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Sexual Partner Types and Incident HIV Infection among Rural South African Adolescent Girls and Young Women Enrolled in HPTN 068

A Latent Class Analysis

Nguyen, Nadia PhD1,2; Powers, Kimberly A. PhD1; Miller, William C. MD, PhD, MPH3; Howard, Annie Green PhD4,5; Halpern, Carolyn T. PhD5,6; Hughes, James P. PhD7,8; Wang, Jing MS, MA8; Twine, Rhian9; Gomez-Olive, Xavier PhD9,10; MacPhail, Catherine PhD9,11,12; Kahn, Kathleen MD, PhD9,10,13; Pettifor, Audrey E. PhD1,5

JAIDS Journal of Acquired Immune Deficiency Syndromes: May 29, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/QAI.0000000000002096
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Background: Sexual partners are the primary source of incident HIV infection among adolescent girls and young women (AGYW) in sub-Saharan Africa. Identifying partner types at greatest risk of HIV transmission could guide the design of tailored HIV prevention interventions.

Methods: We conducted a secondary analysis of data from AGYW (ages 13-23) enrolled in a randomized controlled trial of cash transfers for HIV prevention in South Africa. Annually, AGYW reported behavioral and demographic characteristics of their three most recent sexual partners, categorized each partner using pre-specified labels, and received HIV testing. We used latent class analysis (LCA) to identify partner types from reported characteristics, and generalized estimating equations to estimate the relationship between both LCA-identified and pre-specified partner types and incident HIV infection.

Results: Across 2140 AGYW-visits, 1034 AGYW made 2968 partner-reports, and 63 AGYW acquired HIV infection. We identified five LCA partner types, which we named monogamous HIV-negative peer partner; one-time protected in-school peer partner; out-of-school older partner; anonymous out-of-school peer partner; and cohabiting with children in-school peer partner. Compared to AGYW with only monogamous HIV-negative peer partners, AGYW with out-of-school older partners had 2.56 times the annual risk of HIV infection (95% CI: 1.23, 5.33), while AGYW with anonymous out-of-school peer partners had 1.72 times the risk (95% CI: 0.82, 3.59). Pre-specified partner types were not associated with incident HIV.

Conclusion: By identifying meaningful combinations of partner characteristics and predicting the corresponding risk of HIV acquisition among AGYW, LCA-identified partner types may provide new insights for the design of tailored HIV prevention interventions.

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal.

1Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC

2HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY

3Division of Epidemiology, The Ohio State University, Columbus, OH

4Department of Biostatistics, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC

5Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC

6Department of Maternal and Child Health, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC

7Department of Biostatistics, University of Washington, Seattle, WA

8Fred Hutchinson Cancer Research Center, Seattle, WA

9Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of the Health Sciences, University of the Witwatersrand, South Africa

10INDEPTH Network, Accra, Ghana

11Wits Reproductive Health and HIV Research Institute, University of the Witwatersrand, South Africa

12School of Health and Society, University of Wollongong, NSW, Australia

13Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine,UmeåUniversity,Umeå, Sweden

Corresponding Author: Nadia Nguyen, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY; 722 W 168, New York, NY 10032, USA, 646-774-6925 (phone), 646-774-6955 (fax), nadia.nguyen@nyspi.columbia.edu

The authors report no conflicts of interest related to this work.

Sources of funding: This work was supported by NIH grants T32AI007001, P30MH43520, UM1AI068619, UM1AI068613, and UM1AI1068617. The HIV Prevention Trials Network is funded by the National Institute of Allergy and Infectious Diseases (UM1AI068619, UM1AI068613, UM1AI1068617), with co-funding from the National Institute of Mental Health, and the National Institute on Drug Abuse, all components of the U.S. National Institutes of Health. This work was also supported by NIMH (R01MH087118) and the Carolina Population Center and its NIH Center grant (P2C HD050924). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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