Improving Identification of new HIV infections and primary drug resistance amongadolescent girls, young women and their sexual partners in Uganda

Unidentified HIV infections are responsible for the continued transmission and sustenance of the HIV pandemic. Identifying populations at increased risk of HIV but who have low uptake of HIV testing is critical for the control and elimination of HIV. Adolescent girls and young women (AGYW) and their sexual partners are a well-recognised group at high risk of HIV but rarely test for HIV.

Therefore, interventions are needed to improve HIV testing and identify unknown infections in these populations. AGYW and their sexual contacts belong to a population with known poor adherence to antiretroviral treatment, increased risk of HIV drug resistance mutations, and hence can transmit virus with pre-existing resistance mutations to their partners. There is a need to identify transmitted drug-resistance mutations among newly diagnosed individuals in this population. This study therefore hopes to improve the identification of HIV infection and describe transmitted drug resistance mutations among AGYW and their sexual partners in Uganda.

The research project will use approaches that have been used to improve outcomes in the care of people living with HIV (PLWH) to improve HIV testing among the AGYW and their sexual partners. These include the use of SMS technology, the young people and peer support (YAPS) model, and methods of identifying challenging populations like snowball sampling.

Identifying more AGYW and their sexual partners infected with HIV and linking them to care will improve their health outcomes and will contribute to the prevention of HIV transmission since they will be started on treatment which is also a prevention strategy. The HIV-negative AGYW will be provided with HIV-negative counseling and informed of available options for HIV prevention such as pre-exposure prophylaxis and condoms. Primary HIV drug resistance among the AGYW will be identified, and policymakers will be informed of their existence and potential impact on treatment outcomes for this population.

Findings from this study will inform policymakers of the potential for using approaches that have been used to improve HIV treatment outcomes among HIV-infected young people, to improve uptake of HIV testing and identification of HIV infection among AGWY and their sexual partners.

SANTHE is an Africa Health Research Institute (AHRI) flagship programme funded by the Science for Africa Foundation through the DELTAS Africa programme; the Bill & Melinda Gates Foundation; Gilead Sciences Inc.; and the Ragon Institute of Mass General, MIT, and Harvard.