Use of Couple’s Voluntary Counselling and Testing for HIV (CVCT) and Long Acting Reversible Contraception (LARC) Services by Adolescents in Urban Zambia Ann Lockard 1, Erika Mwenda 1, Alexandra Hoagland 2, Kalonde Malama 2, Change Kwesele 2, Katie Fox 1, Tyronza Sharkey 1, Rachel Parker 3, Amanda Tichacek 3, Mubiana Inambao 2, William Kilembe 1, Susan Allen 3 1 Zambia Emory HIV Research Project, Lusaka, Zambia, 2 Zambia Emory HIV Research Project, Ndola, Zambia, 3 Rwanda Zambia HIV Research Group, Atlanta, GA, United States

Background In sub-Saharan Africa, the majority of new HIV infections are acquired from a spouse or long-term partner. Couples Voluntary Counseling and Testing (CVCT), pioneered by RZHRG, has proven to decrease the transmission of HIV/AIDS among couples by more than 50 percent. Couples’ Family Planning Counselling (CFPC), an innovative approach to engaging both partners in fertility discussions, promotes gender equality, HIV prevention, and prevention of unplanned pregnancies. In 2013, ZEHRP was funded by the UK-DFID to integrate CVCT with CFPC and the provision of long acting reversible contraceptive (LARC) for target populations, including adolescents.

Benefits of LARC Copper IUD Can be used for up to 10 years Hormone free 99% effective Jadelle Implant Can be used up to 5 years Hormonal 99% effective

Adolescents in Zambia HIV prevalence is lower for those aged at 4%, compared to 13% for those aged Teenage pregnancy is a social and health issue. 29% of women aged have already had a birth or are pregnant with their first child. By age 19, 59% of women have begun childbearing. Higher levels of fertility are associated with reductions in education and employment opportunities.

Adolescent Uptake of CVCT/CFPC and LARC ZEHRP has tracked use of its services by adolescents since March 2013 through the collection of demographic data. Adolescents are defined as those under age 20. Findings among this age group compared to the rest of the population emphasize the need for integrated reproductive and sexual health services targeted to adolescents.

Urban Couples Receiving CVCT and CFPC

Proportion of CVCT and CFPC Uptake by Age Group

Findings: Adolescent Couples at CVCT Adolescents in couples receiving CVCT were significantly less likely to be previously tested for HIV compared to adults. Women: 58% adolescents compared to 82% adults (p<.0001) Men: 40% adolescents compared to 65% adults (p<.0001) Seroprevalence among couples with at least one adolescent partner was 92% M-F-, 4% M+F+, 2% M-F+, and 1% M+F- as compared to 78% M-F-, 15% M+F+, 4% M-F+, and 3% M+F- among adult couples. 89% of couples with at least one adolescent partner were cohabiting.

Findings: Adolescent couples at CVCT Cont’d 27% of adolescent women in couples were pregnant as compared to 21% of adult women in couples (p<0.0001) In non-pregnant couples, more adults were using modern contraceptives compared to adolescents (50% compared to 28%, p<0.0001). Among modern contraceptive users, 28% of adults were using a LARC method compared to 22% of adolescents (p<0.0001). In non-pregnant couples not already using a LARC method, three times more adult women take up LARC at their CVCT M0 visit compared to adolescent women (12% compared to 4%, p<.0001). Among those uptaking LARC, 6% of adults chose IUD compared to 3% of adolescents (p=0.0135)

Proportion of LARC Uptake by Age Group

Findings: Adolescent women accessing LARC More adults were using modern contraceptives compared to adolescents (68% compared to 41%, p<0.0001). Among modern contraceptive users, 45% of adults were using a LARC method compared to 33% of adolescents (p<0.0001). Among those uptaking LARC, 10% of adults chose IUD compared to 3% of adolescents (p<.0001) Adolescent women accessing LARC were significantly less likely to be previously tested for HIV compared to adults (50% compared to 44%, p<.0001).

Conclusions Relatively low prevalence of HIV among adolescents compared to adults. However, among both of our client populations, adolescents had lower rates of previous testing, higher rates of pregnancy and were less likely to be already using a modern contraceptive method. When uptaking a modern method, adolescents are less likely to chose IUDs than adults.

Next Steps CVCT/CFPC and LARC would be beneficial for adolescents as a tool for HIV prevention and prevention of unintended pregnancy and should be designed with them in mind: Adolescent friendly spaces Community sensitization Provider training Promotional activities should also be targeted specifically to adolescents.