The effect of school attendance and school dropout on incident HIV and HSV-2 among young women in rural South Africa enrolled in HPTN 068

Authors

Marie Stoner, University of North Carolina
Audrey Pettifor, University of North Carolina
Jessie Edwards, University of North Carolina
Allison Aiello, University of North Carolina
Carolyn Halpern, University of North Carolina
Aimee Julien, University of The Witwatersrand
Amanda Selin, University of North Carolina
Rhian Twine, University of The Witwatersrand
James Hughes, University of Washington
Jing Wang, Fred Hutchinson Cancer Research Center
Yaw Agyei, Johns Hopkins University
Xavier Gomez-Olive, University of The Witwatersrand
Ryan Wagner, University of The Witwatersrand
Catherine L. Mac Phail, University of WollongongFollow
Kathleen Kahn, University of The Witwatersrand

RIS ID

115388

Publication Details

Stoner, M. C. D., Pettifor, A., Edwards, J. K., Aiello, A. E., Halpern, C. T., Julien, A., Selin, A., Twine, R., Hughes, J. P., Wang, J., Agyei, Y., Gomez-Olive, F. X., Wagner, R. G., MacPhail, C. & Kahn, K. (2017). The effect of school attendance and school dropout on incident HIV and HSV-2 among young women in rural South Africa enrolled in HPTN 068. AIDS, 31 (15), 2127-2134.

Abstract

Objective:

To estimate the association between school attendance, school dropout, and risk of incident HIV and HSV-2 infection among young women.

Design:

We used longitudinal data from a randomized controlled trial in rural Mpumalanga province, South Africa, to assess the association between school days attended, school dropout and incident HIV and HSV-2 in young women aged 13–23 years.

Methods:

We examined inverse probability of exposure weighted survival curves and used them to calculate 1.5, 2.5 and 3.5-year risk differences and risk ratios for the effect of school attendance on incident HIV and HSV-2. A marginal structural Cox model was used to estimate hazard ratios for the effect of school attendance and school dropout on incident infection.

Results:

Risk of infection increased over time as young women aged, and was higher in young women with low school attendance (<80% school days) compared to high (≥80% school days). Young women with low attendance were more likely to acquire HIV (HR: 2.97; 95% CI: 1.62, 5.45) and HSV-2 (HR: 2.47; 95% CI: 1.46,4.17) over the follow up period than young women with high attendance. Similarly, young women who dropped out of school had a higher weighted hazard of both HIV (HR 3.25 95% CI: 1.67,6.32) and HSV-2 (HR 2.70; 95% CI 1.59,4.59).

Conclusion:

Young women who attend more school days and stay in school have a lower risk of incident HIV and HSV-2 infection. Interventions to increase frequency of school attendance and prevent dropout should be promoted to reduce risk of infection.