病毒感染者（ALHIV）在全球所有艾滋病毒感染者中所占比例不断增加，其中包括通过垂直传播（AVH）和行为传播（ABH）感染艾滋病毒的青少年。
我们对 2019 年在莫桑比克楠普拉的三家政府卫生机构中接受调查的符合条件的 15-19 岁接受抗逆转录病毒治疗（ART）的 ALHIV 进行了一项调查，以测量其社会人口统计学特征、教育状况、健康史和抗逆转录病毒治疗（ART）依从性。接受产前保健的女性被视为 ALHIV。从病历中提取了常规 HIV 护理数据。根据病历和调查数据对 ALHIV 进行传播模式分类。15 岁以下开始接受 ART 或报告无性行为的 ALHIV 被视为 AVH；所有其他 ABH。通过卡方检验、Fisher 确切检验和 Wilcoxon 秩和检验比较不同性别和同性别中传播模式（AVH 与 ABH）之间的差异。
在 208 名 ALHIV 中，143 名（69%）为女性，中位年龄为 18 岁[四分位距（IQR）16-19]。超过一半的 ALHIV（53%）接受过中学或更高水平的教育；36%的女性因怀孕或有子女而无法上学。在所有的 ALHIV 中，有 122 名（59%）有病毒载量数据，其中 62%的病毒载量<1000 拷贝/ml。近一半（46%）的 ALHIV 在过去一个月内漏服 ARV 药物≥1 天（男性占 62%，女性占 39%；p=0.003）。超过一半（58%）处于恋爱关系中的 ALHIV 已经透露了他们的 HIV 状况：13%的男性和 69%的女性（p<0.001）。在有性行为的男性中，61%的人报告在上一次性行为中使用了避孕套，而女性中这一比例为 26%（p<0.001）。在女性 ALHIV 中，有 50 名（35%）为 AVH，93 名（65%）为 ABH，其中 67%的人未上学，而 ABH 中这一比例为 16%（p<0.001）。
我们的研究数据强调了莫桑比克艾滋病毒护理中登记的青少年艾滋病毒感染者所面临的高度剥夺问题，以及按性别和传播模式划分的重要差异。这些数据可以为针对这一复杂而重要人群的有效干预措施的制定提供信息。
