Abstract
Ethical concerns about risks to minor adolescents participating in HIV prevention research is a barrier to their inclusion. One concern is whether HIV testing and results disclosure venue affects the health and behavior of adolescent participants. We assessed for differential effects on quality of life (QOL), depressive symptoms, and sexual behavior due to (1) testing venue (home or health facility) and (2) test result (HIV-positive, HIV-negative, indeterminate). We collected data at three timepoints (baseline, 2-month follow-up, 12-month follow-up) from 113 Kenyan adolescents aged 15–19 (51% female). We analyzed the data using linear mixed effects models for the QOL and depressive symptoms outcomes and a logistic model for the sexual behavior outcome. Results showed a small mental health benefit for adolescents tested for HIV at a health facility compared with home. There was little evidence that testing venue influenced sexual behavior or that test results moderated the effects of HIV testing across all outcomes. The decision to conduct HIV testing at home or a health facility may not be very consequential for adolescents’ health and behavior. Findings underscore the need to critically examine assumptions about adolescent vulnerability to better promote responsible conduct of HIV prevention research with youth in sub-Saharan Africa.
Highlights
There continues to be a pressing need to develop, test, and implement effectiveHIV prevention and treatment strategies for adolescents in high burden countries [1–5], especially in sub-Saharan Africa where the majority of the world’s adolescentsliving with HIV reside [6,7]
One important ethical issue pertains to the effects of venue of HIV testing and disclosure of results in the context of HIV prevention research on adolescent health and behavior [17]
Data are from baseline and follow-up data collection sessions of a hybrid design study with experimental components embedded within an observational cohort study
Summary
There continues to be a pressing need to develop, test, and implement effectiveHIV prevention and treatment strategies for adolescents in high burden countries [1–5], especially in sub-Saharan Africa where the majority of the world’s adolescents (ages 10–19)living with HIV reside [6,7]. HIV prevention and treatment strategies for adolescents in high burden countries [1–5], especially in sub-Saharan Africa where the majority of the world’s adolescents (ages 10–19). Despite the high public health value of involving adolescents in such research, investigators are sometimes reluctant to include minors under 18 years of age in HIV studies because of ethical concerns about the risks of their participation coupled with the lack of consistent, unambiguous ethical principles to guide HIV-related research among adolescent minors [9,11–16]. One important ethical issue pertains to the effects of venue of HIV testing and disclosure of results in the context of HIV prevention research on adolescent health and behavior [17]. Given the known limitations of self-reported sexual behavior, HIV biological measures obtained via testing are important for evaluating the effectiveness of prevention interventions for adolescents.
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