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Project Topic
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Introduction FERDAR is an EDCTP funded cohort study among 14-19 year old adolescents at risk of HIV infection. The study, which has obtained ethics approval, is enrolling female and male adolescents from commercial hotspots in Kampala, Uganda, and assessing epidemiological outcomes including HIV, sexually transmitted infections (STIs), alcohol use disorders, gender based violence and annual retention. Methods During reporting period 1 (August 2018 to July 2019) field workers mobilised and pre-screened adolescents in the community and invited them to the study clinic for formal screening and possible enrolment into the study. Study staff gave information to potential participants and after they had responded to questions, participants gave written informed consent for study screening and enrolment, use of anonymised data and sample storage for future use. Study staff collected data from participants using interviewer administered questionnaires and samples collected as follows: blood for HIV, syphilis and hepatitis B testing, urine for pregnancy testing (females), endo-cervical swabs for STI testing in females and urethral swab for STI testing in males. Female participants were assessed for use of reliable contraceptive services and also offered contraception if they were willing to use them. We screened for pregnancy every 3 months. Study nurses offered periodic presumptive treatment/ PPT for STIs (directly observed therapy) at enrolment and every 6 weeks for the first 6 months. Participants received one or a combination of single doses of azithromycin, cefixime and metronidazole. Study data was double entered in Open Clinica software and analysed using Stata v14.0 Three focus group discussions were conducted among females to collect qualitative data on facilitators and barriers to participation in HIV prevention research and attitudes and perceptions towards on-demand PrEP. Data will be analysed using thematic analysis. Results During the reporting period, we screened 158 participants and enrolled 137 (130 females and 7 males). Reasons for screen out were: not being sexually active (12), not willing to undergo study procedures (5), unable to comply with study visits e.g. will be out of the study area (3) and being enrolled in care at another facility (1). Participants’ mean age was 17.2 years (± 1.1), 56% had not attained primary level education and 23% were married. Out of 137 enrolled volunteers, 9 were HIV positive (all female) giving a baseline prevalence of 6.5% among 14-19 year olds. Baseline STI prevalence was 18% (25/137). Specific STIs were: chlamydia (13), gonorrhoea (6), duo infection CT/NG (3) and active syphilis (3). Baseline uptake of PPT was 99%. Contraceptive prevalence among enrolled participants was 63%. The common methods being used were implants and injectable contraceptives. Of 130 enrolled volunteers, 17 were pregnant giving a baseline pregnancy prevalence of 13%. Use of illicit drugs among enrolled participants was 58%, the most common drug being khat. Of 85 who reported to take alcohol (AUDIT tool), 21% were alcohol dependent. Eighty four participants reported experiencing violence from sexual partners in the 3 months prior to enrolment as follows: 7% physical violence, 14% emotional violence, 11% sexual violence and 68% experienced more than one type of intimate partner violence. Conclusions Adolescent (14-19 years) at risk of HIV infection have a high prevalence of STIs, intimate partner violence (IPV) and illicit drug and alcohol use. Uptake of PPT is high at baseline and contraceptive prevalence relatively high. Recommendations Although the data collected so far is still limited (study still enrolling), STIs, IPV and substance use are issues to address in this young population at risk of HIV infection.
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