Provider assisted partner notification utilization and associated factors among adolescents living with HIV in Uganda, a cross-sectional study.

Abstract

Background: Assisted Partner Notification (APN) is a high yield HIV testing strategy that is recommended by the World Health Organization (WHO) for adults and adolescents aged at least 15 years in sub-Saharan Africa for HIV care and prevention. Although studies among adults have been done, there remains a paucity of data of APN service utilization among adolescents in Uganda, yet Adolescents Girls and Young Women (AGYW) have the highest incidence of HIV in Uganda, and generally, adolescents have the lowest HIV viral suppression rates. Failure to disclose to sexual partners poses a risk of propagating infection. This study aimed to explore utilization of provider APN and associated factors among sexually active adolescents living with HIV (ALWH) aged 15-19 years in routine HIV care.

Methods: We conducted a cross-sectional study at Baylor College of Medicine Children's Foundation Uganda's Center of Excellence Clinic located at Mulago Hospital in Kampala, Uganda. We consecutively enrolled sexually active ALWH aged 15 to 19 years in routine HIV care. We collected data on the individual ALWH, partner characteristics, and APN service utilization, using a structured questionnaire. Medical history for the ALWH was abstracted from the electronic database at the facility. Chi square tests and modified poisson regression were used for analysis of associated factors.

Results: From February to March 2023, 372 ALWH were enrolled. The median (IQR) age was 17 years [16-19], 52.4% were females, and 82% had completed secondary school. Of the 372 participants, (49%) consented to utilize APN, mostly via the passive-referral approach (41.4%), and as a last resort via a provider referral (12.4%). The factors associated with increased likelihood of provider partner notification utilization included relationship duration ≥  2years [adjusted prevalence ratio (aPR), 1.3, (1.05 to 1.60)]; being doubly orphaned (aPR 1.54, 1.12 to 2.30); not watching pornography (aPR 2.16, 1.5 to 3.11).

Conclusions: There was low utilization of APN services among sexually active adolescents with HIV. Passive referral was the preferred method. While acceptable, provider APN was not the preferred method for partner notification among adolescents. There is need to develop adolescent-friendly APN strategies to improve utilization of this important intervention.