Effects of quality of caregiver-adolescent relationship on HIV, HSV-2 and on pregnancy incidence among young women in rural South Africa enrolled in HPTN 068


BACKGROUND: Adolescent girls and young women (AGYW) are at an increased risk of acquiring HIV and HSV-2, and pregnancies are high as well in AGYW. Despite the protective effect of caregiver-adolescent relationships on risk behaviors, less attention has been paid to the effect of these relationships on sexually transmitted infections (STIs) and pregnancy.
METHODS: We used longitudinal data from HIV Prevention Trial Network 068 ' conducted among 2,533 AGYW (13 ' 20 years) over 5 years in Agincourt, South Africa. Quality of caregiver-adolescent relationship (caring and closeness) was measured by asking AGYW perceptions of their relationship with their primary caregiver. Kaplan Meier and Cox models were used to estimate the effect of quality of caregiver-adolescent relationships (caring and closeness) on STIs and pregnancy. Also, we assessed effect measure modification (EMM) by age (14-19 vs. 20-25 years) for STI risk using stratum-specific estimates and likelihood ratio tests (LRT) with a p-value <0.1 indicative of EMM.
RESULTS: There were no significant differences in the hazard of HIV by our exposures (caring: hazard ratio (HR): 1.03, 95% CI: 0.75, 1.42; closeness: HR: 0.80, 95% CI: 0.57, 1.11). Among 14-19-year-olds, those who reported caregiver caring were less likely to acquire HSV-2 (HR: 0.69, 95% CI: 0.51, 0.94, LRT = 3.89, p-value=0.0487); in contrast, there were no significant differences among 20 ' 25-year-olds. AGYW who reported high quality relationships had a lower hazard of incidence pregnancy (caring: HR: 0.79, 95% CI: 0.68, 0.93; closeness: HR: 0.76; 95% CI: 0.64, 0.91).
CONCLUSIONS: Findings indicate, positive caregiver-adolescent relationships are associated with reduced risk of HSV-2 among younger AGYW and pregnancy incidence. Family-centered interventions focused on improving these relationships are recommended.

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