Recent Diagnosis, Lower Rates of HIV Disclosure, and High Technology Access in Pregnant Adolescent Girls and Young Women Living With HIV: A Descriptive Study.

Adolescent girls and youngwomen (AGYW)between the ages of 15 and 24 years are disproportionately affected by HIV in sub-Saharan Africa (SSA). In Kenya, nearly one third of new HIV infections in 2019 were in AGYW, with risks of acquisition more than double that of their male peers (National AIDS and STI Control Programme, 2020). HIV infections in AGYW coincide with high fertility and unique risk factors, including inadequate sexual knowledge (Kassa et al., 2018), unmet need for contraceptive use (Yakubu&Salisu, 2018), and unequal gender power in relationships (Yakubu & Salisu, 2018), all leading to high-risk sexual behaviors. Compared with pregnant adult women, pregnant AGYWhave a higher frequency of delaying initiation of antenatal care (ANC), fewer overall ANCvisits, and low uptake of prevention of mother-to-child transmission (PMTCT) services (Ramraj et al., 2018). Concurrent risk factors for poor engagement in PMTCT include lack of partner support, unplanned pregnancy (Adeniyi et al., 2018; Koech et al., 2014), and incomplete transition to autonomy in HIV medication management and treatment (Parienti, 2014). Despite the high HIV prevalence and high birth rate among AGYW, few studies of PMTCT implementation have specifically focused on the characteristics and outcomes of this group. Mobilehealth (mHealth) is apotentially feasibleway to improve health outcomes by providing education, clinic visit reminders, and support beyond the clinic (ArandaJan et al., 2014). Short message service (SMS) has been used in PMTCT programs to improve maternal postpartum visit attendance (Odeny et al., 2014) and antiretroviral therapy (ART) adherence among adults living with HIV (Daher et al., 2017). AGYW populations may be particularly responsive to SMS because they are typically enthusiastic users of modern technologies including mobile phones (Mitchell et al., 2011). However, data on the reach and effectiveness of SMS interventions in achieving behavior change among AGYW with HIV are sparse (Linnemayr et al., 2017). This study aimed to understand how pregnant AGYW living with HIV differ from older adult women in ways that could potentially inform design of interventions to support PMTCT in this group. To address this question, we compared characteristicsofAGYWandolder adultwomenparticipating in Authors’Contributions:W.Jiangwasresponsible for thedevelopmentof themanuscript’s methodology,conducting the formalanalysis includingdevelopmentofstatistical software coding, wrote the original draft, and oversaw revisions of the manuscript. L. Osborn was responsible for data management during parent study follow-up and contributed to revision of the original draft of the manuscript. A. L. Drake contributed to conceptualizing theparentstudy,securing resourcesbyobtaininggrant funding,andrevisionof theoriginal draft of the manuscript. J. A. Unger contributed to conceptualizing the parent study, securing resources by obtaining grant funding, management of the parent study, and revision of the original draft of the manuscript. D. Matemo contributed to study coordinationandmanagementof theparent studyaswell as revisionof theoriginal draft of themanuscript. J.Kinuthiawas responsible for conceptualizing theparent study, securing resourcesbyobtaininggrant funding,managementof theparent study,and revisionof the originaldraft of themanuscript.G. John-Stewartcontributed toconceptualizing theparent study, securing resources by obtaining grant funding, management of the parent study, and providing mentorship during original draft development and revisions of the manuscript. K. Ronen was responsible for management of the parent study, providing mentorship, development of the manuscript’s methodology, and oversaw the original draft and revisions of the manuscript.