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Abstract
ObjectivesRates of pregnancy and HIV infection are high among South African adolescents, yet little is known about rates of mother-to-child transmission of HIV (MTCT) in this group. We report a comparison of the characteristics of adolescent mothers and adult mothers, including HIV prevalence and MTCT rates.MethodsWe examined patterns of health service utilization during the antenatal and early postnatal period, HIV prevalence and MTCT amongst adolescent (<20-years-old) and adult (20 to 39-years-old) mothers with infants aged ≤16 weeks attending immunization clinics in six districts of KwaZulu-Natal between May 2008 and April 2009.FindingsInterviews were conducted with 19,093 mothers aged between 12 and 39 years whose infants were aged ≤16 weeks. Most mothers had attended antenatal care four or more times during their last pregnancy (80.3%), and reported having an HIV test (98.2%). A greater proportion of HIV-infected adult mothers, compared to adolescent mothers, reported themselves as HIV-positive (41.2% vs. 15.9%, p<0.0001), reported having a CD4 count taken during their pregnancy (81.0% vs. 66.5%, p<0.0001), and having received the CD4 count result (84.4% vs. 75.7%, p<0.0001). Significantly fewer adolescent mothers received the recommended PMTCT regimen. HIV antibody was detected in 40.4% of 7,800 infants aged 4–8 weeks tested for HIV, indicating HIV exposure. This was higher among infants of adult mothers (47.4%) compared to adolescent mothers (17.9%, p<0.0001). The MTCT rate at 4–8 weeks of age was significantly higher amongst infants of adolescent mothers compared to adult mothers (35/325 [10.8%] vs. 185/2,800 [6.1%], OR 1.7, 95% CI 1.2–2.4).ConclusionDespite high levels of antenatal clinic attendance among pregnant adolescents in KwaZulu-Natal, the MTCT risk is higher among infants of HIV-infected adolescent mothers compared to adult mothers. Access to adolescent-friendly family planning and PMTCT services should be prioritised for this vulnerable group.
Highlights
The rate of adolescent pregnancy in South Africa is high [1,2], with one-third of women reporting having been pregnant before the age of 20 years [3]
Despite high levels of antenatal clinic attendance among pregnant adolescents in KwaZulu-Natal, the mother-to-child transmission of HIV (MTCT) risk is higher among infants of HIV-infected adolescent mothers compared to adult mothers
Access to adolescent-friendly family planning and prevention of mother-to-child transmission of HIV (PMTCT) services should be prioritised for this vulnerable group
Summary
The rate of adolescent pregnancy in South Africa is high [1,2], with one-third of women reporting having been pregnant before the age of 20 years [3]. In this setting, age and gender represent significant hierarchies that accord young women relatively little power, such that adolescent pregnancy is not just a reproductive health issue but reflects the social environment of women [4]. Adolescent pregnancy rates are higher in rural areas, among women from low-income families and who have lower educational achievement, and are highest among black South African adolescents compared to those of Indian or European origin [5].
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