Page 149 - SAHCS HIVMed Journal Vol 20 No 1 2019

Page 2 of 8 Original Research

Using baseline (pre-intervention) data collected in the YaTsie 12 months, number of sexual partners, intergenerational
study, a large community-based HIV prevention study, we sex, transactional sex, alcohol use during intercourse either
analysed self-reported sexual practices in a large population- by the respondent or the respondent’s partner and
based random sample of adolescents and young adults aged consistency of condom use either by self or partner. All
16–24 years from 30 communities in rural and peri-urban respondents were asked about their HIV testing history
Botswana to describe sexual practices that place individuals and asked to provide documentation of prior tests (medical
at risk of HIV acquisition. We evaluated self-reported risky records with written test results or antiretroviral treatment
sexual practices by gender and modelled predictors of these prescriptions). Any individual who was not known to be
practices. HIV-positive (with supporting documentation) was asked
to undergo HIV testing and counselling during home
Methods visits. Demographic information was collected from each

Study design and population participant, including information on education level,
employment, income, water source in home, access to
YaTsie, also known as the Botswana Combination Prevention electricity and household commodities.
Project (clinicaltrials.gov NCT01965470), is a pair-matched,
cluster-randomised study, funded by the United States Statistical analysis
President’s Emergency Plan for AIDS Relief (PEPFAR). The
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study was designed to determine whether implementation of We a priori defined risky sexual practices as self-reported
a package of combination prevention interventions reduces participation in any of the following: sexual debut before
population-level cumulative 3-year HIV incidence. 15 years of age, sexual intercourse with a partner older
than the respondent by 10 years or more (intergenerational
sex); receipt of money, transport, food, drink or other
The trial, which began in October 2013, was conducted goods in exchange for sex (transactional sex); any alcohol
in 30 rural and peri-urban communities in Botswana use (by the respondent, the respondent’s partner or both)
(15 matched pairs), with a combined population of during sexual intercourse; and more than one occasion of
approximately 180 000 people, representing nearly 10% of not using a condom by the respondent or the respondent’s
Botswana’s total estimated population. Fifteen communities partner (inconsistent condom use) over the preceding
were randomised to a combination prevention intervention 12 months.
package with HIV testing, linkage to care, expanded ART
and male circumcision components. Fifteen communities We compared the socio-demographic characteristics of
were randomised to a non-intervention group where adolescents and young adults who reported being sexually
standard of care was maintained. Prior to initiation of the active and those who were not, using a Wald χ test. Modified
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interventions, we enrolled a prospective cohort to measure Poisson estimating equations were used to obtain prevalence
HIV incidence and intervention uptake over time (main ratios (PR) for engagement in risky sexual practices
objectives of the parent study). The survey participants according to gender, adjusting for community-level
were community residents aged 16–64 years, recruited from clustering. Modified Poisson regression, as opposed to
a random sample of approximately 20% of households in logistic regression, was necessary given the overall
each study community. Refer to prior publications for more commonality of the outcomes of interest. Specifically, we
details on sampling approach in the parent study. A total of note that in settings such as ours where the outcome is not
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12 610 consenting or assenting household residents were rare (i.e. > 10%), the odds ratio estimated by logistic
enrolled into the main study between October, 2013, and regression will be an upwardly biased estimate of the
November, 2015. For inclusion in the analysis of risky underlying risk ratio. For risky sexual practices found to
sexual practices, individuals aged 16–24 years must have differ significantly between male and female respondents,
provided consent or assent for the YaTsie parent study and gender-specific multivariate models were constructed by
completed the risky sexual practices questionnaire, a including all covariates with a p-value ≤ 0.10 in univariate
questionnaire that could be completed at the discretion of analyses. All analyses were conducted using SAS, version
the study participant. 9.3 (SAS Institute, Cary, North Carolina, USA), assuming a
two-sided, 95% confidence interval (CI).
Data collection
We used descriptive statistics to report the proportion of
This analysis uses only initial cross-sectional data from adolescents and young adults with presumed perinatal
responding participants in the first household survey acquisition of HIV, defining perinatal HIV acquisition as
conducted prior to initiation of interventions. Research documentation of HIV diagnosis before 10 years of age.
assistants administered structured case report forms to Using Fisher’s exact tests, we compared HIV testing history
collect data on sexual practices. All participants were asked among sexually active adolescents and young adults by
whether or not they had ever engaged in sexual intercourse. gender, known HIV diagnosis prior to the BCPP baseline
Among those who reported being sexually active, further survey and by self-reported risky sexual practices,
questions were asked of the participant, including age of comparing those reporting ≥ two risky sexual practices to
sexual debut, specifically about sexual activity in the last those with ≤ one.

http://www.sajhivmed.org.za 142 Open Access