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Associations of Father and Adult Male Presence with First Pregnancy and HIV Infection: Longitudinal Evidence from Adolescent Girls and Young Women in Rural South Africa (HPTN  068)

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Abstract

This study, a secondary analysis of the HPTN 068 randomized control trial, aimed to quantify the association of father and male presence with HIV incidence and first pregnancy among 2533 school-going adolescent girls and young women (AGYW) in rural South Africa participating in the trial between March 2011 and April 2017. Participants’ ages ranged from 13–20 years at study enrollment and 17–25 at the post-intervention visit. HIV and pregnancy incidence rates were calculated for each level of the exposure variables using Poisson regression, adjusted for age using restricted quadratic spline variables, and, in the case of pregnancy, also adjusted for whether the household received a social grant. Our study found that AGYW whose fathers were deceased and adult males were absent from the household were most at risk for incidence of first pregnancy and HIV (pregnancy: aIRR = 1.30, Wald 95% CI 1.05, 1.61, Wald chi-square p = 0.016; HIV: aIRR = 1.27, Wald 95% CI 0.84, 1.91, Wald chi-square p = 0.263) as compared to AGYW whose biological fathers resided with them. For AGYW whose fathers were deceased, having other adult males present as household members seemed to attenuate the incidence (pregnancy: aIRR = 0.92, Wald 95% CI 0.74, 1.15, Wald chi-square p = 0.462; HIV: aIRR = 0.90, Wald 95% CI 0.58, 1.39, Wald chi-square p = 0.623) such that it was similar, and therefore not statistically significantly different, to AGYW whose fathers were present in the household.

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Acknowledgements

This research would not have been possible without the mentorship of the HPTN068 study team, particularly Amanda Selin who served as project manager for the HPTN068 study, as well as the contributions from the team at MRC/Wits-Agincourt Research Unit and Health and Socio-Demographic Surveillance System. Overall support for the HIV Prevention Trials Network (HPTN) was provided by the National Institute of Allergy and Infectious Diseases (NIAID), the National Institute of Mental Health (NIMH) and the National Institute on Drug Abuse (NIDA) of the National Institutes of Health (NIH) under Award Numbers UM1AI068619 (HPTN Leadership and Operations Center), UM1AI068617 (HPTN Statistical and Data Management Center), and UM1AI068613 (HPTN Laboratory Center). The study was also funded under Award Number 5R01MH087118-02 and R24 HD050924 to the Carolina Population Center. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Allergy and Infectious Diseases or the National Institutes of Health. The MRC/Wits-Agincourt Research Unit and Health and Socio-Demographic Surveillance System is supported by the School of Public Health, University of the Witwatersrand, and Medical Research Council, South Africa, and the UK Wellcome Trust (Grants 058893/Z/99/A; 069683/Z/02/Z; 085477/Z/08/Z; and 085477/B/08/Z)

Funding

Overall support for the HIV Prevention Trials Network (HPTN) was provided by the National Institute of Allergy and Infectious Diseases (NIAID), the National Institute of Mental Health (NIMH) and the National Institute on Drug Abuse (NIDA) of the National Institutes of Health (NIH) under Award Numbers UM1AI068619 (HPTN Leadership and Operations Center), UM1AI068617 (HPTN Statistical and Data Management Center), and UM1AI068613 (HPTN Laboratory Center). The study was also funded under Award Number 5R01MH087118-02 and R24 HD050924 to the Carolina Population Center. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Allergy and Infectious Diseases or the National Institutes of Health. The MRC/Wits-Agincourt Research Unit and Health and Socio-Demographic Surveillance System is supported by the School of Public Health, University of the Witwatersrand, and Medical Research Council, South Africa, and the UK Wellcome Trust (Grants 058893/Z/99/A; 069683/Z/02/Z; 085477/Z/08/Z; and 085477/B/08/Z).

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Authors and Affiliations

  1. Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, 2101 McGavran-Greenberg Hall, Chapel Hill, NC, 27599-7435, USA

    Lisa M. Albert, Jess Edwards, Brian Pence & Audrey Pettifor

  2. Palladium, Washington, D.C, USA

    Lisa M. Albert

  3. Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Ilene S. Speizer & Audrey Pettifor

  4. Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Ilene S. Speizer

  5. National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA

    Susan Hillis

  6. Medical Research Council/Wits University Rural Public Health and Health Transitions Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

    Kathleen Kahn, F. Xavier Gómez-Olivé, Ryan G. Wagner, Rhian Twine & Audrey Pettifor

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  1. Lisa M. Albert
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Contributions

LMA contributed to study design, data analysis, and writing of this manuscript. JE contributed to study design, data analysis, and editing of the manuscript. AP, BP, IS, and SH contributed to study design and editing of this manuscript. FXG, KK, RT, and RW contributed to editing of this manuscript.

Corresponding author

Correspondence to Lisa M. Albert.

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Conflict of interest

The authors declare that they have no competing interests.

Ethical Approval

Institutional Review Board approval for this secondary data analysis was obtained from the University of North Carolina at Chapel Hill; the parent study received approval from University of North Carolina at Chapel Hill as well as the University of the Witwatersrand in South Africa and the Mpumalanga Province’s Research and Ethics Committee.

Informed Consent

Each young woman and her parent or guardian provided written informed consent for participation in the parent study at the home visit. Written assent was obtained for young women younger than 18 years. Consent and assent forms were available in English and Shangaan.

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Appendix

Appendix

See Figs. 1, 2, 3, 4 and Tables 5, 6 and 7.

Fig. 1
figure 1

Consort diagram for HIV outcome by 5-category father and adult male presence combined with father’s living status (exposure 3)

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Fig. 2
figure 2

Consort diagram for pregnancy outcome by the 5-category father and adult male presence combined with father’s living status (exposure 3)

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Fig. 3
figure 3

Directed acyclic graph depicting the hypothesized relationship between father presence and pregnancy

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Fig. 4
figure 4

Directed acyclic graph depicting the hypothesized relationship between father presence and HIV incidence

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Table 5 Stability of 5-category father presence (exposure 3) from visit to visit
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Table 6 Stratified incidence rate ratios of HIV based on father and adult male presence among AGYW who participated in the HPTN 068 conditional cash transfer trial in Agincourt, South Africa, which took place between March 2011 and April 2017
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Table 7 Stratified incidence rate ratios of pregnancy based on father and adult male presence among young women who participated in the HPTN 068 conditional cash transfer trial in Agincourt, South Africa, which took place between March 2011 and April 2017
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Albert, L.M., Edwards, J., Pence, B. et al. Associations of Father and Adult Male Presence with First Pregnancy and HIV Infection: Longitudinal Evidence from Adolescent Girls and Young Women in Rural South Africa (HPTN  068). AIDS Behav 25, 2177–2194 (2021). https://doi.org/10.1007/s10461-020-03147-y

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