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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.

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.
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Stoner MCD, Pettifor A, Edwards JK, Aiello AE, Halpern CT, Julien A, Selin A, Twine R, Hughes JP, Wang J, Agyei Y, Gomez-Olive FX, Wagner RG, MacPhail C, Kahn K,


Stoner MCD, Pettifor A, Edwards JK, Aiello AE, Halpern CT, Julien A, Selin A, Twine R, Hughes JP, Wang J, Agyei Y, Gomez-Olive FX, Wagner RG, MacPhail C, Kahn K, (click to view)

Stoner MCD, Pettifor A, Edwards JK, Aiello AE, Halpern CT, Julien A, Selin A, Twine R, Hughes JP, Wang J, Agyei Y, Gomez-Olive FX, Wagner RG, MacPhail C, Kahn K,

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AIDS (London, England) 31(15) 2127-2134 doi 10.1097/QAD.0000000000001584

Abstract
OBJECTIVE
To estimate the association between school attendance, school dropout, and risk of incident HIV and herpes simplex virus type 2 (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 with high (≥80% school days). Young women with low attendance were more likely to acquire HIV [hazard ratio (HR): 2.97; 95% confidence interval (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.

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