P13.15
Background: Young women below age 18 are underrepresented in HIV prevention trials, despite being among the most at risk groups in Africa. Their non-inclusion is due in part to ethical concerns. But, adolescents may also face challenges with trial follow-up due to mobility, lower HIV risk perception and less access to sexual and reproductive health (SRH) services. We examine whether retention differs among adolescents aged 15–17 and young women aged 18–21, and what factors might account for this difference.
Methods: We enrolled 135 sexually-active, non-pregnant, HIV-negative women, aged 15–21, into a 6-month mock clinical trial in Dar es Salaam, Tanzania, with visits at baseline and months 2, 4, and 6. A mediation analysis assessed direct and indirect effects of age and potential mediators on number of missed visits. Mediators included theoretically-derived barriers and facilitators to retention.
Results: Adolescents held significantly lower risk perception and were less likely to have used SRH services compared to young adults. Both of these factors were positively associated with missed visits, suggesting that adolescents should have missed more visits than adult women. However, controlling for mediators, adolescents were less likely [trending towards significance] to miss visits than adult women. These results suggest that HIV risk perception and previous SRH service use may act as suppressor variables in the relationship between age and retention in a clinical study.
Conclusions: Adolescents were no more likely to miss visits than adult women, despite having lower risk perception and less exposure to SRH services. Interventions that realistically increase adolescent risk perception and link them to services - getting their feet in the door - may support their retention in future HIV prevention trials and in SRH services more generally. Also, these analyses suggest that doing so may lead to improvements in retention beyond what is seen in an older cohort of study participants.
