ENding HIV transmission to infants by Generating Evidence to optimize care for pregnant and postpartum Adolescent Girls and young women with HIV in Tanzania (ENGAGE)

In sub-Saharan Africa, adolescent girls and young women (AGYW) aged 15-24-years are more likely than older women to acquire HIV, and once pregnant, to transmit HIV to their infants and drop out of care.

This highlights an urgent need to revisit the current one-size-fits-all model of prevention of mother-to-child transmission (PMTCT) programs.

The purpose of this project is to optimize PMTCT care for AGYWs, and later their infants, in Tanzania – a setting where HIV remains endemic.

To do so, we will use data from a large registry-based cohort (N≈13,800 with 22% 15-24-years) to investigate PMTCT service uptake, retention and health outcomes for AGYWs, as well as subsequent pregnancies and contraceptive use (study 1).

We will combine this with a nested prospective cohort to identify social-structural predictors of these outcomes (study 2).

We will utilize findings to develop (together with young women, health providers and managers) and prototype a package of micro-interventions that can be implemented in routine care to optimize PMTCT services for AGYWs.

Using a cluster-randomized design, we will pilot-test the intervention package for feasibility and preliminary effect, as well as cost-effectiveness.

This five-year project is highly feasible considering the multidisciplinary team with skills and experience in both implementation and experimental research, and will contribute much-needed evidence to advance PMTCT care for AGYWs in line with their unique needs.