Characteristics of Adolescents and Young Adults Living with HIV in a Care and Treatment Centre in a Tertiary Care Facility in Owerri, Nigeria: A Cross-Sectional Survey.

Characteristics of Adolescents and Young Adults Living with HIV in a Care and Treatment Centre in a Tertiary Care Facility in Owerri, Nigeria: A Cross-Sectional Survey. | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Characteristics of Adolescents and Young Adults Living with HIV in a Care and Treatment Centre in a Tertiary Care Facility in Owerri, Nigeria: A Cross-Sectional Survey. Joseph Ezeogu, Alaoma Kawa, Chioma Chimah, Emeka Nwolisa This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8370188/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 30 Mar, 2026 Read the published version in Egyptian Pediatric Association Gazette → Version 1 posted 15 You are reading this latest preprint version Abstract Background A generation of children with perinatally-acquired HIV or behaviorally acquired HIV (ABH) is now aging into adolescence and young adulthood (AYA). This increasing fraction of people living with HIV globally experience worse HIV care outcomes; therefore, understanding the unique sociodemographic and clinical characteristics of this population is vital for tailoring long-term care. Methods A cross-sectional analysis of 92 AYAs living with HIV was conducted between May and August 2025. Data on sociodemographics, risk behaviours, HIV-related knowledge, and treatment history were collected using a structured questionnaire, and clinical data, including viral load (VL), were extracted from medical records. Statistical analyses included descriptive statistics depicted in percentages and frequency, while non-parametric tests were utilized to assess associations. Results Most of the adolescents and young adults were female 51 (55.4%), aged between 10–22 years, and a mean age of 15.7 ± 2.7, 82 (89.1%) were students and not sexually active. Substance use was low, with alcohol use documented by 12 (13%) participants, 3 (3.3%) had a history of tobacco use, and only 1(1.1%) used illicit drugs. A majority, 69 (75.0%), were aware of their HIV diagnosis, only 63(68.5%) knew their own positive status, and knowledge of HIV transmission routes was suboptimal. Antiretroviral therapy (ART) adherence was reported as regular by 85 (92.4%), with 83(90.2%) currently on Tenofovir/Lamivudine/Dolutegravir (TLD). Virological suppression was high, median latest viral load (VL): 20 copies/mL, IQR: 19–20. However, only 12(13.0%) had ever disclosed their status to anyone. Conclusion This cohort demonstrates successful virological control attributable to high adherence to modern ART regimens. However, critical gaps remain in status awareness, comprehensive knowledge of HIV transmission, and disclosure. These findings highlight the need for targeted multi-sectoral AYA-friendly interventions that address psychosocial needs and disclosure counseling, comprehensive sexual health education. Adolescent Young Adult HIV Viral Suppression Antiretroviral Therapy Disclosure Nigeria Introduction Sub-Saharan Africa hosts about 80% of the adolescents and young adults (aged between 10–24 years) living with HIV, 1 of the estimated 3% of all people living with HIV globally, and 12% of new HIV infections. 2 , 3 The high HIV infection rate amongst adolescents could be ascribed to challenges and experiences particular to the adolescent. 4 Adolescence is a critical transitional period whereby physical, emotional, and social maturation occurs, characterized by heightened vulnerability and challenges 4 – 7 often resulting in hesitancy in HIV care engagement. 5 , 8 The healthcare system is faced with new challenges from this cohort of adolescents and young adults who were born with HIV and live longer, healthier lives with the lifelong chronic condition due to the scale-up of prevention of mother-to-child transmission (PMTCT) programs and antiretroviral therapy (ART). 9 These AYA with HIV are a priority group within the HIV population because of their rapid expansion. 2 , 10 Despite AYA’s with HIV vital position in the HIV population, when compared to adults, they have poorer rates of HIV testing, disclosure, 11 treatment adherence, 12 long-term immunologic recovery, 13 and viral suppression. 14 , 15 Furthermore, legal guardians and parents often deny ALHIV care, 16 with restrictive parental consent laws denying them some medical services, 17 and during sexual debut, they are often inexperienced in negotiation for safer sex. 18,19 In addition, they may be identified as a result of teenage pregnancies 20 , 21 and are more likely to experience gender-based violence and gender inequality. 22 Equally critical are the behavioral challenges (limited knowledge of HIV and poor adherence) as well as psychosocial challenges (low self-esteem, isolation, and a lack of adequate social support) affecting these ALHIVs. 1 , 23 , 24 , 25 This is inclusive of structural barriers caused by delayed disclosure, inefficient adolescent-friendly services, and the absence of structured transition protocols or guidelines. 1 , 7 , 26 , 27 Understanding these complexities and characterizing the AYA with HIV population is essential to inform the development and implementation of tailored and contextually relevant effective intervention models of healthcare practices that would promote autonomy and improve outcomes for ALHIVs. Furthermore, appreciating their sociodemographic profile, knowledge, and risk behaviours is essential to developing effective, age-appropriate support services. However, data from Southeastern Nigeria remains limited. We report data from a study conducted amongst 10–22-year-old AYA, enrolled in a HIV care centre in Owerri, Nigeria. This is to offer a more robust representation of the sociodemographic, biomedical, and clinical characteristics of this key priority population, which would help design/redesign effective prevention and treatment policy(s) adapted to the exact needs of AYA with HIV in Nigeria Methods Study Design and Participants A cross-sectional study was conducted between May and August 2025 amongst 92 AYAs living with HIV, aged 10 to 22 years, actively receiving care in the HIV care centre of a Federal Teaching Hospital in Owerri, Nigeria. The centre provides care to approximately 1,569 children and adolescents, with about 100 adolescents seen annually. The adolescent clinic is run once a month, with an average of 30 AYA with HIV seen monthly. Informed consent and assent (where appropriate) were obtained from all participants or their parents/ legal guardians. Sample Size: The minimum sample size was calculated using the formula for estimating sample size in cross-sectional studies 28 as shown: n = Minimum sample size Z = Standard normal deviation at 95% confidence level = 1.96 P = National prevalence of HIV amongst adolescent = 0.2% 29 q = 1-P = (1-0.002) = 0.998 d = Level of precision = 5% Calculated sample size= The calculated sample size was supplemented by a convenience sampling approach, aiming to recruit a high proportion of the clinic's AYA population over the study period, to increase the power of the study. Therefore, 92 adolescents and young adults living with HIV/AIDS, aged 10–22 years, were enrolled. Data Collection Data were collected using a structured questionnaire administered in a private room in the health facility. Individual variables considered included sociodemographics of the adolescents’ gender, schooling, parental status, socioeconomic status SEC (determined using Oyedeji’s classification, 30 which uses parental education and occupation to categorize SEC into upper, middle, and lower), their caregivers and households, educational and employment status, as well as medical history, HIV knowledge, and ART adherence. The interpersonal domain measured behavioural factors such as sexual activity, substance use, and HIV-specific characteristics; awareness of status and ART, treatment history, and HIV disclosure. Clinical data, including current ART regimen and the latest viral load (VL), were extracted from medical records. Viral load was analysed as a continuous variable (copies/mL). Statistical Analysis Data were analysed using SPSS version 25. Descriptive statistics on the characteristics of AYA aged 10–22 years old were described as means (± SD) or medians (with interquartile ranges) based on distribution for continuous variables. Categorical variables were summarized as frequencies and percentages. The Spearman's rank correlation coefficient was used to assess the relationship between viral load (VL) and duration of ART. The Mann-Whitney U test and Kruskal-Wallis test were used to compare VL medians across categorical variables. A p-value of < 0.05 was considered statistically significant. For significant Kruskal-Wallis results, post-hoc pairwise comparisons were performed with a Bonferroni adjustment. Results Sociodemographic and Behavioural Characteristics Of the 92 AYA living with HIV included in the study, 51 (55.4%) were males, and 41 (44.6%) were females. Mean age was 15.7 (±2.7) years. Half of all AYA (50%) reported both parents alive, with more of the females 24, (58.5%) having their parents alive. Half of the participants (50.0%) had both parents alive, while 7(15.1%) were double orphans, with more males, 4 (7.8%) than females, 3 (7.3%) affected. A significantly high proportion of subjects SEC could not be determined because they don’t know the occupation and educational level of their parents, with more males, 26 (51%), not knowing. Very few AYA reported ever using tobacco, 3(5.9%) males only (p>0.999), alcohol 12(13%) with 7(13.7) males reporting alcohol ingestion and 5(12.2%) being females at p>0.999. Illicit drug use was reported by only one male participant (2%), p>0.999. Education & employment: Eighty-one (89.1%) of the participants were students. Just over half, 58 (63%) of AYA living with HIV were in secondary with more males, 38(74.5%), compared to the females. For higher levels of education, 15(16.3%) were in or had completed it, with 6(11.8%) being males. 9(2%) were in primary school and 10(10.9%) were not in school. Medical chart data: Only 83 (90.2%) of AYA living with HIV had viral load data in medical charts. The median latest viral load was 20 copies/mL (IQR: 19-20, n=83), with a range from 0 to 41,355 copies/mL, indicating a high rate of virological suppression. The median duration on ART was 10 years (IQR: 5-14, n=73). A total of 79 subjects documented awareness of ART; more males, 42 (82.4%), were aware compared to the females (p < 0.280). While most males 39 (76.6%) of the 69 were aware of HIV. Sexual behaviour: Most participants reported no history of sexual activity (89.1%). Among the 10 (10.9%) AYA living with HIV who reported having had sexual intercourse, 6(11.8) were males, and 4 (9.8%) were females (p = 0.999). When use of condoms was analysed, of the 8 that reported condom use, 5 (9.8%) were male, and 3 (7.3%) were female (p = 0.728). (For the females, the type of condom used-male or female- was not indicated). Current relationship: Among 92 AYALHIV, 82 (85.9%) did not have a boyfriend/girlfriend; however, 10 (10.9%) reported a current relationship, 7 (13.7%) were males, and 6 (14.6%) were females (p > 0.999). HIV-Related Characteristics and Treatment Most participants, 69 (75.0%), were aware of HIV, but only 63 (68.5%) were aware of their own HIV positive status. A remarkable 57(62.0%) AYA with HIV did not know how they had acquired the virus, with mother-to-child transmission being the most commonly identified mode, reported by 29 (31.5%). Awareness of ART was high, documented by 79 (85.9%) participants who had been on treatment for a median of 10 years (IQR: 5-14). The large majority, 83 (90.2%) of subjects were currently on the TLD regimen, and self-reported adherence was documented by 85 (92.4%). This high adherence was reflected in an excellent virological outcome, with a median latest viral load of 20 copies/mL (IQR: 19-20). Status disclosure was very low; only 12 (13.0%) participants had ever disclosed their status to anyone, with siblings being reported by 5 (41.7%) as the most common confidants of those who disclosed. This is shown in Table 2 below. Knowledge of HIV Transmission Participants’ knowledge of HIV transmission modes was suboptimal, with less than half of AYA with HIV 42 (45.7%) correctly identifying mother-to-child transmission routes. Sexual relations, sharing sharps, and blood transfusion were identified by 34 (37.0%), 33 (35.9%), and 33 (35.9%) participants, respectively. A concerning proportion of subjects, 30 (32.6%), reported not knowing any mode of transmission. This is depicted in Table 3. The number of responses is more than the sample size, and percentages do not sum to 100%, indicating multiple responses. Discussion Our cross-sectional study describes the detailed profile of the sociodemographic, behavioural, and clinical characteristics of adolescents and young adults (AYA) living with HIV and receiving care at a tertiary care facility in Owerri, Nigeria. It highlights the unique challenges faced by this vulnerable group. Generally, study participants had high self-reported adherence at 92.4%, demonstrated average knowledge/awareness of HIV and ART, but suboptimal for the transmission route. Very few AYA living with HIV had disclosed their HIV status to siblings, and fewer reported condom use. Collectively, these characteristics underscore the high degree and extent of unmet needs in several areas amongst AYA living with HIV in this low-income country. Poverty was found to be significant among our study participants, as only 6.7% of them belonged to the upper SEC. This aligns with several African studies. 31 – 33 Furthermore, our study reveals important deficits in HIV-related knowledge. While 75.0% of AYAs were aware of HIV, only 68.5% were aware of their own positive status, and a majority (62.0%) did not know how they had acquired the virus. This is similar to findings in other studies. 34 , 35 Knowledge of specific transmission modes was also suboptimal, with a lowly 45.7% rightly identifying mother-to-child transmission and a troubling 17.3% of AYA living with HIV unaware of any transmission routes. While this lack of comprehensive knowledge is not limited to AYA living with HIV, 35, 36 a vital part of treatment literacy is a good insight into HIV and its natural history. With 10.9% of the participants being sexually active, there is a heightened risk for onward HIV transmission, which underscores the seeming failure of current health education strategies within the care system. It suggests that merely growing up in an HIV care environment does not equate to adequate health literacy, pointing to a need for structured, repeated, and age and developmentally appropriate education sessions for these AYA living with HIV. Another significant finding in this study is that 90.2% of AYA living with HIV were on TLD, a first-line ART, and had a high self-reported level of adherence to ART at 92.4%. This level of adherence contrasts with other workers who documented much lower rates among adolescents and children, 37,38 where factors like treatment fatigue, side effects, psychological factors, and client-provider relationship are attributed to low adherence among older adolescents. 33 , 39 , 40 However, the 92% self-reported adherence aligns with the 89% and 95.4% documented in the Mozambican 31 and Cambodian studies. 34 Social desirability may in part be responsible for the high level of self-reported adherence, which has been found in other studies [57–59]. The availability of donor-funded free HIV services, including ART and sociocultural support systems (available because of the extended family system in Africa, when only 46% of participants have both parents alive), may provide elucidation for the high self-reported adherence documented in this study. It contrasts significantly with the low suppression rate reported by Teasdale et al 31 and the 7686 copies/mL reported as viral load by Yi et al. 34 Yi and other workers 34 thought that the high viral load maybe due to the time lag between the viral load and the adherence measurements (viral load was assessed six monthly for new and unstable patients and yearly for stable patients). These reported successes demonstrate that with access to effective therapy and consistent care, excellent biomedical outcomes are achievable for AYAs living with HIV in this low-income setting and improve long-term well-being. Several critical psychosocial and knowledge-based gaps that could threaten long-term well-being and secondary prevention were also documented. Reported in this study is that only 13.0% of participants have ever disclosed their HIV status to anyone; this extremely low rate of status disclosure is deeply perturbing. This disclosure rate is lower than the 50% and 58% reported by other workers. 31 , 34 While 47%, 16.7% and 0% of the disclosure was to their sibling, friends, and teachers. This secrecy is often driven by stigma and fear of discrimination even from loved ones, 11,41 therefore, adolescents require information and ongoing support to make informed decisions in determining how, when, and whom to disclose their status to, while balancing the risks and benefits of disclosure. 42 The fact that siblings were the most common confidants is remarkable since it can open opportunities for support from family members and intimate partners, 43 highlights the potential role of family-centered disclosure counseling, which should be a cornerstone of adolescent HIV care. The behavioral profile of our cohort was largely reassuring, with a low 10.9% of participants reporting sexual activity, of which 11.8% and 9.8% were male and female. Our findings contrast with the universal observation of early sexual maturity among adolescent females 44 and documented predominant female sexual activity in other studies. 34 This low reported sexual activity may mirror the young mean age of 15.7 years and the fact that most participants were students and potentially buffered from some risk environments. Understanding sexual risks is a significant part of ensuring that adolescents can autonomously handle their health; hence, empowering adolescents to negotiate sexual relationships is a required skill as they develop physically and psychologically. 45 , 46 Despite the low 10.9%, 13% and 1.1% for sexual activity, alcohol use, and illicit drug use, the presence of these behaviours in a minority signals the need for continuing screening and preventive counseling as these AYA’s living with HIV, ages. Limitations: Our findings must be interpreted in the context of the cross-sectional design of the study that prevents causal inferences. Generalizability may be limited because the sample, despite representing a high proportion of the clinic's AYA population, was from a single tertiary centre. Data on sensitive topics like sexual behaviour and substance use are subject to social desirability bias, potentially leading to under-reporting. Furthermore, adherence was self-reported and likely overestimated, though the corroborating virological data provide objective validation of overall good adherence in this group of AYA living with HIV. Conclusion These groups of AYAs living with HIV in Owerri, Southeastern Nigeria, highlight the profound and persistent psychosocial challenges they face. The combination of excellent virological suppression with poor status disclosure, inadequate knowledge of HIV transmission, and the influence of socioeconomic factors paints a picture of a population at a crossroads. To ensure these adolescents not only survive but thrive, a multi-sectoral approach is essential. We recommend the commencement/integration of structured ongoing disclosure counseling, comprehensive sexual and reproductive health education, and robust psychosocial support services into routine adolescent HIV care. Future research should focus on developing and evaluating interventions that address these critical gaps to support the long-term health and autonomy of this vulnerable yet resilient generation. Declarations Funding: The authors did not receive any funding for the study. Human Ethics and Consent to Participate declarations: Ethical approval was sought for and obtained from the Health Research Ethics Committee of a Nigerian Federal Tertiary Health Institution in Owerri, Nigeria (FTHO), and protocol approval was obtained with the number: FTH/OW/HREC/Vol.2/85. Study details were explained to the caregivers/adolescents. Written informed consent was then obtained from the participants. Only the adolescents who assented and whose caregivers consented were enrolled. 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Additional Declarations No competing interests reported. Supplementary Files Table13.docx Cite Share Download PDF Status: Published Journal Publication published 30 Mar, 2026 Read the published version in Egyptian Pediatric Association Gazette → Version 1 posted Editorial decision: Revision requested 07 Jan, 2026 Reviews received at journal 06 Jan, 2026 Reviews received at journal 05 Jan, 2026 Reviews received at journal 05 Jan, 2026 Reviews received at journal 28 Dec, 2025 Reviewers agreed at journal 28 Dec, 2025 Reviews received at journal 27 Dec, 2025 Reviewers agreed at journal 26 Dec, 2025 Reviewers agreed at journal 23 Dec, 2025 Reviewers agreed at journal 23 Dec, 2025 Reviewers agreed at journal 23 Dec, 2025 Reviewers invited by journal 23 Dec, 2025 Editor assigned by journal 23 Dec, 2025 Submission checks completed at journal 23 Dec, 2025 First submitted to journal 15 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Kawa","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+klEQVRIiWNgGAWjYDACdjCZAMTMx398AFJs7IS0MMO1sCVIzgBRzMRr4TGQ5kGI4Ab8zcwPH92oSZM3OH4swdjm1zZ5PmYGxg8fc3BrkTjMZmyccyzHcMOZ5APJuX23DduYGZglZ27DY81hBjPpHLYKxm0H0hIO5/bcZgRqYWPmxaNF/jD7N+mcfxX2286/MWy27LltT1CLwWEeM+nctpzEbTdyjJkZftxOJKjF8DBPsXFuX1ry/hvP0hh7G24ntzEzNuP1i9zx9o2Pc74l287sTz7G8OPPbdv57c0HP3zE530UwNgGJhuIVQ8Cf0hRPApGwSgYBSMFAAC6DFJIzJxncwAAAABJRU5ErkJggg==","orcid":"","institution":"Federal Teaching Hospital, Owerri","correspondingAuthor":true,"prefix":"","firstName":"Alaoma","middleName":"","lastName":"Kawa","suffix":""},{"id":565111227,"identity":"b67ee479-b08e-4b38-86de-83ac071476a3","order_by":2,"name":"Chioma Chimah","email":"","orcid":"","institution":"Federal Teaching Hospital, Owerri","correspondingAuthor":false,"prefix":"","firstName":"Chioma","middleName":"","lastName":"Chimah","suffix":""},{"id":565111228,"identity":"be2904f5-95b0-4851-83a1-f6374694b50e","order_by":3,"name":"Emeka Nwolisa","email":"","orcid":"","institution":"Federal Teaching Hospital, Owerri","correspondingAuthor":false,"prefix":"","firstName":"Emeka","middleName":"","lastName":"Nwolisa","suffix":""}],"badges":[],"createdAt":"2025-12-15 22:23:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8370188/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8370188/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s43054-026-00535-2","type":"published","date":"2026-03-30T15:59:01+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":98990643,"identity":"492da350-4c9d-4dec-95d8-49262bab3525","added_by":"auto","created_at":"2025-12-25 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10:18:37","extension":"html","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":111392,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8370188/v1/e6ac7bdadd3f7fb293e0b2da.html"},{"id":106343887,"identity":"c54bc8a3-69e7-4056-8dd4-85cd26c9a677","added_by":"auto","created_at":"2026-04-07 16:10:24","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":585481,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8370188/v1/f154cbc0-e07e-4938-8171-29ca31924b7c.pdf"},{"id":99313090,"identity":"af4208b7-f08d-453c-bfa2-e6a640314c46","added_by":"auto","created_at":"2025-12-31 16:19:46","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":20464,"visible":true,"origin":"","legend":"","description":"","filename":"Table13.docx","url":"https://assets-eu.researchsquare.com/files/rs-8370188/v1/5e872524e06f72518173ef3d.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Characteristics of Adolescents and Young Adults Living with HIV in a Care and Treatment Centre in a Tertiary Care Facility in Owerri, Nigeria: A Cross-Sectional Survey.","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSub-Saharan Africa hosts about 80% of the adolescents and young adults (aged between 10\u0026ndash;24 years) living with HIV,\u003csup\u003e1\u003c/sup\u003e of the estimated 3% of all people living with HIV globally, and 12% of new HIV infections.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e The high HIV infection rate amongst adolescents could be ascribed to challenges and experiences particular to the adolescent.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e Adolescence is a critical transitional period whereby physical, emotional, and social maturation occurs, characterized by heightened vulnerability and challenges\u003csup\u003e\u003cspan additionalcitationids=\"CR5 CR6\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e often resulting in hesitancy in HIV care engagement.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe healthcare system is faced with new challenges from this cohort of adolescents and young adults who were born with HIV and live longer, healthier lives with the lifelong chronic condition due to the scale-up of prevention of mother-to-child transmission (PMTCT) programs and antiretroviral therapy (ART).\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e These AYA with HIV are a priority group within the HIV population because of their rapid expansion.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eDespite AYA\u0026rsquo;s with HIV vital position in the HIV population, when compared to adults, they have poorer rates of HIV testing, disclosure,\u003csup\u003e11\u003c/sup\u003e treatment adherence,\u003csup\u003e12\u003c/sup\u003e long-term immunologic recovery,\u003csup\u003e13\u003c/sup\u003e and viral suppression.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e,\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e Furthermore, legal guardians and parents often deny ALHIV care,\u003csup\u003e16\u003c/sup\u003e with restrictive parental consent laws denying them some medical services,\u003csup\u003e17\u003c/sup\u003e and during sexual debut, they are often inexperienced in negotiation for safer sex. \u003csup\u003e18,19\u003c/sup\u003e In addition, they may be identified as a result of teenage pregnancies\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e,\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e and are more likely to experience gender-based violence and gender inequality.\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e Equally critical are the behavioral challenges (limited knowledge of HIV and poor adherence) as well as psychosocial challenges (low self-esteem, isolation, and a lack of adequate social support) affecting these ALHIVs.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e,\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e,\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e This is inclusive of structural barriers caused by delayed disclosure, inefficient adolescent-friendly services, and the absence of structured transition protocols or guidelines.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e,\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e Understanding these complexities and characterizing the AYA with HIV population is essential to inform the development and implementation of tailored and contextually relevant effective intervention models of healthcare practices that would promote autonomy and improve outcomes for ALHIVs. Furthermore, appreciating their sociodemographic profile, knowledge, and risk behaviours is essential to developing effective, age-appropriate support services. However, data from Southeastern Nigeria remains limited.\u003c/p\u003e \u003cp\u003eWe report data from a study conducted amongst 10\u0026ndash;22-year-old AYA, enrolled in a HIV care centre in Owerri, Nigeria. This is to offer a more robust representation of the sociodemographic, biomedical, and clinical characteristics of this key priority population, which would help design/redesign effective prevention and treatment policy(s) adapted to the exact needs of AYA with HIV in Nigeria\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design and Participants\u003c/h2\u003e \u003cp\u003eA cross-sectional study was conducted between May and August 2025 amongst 92 AYAs living with HIV, aged 10 to 22 years, actively receiving care in the HIV care centre of a Federal Teaching Hospital in Owerri, Nigeria. The centre provides care to approximately 1,569 children and adolescents, with about 100 adolescents seen annually. The adolescent clinic is run once a month, with an average of 30 AYA with HIV seen monthly. Informed consent and assent (where appropriate) were obtained from all participants or their parents/ legal guardians.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSample Size:\u003c/h3\u003e\n\u003cp\u003eThe minimum sample size was calculated using the formula for estimating sample size in cross-sectional studies \u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e as shown:\u003c/p\u003e\u003cp\u003e\u003cimg src=\"https://myfiles.space/user_files/127393_c7e80a1c9bb65875/127393_custom_files/img1766657433.png\" style=\"width: 92px;\"\u003e\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;Minimum sample size\u003c/p\u003e \u003cp\u003eZ\u0026thinsp;=\u0026thinsp;Standard normal deviation at 95% confidence level\u0026thinsp;=\u0026thinsp;1.96\u003c/p\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;National prevalence of HIV amongst adolescent\u0026thinsp;=\u0026thinsp;0.2% \u003csup\u003e29\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eq\u0026thinsp;=\u0026thinsp;1-P = (1-0.002)\u0026thinsp;=\u0026thinsp;0.998\u003c/p\u003e \u003cp\u003ed\u0026thinsp;=\u0026thinsp;Level of precision\u0026thinsp;=\u0026thinsp;5%\u003c/p\u003e \u003cp\u003eCalculated sample size=\u003c/p\u003e \u003cp\u003eThe calculated sample size was supplemented by a convenience sampling approach, aiming to recruit a high proportion of the clinic's AYA population over the study period, to increase the power of the study. Therefore, 92 adolescents and young adults living with HIV/AIDS, aged 10\u0026ndash;22 years, were enrolled.\u003c/p\u003e\n\u003ch3\u003eData Collection\u003c/h3\u003e\n\u003cp\u003eData were collected using a structured questionnaire administered in a private room in the health facility. Individual variables considered included sociodemographics of the adolescents\u0026rsquo; gender, schooling, parental status, socioeconomic status SEC (determined using Oyedeji\u0026rsquo;s classification,\u003csup\u003e30\u003c/sup\u003e which uses parental education and occupation to categorize SEC into upper, middle, and lower), their caregivers and households, educational and employment status, as well as medical history, HIV knowledge, and ART adherence. The interpersonal domain measured behavioural factors such as sexual activity, substance use, and HIV-specific characteristics; awareness of status and ART, treatment history, and HIV disclosure. Clinical data, including current ART regimen and the latest viral load (VL), were extracted from medical records. Viral load was analysed as a continuous variable (copies/mL).\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eData were analysed using SPSS version 25. Descriptive statistics on the characteristics of AYA aged 10\u0026ndash;22 years old were described as means (\u0026plusmn;\u0026thinsp;SD) or medians (with interquartile ranges) based on distribution for continuous variables. Categorical variables were summarized as frequencies and percentages. The Spearman's rank correlation coefficient was used to assess the relationship between viral load (VL) and duration of ART. The Mann-Whitney U test and Kruskal-Wallis test were used to compare VL medians across categorical variables. A p-value of \u0026lt;\u0026thinsp;0.05 was considered statistically significant. For significant Kruskal-Wallis results, post-hoc pairwise comparisons were performed with a Bonferroni adjustment.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eSociodemographic and Behavioural Characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOf the 92 AYA living with HIV included in the\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003estudy, 51 (55.4%) were males, and 41 (44.6%) were females. \u0026nbsp;Mean age was 15.7 (\u0026plusmn;2.7) years. Half of all AYA (50%) reported both parents alive, with more of the females 24, (58.5%) having their parents alive. Half of the participants (50.0%) had both parents alive, while 7(15.1%) were double orphans, with more males, 4 (7.8%) than females, 3 (7.3%) affected.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;A significantly high proportion of subjects SEC could not be determined because they don\u0026rsquo;t know the occupation and educational level of their parents, with more males, 26 (51%), not knowing. Very few AYA reported ever using tobacco, 3(5.9%) males only (p\u0026gt;0.999), alcohol 12(13%) with 7(13.7) males reporting alcohol ingestion and 5(12.2%) being females at p\u0026gt;0.999. Illicit drug use was reported by only one male participant (2%), p\u0026gt;0.999.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEducation \u0026amp; employment:\u0026nbsp;\u003c/strong\u003eEighty-one (89.1%) of the participants were students. \u0026nbsp;Just over half, 58 (63%) of AYA living with HIV were in secondary with more males, 38(74.5%), compared to the females. For higher levels of education, 15(16.3%) were in or had completed it, with 6(11.8%) being males. 9(2%) were in primary school and 10(10.9%) were not in school.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMedical chart data: Only 83 (90.2%) of AYA living with HIV had viral load data in medical charts.\u0026nbsp;\u003c/strong\u003eThe median latest viral load was 20 copies/mL (IQR: 19-20, n=83), with a range from 0 to 41,355 copies/mL, indicating a high rate of virological suppression.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eThe median duration on ART was 10 years (IQR: 5-14, n=73). A total of 79 subjects documented awareness of ART; more males, 42 (82.4%), were aware compared to the females (p\u003cem\u003e\u0026lt;\u003c/em\u003e0.280). While most males 39 (76.6%) of the 69 were aware of HIV. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSexual behaviour:\u0026nbsp;\u003c/strong\u003eMost participants reported no history of sexual activity (89.1%). Among the 10 (10.9%) AYA living with HIV who reported having had sexual intercourse, 6(11.8) were males, and 4 (9.8%) were females (p = 0.999). When use of condoms was analysed, of the 8 that reported condom use, 5 (9.8%) were male, and 3 (7.3%) were female (p\u003cem\u003e=\u003c/em\u003e0.728). (For the females, the type of condom used-male or female- was not indicated). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCurrent relationship:\u0026nbsp;\u003c/strong\u003eAmong 92 AYALHIV, 82 (85.9%) did not have a boyfriend/girlfriend; however, 10 (10.9%) reported a current relationship,\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e7 (13.7%) were males, and 6 (14.6%) were females (p\u003cem\u003e\u0026gt;\u003c/em\u003e0.999).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHIV-Related Characteristics and Treatment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMost participants, 69 (75.0%), were aware of HIV, but only 63 (68.5%) were aware of their own HIV positive status. A remarkable 57(62.0%) AYA with HIV did not know how they had acquired the virus, with mother-to-child transmission being the most commonly identified mode, reported by 29 (31.5%). Awareness of ART was high, documented by 79 (85.9%) participants who had been on treatment for a median of 10 years (IQR: 5-14). The large majority, 83 (90.2%) of subjects were currently on the TLD regimen, and self-reported adherence was documented by 85 (92.4%). This high adherence was reflected in an excellent virological outcome, with a median latest viral load of 20 copies/mL (IQR: 19-20). Status disclosure was very low; only 12 (13.0%) participants had ever disclosed their status to anyone, with siblings being reported by 5 (41.7%) as the most common confidants of those who disclosed. This is shown in Table 2 below.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eKnowledge of HIV Transmission\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants\u0026rsquo; knowledge of HIV transmission modes was suboptimal, with less than half of AYA with HIV 42 (45.7%) correctly identifying mother-to-child transmission routes. Sexual relations, sharing sharps, and blood transfusion were identified by 34 (37.0%), 33 (35.9%), and 33 (35.9%) participants, respectively. A concerning proportion of subjects, 30 (32.6%), reported not knowing any mode of transmission. This is depicted in Table 3.\u003c/p\u003e\n\u003cp\u003eThe number of responses is more than the sample size, and percentages do not sum to 100%, indicating multiple responses.\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur cross-sectional study describes the detailed profile of the sociodemographic, behavioural, and clinical characteristics of adolescents and young adults (AYA) living with HIV and receiving care at a tertiary care facility in Owerri, Nigeria. It highlights the unique challenges faced by this vulnerable group. Generally, study participants had high self-reported adherence at 92.4%, demonstrated average knowledge/awareness of HIV and ART, but suboptimal for the transmission route. Very few AYA living with HIV had disclosed their HIV status to siblings, and fewer reported condom use. Collectively, these characteristics underscore the high degree and extent of unmet needs in several areas amongst AYA living with HIV in this low-income country. Poverty was found to be significant among our study participants, as only 6.7% of them belonged to the upper SEC. This aligns with several African studies.\u003csup\u003e\u003cspan additionalcitationids=\"CR32\" citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eFurthermore, our study reveals important deficits in HIV-related knowledge. While 75.0% of AYAs were aware of HIV, only 68.5% were aware of their own positive status, and a majority (62.0%) did not know how they had acquired the virus. This is similar to findings in other studies.\u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e Knowledge of specific transmission modes was also suboptimal, with a lowly 45.7% rightly identifying mother-to-child transmission and a troubling 17.3% of AYA living with HIV unaware of any transmission routes. While this lack of comprehensive knowledge is not limited to AYA living with HIV, \u003csup\u003e35, 36\u003c/sup\u003e a vital part of treatment literacy is a good insight into HIV and its natural history. With 10.9% of the participants being sexually active, there is a heightened risk for onward HIV transmission, which underscores the seeming failure of current health education strategies within the care system. It suggests that merely growing up in an HIV care environment does not equate to adequate health literacy, pointing to a need for structured, repeated, and age and developmentally appropriate education sessions for these AYA living with HIV.\u003c/p\u003e \u003cp\u003eAnother significant finding in this study is that 90.2% of AYA living with HIV were on TLD, a first-line ART, and had a high self-reported level of adherence to ART at 92.4%. This level of adherence contrasts with other workers who documented much lower rates among adolescents and children,\u003csup\u003e37,38\u003c/sup\u003e where factors like treatment fatigue, side effects, psychological factors, and client-provider relationship are attributed to low adherence among older adolescents.\u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e,\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e,\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eHowever, the 92% self-reported adherence aligns with the 89% and 95.4% documented in the Mozambican \u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e and Cambodian studies.\u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e Social desirability may in part be responsible for the high level of self-reported adherence, which has been found in other studies [57\u0026ndash;59]. The availability of donor-funded free HIV services, including ART and sociocultural support systems (available because of the extended family system in Africa, when only 46% of participants have both parents alive), may provide elucidation for the high self-reported adherence documented in this study.\u003c/p\u003e \u003cp\u003eIt contrasts significantly with the low suppression rate reported by Teasdale et al\u003csup\u003e31\u003c/sup\u003e and the 7686 copies/mL reported as viral load by Yi et al.\u003csup\u003e34\u003c/sup\u003e Yi and other workers\u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e thought that the high viral load maybe due to the time lag between the viral load and the adherence measurements (viral load was assessed six monthly for new and unstable patients and yearly for stable patients).\u003c/p\u003e \u003cp\u003eThese reported successes demonstrate that with access to effective therapy and consistent care, excellent biomedical outcomes are achievable for AYAs living with HIV in this low-income setting and improve long-term well-being.\u003c/p\u003e \u003cp\u003eSeveral critical psychosocial and knowledge-based gaps that could threaten long-term well-being and secondary prevention were also documented. Reported in this study is that only 13.0% of participants have ever disclosed their HIV status to anyone; this extremely low rate of status disclosure is deeply perturbing. This disclosure rate is lower than the 50% and 58% reported by other workers.\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e,\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e While 47%, 16.7% and 0% of the disclosure was to their sibling, friends, and teachers. This secrecy is often driven by stigma and fear of discrimination even from loved ones,\u003csup\u003e11,41\u003c/sup\u003e therefore, adolescents require information and ongoing support to make informed decisions in determining how, when, and whom to disclose their status to, while balancing the risks and benefits of disclosure.\u003csup\u003e\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u003c/sup\u003e The fact that siblings were the most common confidants is remarkable since it can open opportunities for support from family members and intimate partners,\u003csup\u003e43\u003c/sup\u003e highlights the potential role of family-centered disclosure counseling, which should be a cornerstone of adolescent HIV care.\u003c/p\u003e \u003cp\u003eThe behavioral profile of our cohort was largely reassuring, with a low 10.9% of participants reporting sexual activity, of which 11.8% and 9.8% were male and female. Our findings contrast with the universal observation of early sexual maturity among adolescent females\u003csup\u003e\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e\u003c/sup\u003e and documented predominant female sexual activity in other studies.\u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e This low reported sexual activity may mirror the young mean age of 15.7 years and the fact that most participants were students and potentially buffered from some risk environments. Understanding sexual risks is a significant part of ensuring that adolescents can autonomously handle their health; hence, empowering adolescents to negotiate sexual relationships is a required skill as they develop physically and psychologically.\u003csup\u003e\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e,\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e\u003c/sup\u003e Despite the low 10.9%, 13% and 1.1% for sexual activity, alcohol use, and illicit drug use, the presence of these behaviours in a minority signals the need for continuing screening and preventive counseling as these AYA\u0026rsquo;s living with HIV, ages.\u003c/p\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eLimitations:\u003c/h2\u003e \u003cp\u003eOur findings must be interpreted in the context of the cross-sectional design of the study that prevents causal inferences. Generalizability may be limited because the sample, despite representing a high proportion of the clinic's AYA population, was from a single tertiary centre. Data on sensitive topics like sexual behaviour and substance use are subject to social desirability bias, potentially leading to under-reporting. Furthermore, adherence was self-reported and likely overestimated, though the corroborating virological data provide objective validation of overall good adherence in this group of AYA living with HIV.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThese groups of AYAs living with HIV in Owerri, Southeastern Nigeria, highlight the profound and persistent psychosocial challenges they face. The combination of excellent virological suppression with poor status disclosure, inadequate knowledge of HIV transmission, and the influence of socioeconomic factors paints a picture of a population at a crossroads. To ensure these adolescents not only survive but thrive, a multi-sectoral approach is essential. We recommend the commencement/integration of structured ongoing disclosure counseling, comprehensive sexual and reproductive health education, and robust psychosocial support services into routine adolescent HIV care. Future research should focus on developing and evaluating interventions that address these critical gaps to support the long-term health and autonomy of this vulnerable yet resilient generation.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors did not receive any funding for the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHuman Ethics and Consent to Participate declarations:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was sought for and obtained from the Health Research Ethics Committee of a Nigerian Federal Tertiary Health Institution in Owerri, Nigeria (FTHO), and protocol approval was obtained with the number: FTH/OW/HREC/Vol.2/85. Study details were explained to the caregivers/adolescents. Written informed consent was then obtained from the participants. Only the adolescents who assented and whose caregivers consented were enrolled. Data anonymization ensured confidentiality was maintained.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eJE and AK conceptualized the study, CTC cleaned and entered the data, and JE, AK, CTC, and EN were involved in manuscript writing. All authors reviewed the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe acknowledge Dr Eke CE for data analysis and all the adolescents attending the HIV clinic during the study\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eData generated/ analysed is available upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eShimbre MS, Bodicha BB, Gabriel ANA, Ghazal L, Jiao K, Ma W (2024) Barriers and facilitators of transition of adolescents living with HIV into adult care in under-resourced settings of Southern Ethiopia: A qualitative study. 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Lancet Infect Dis 14(7):627\u0026ndash;639\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1 to 3 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"egyptian-pediatric-association-gazette","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"epag","sideBox":"Learn more about [Egyptian Pediatric Association Gazette](https://epag.springeropen.com)","snPcode":"43054","submissionUrl":"https://submission.springernature.com/new-submission/43054/3?","title":"Egyptian Pediatric Association Gazette","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Adolescent, Young Adult, HIV, Viral Suppression, Antiretroviral Therapy, Disclosure, Nigeria","lastPublishedDoi":"10.21203/rs.3.rs-8370188/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8370188/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eA generation of children with perinatally-acquired HIV or behaviorally acquired HIV (ABH) is now aging into adolescence and young adulthood (AYA). This increasing fraction of people living with HIV globally experience worse HIV care outcomes; therefore, understanding the unique sociodemographic and clinical characteristics of this population is vital for tailoring long-term care.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA cross-sectional analysis of 92 AYAs living with HIV was conducted between May and August 2025. Data on sociodemographics, risk behaviours, HIV-related knowledge, and treatment history were collected using a structured questionnaire, and clinical data, including viral load (VL), were extracted from medical records. Statistical analyses included descriptive statistics depicted in percentages and frequency, while non-parametric tests were utilized to assess associations.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eMost of the adolescents and young adults were female 51 (55.4%), aged between 10\u0026ndash;22 years, and a mean age of 15.7\u0026thinsp;\u0026plusmn;\u0026thinsp;2.7, 82 (89.1%) were students and not sexually active. Substance use was low, with alcohol use documented by 12 (13%) participants, 3 (3.3%) had a history of tobacco use, and only 1(1.1%) used illicit drugs. A majority, 69 (75.0%), were aware of their HIV diagnosis, only 63(68.5%) knew their own positive status, and knowledge of HIV transmission routes was suboptimal. Antiretroviral therapy (ART) adherence was reported as regular by 85 (92.4%), with 83(90.2%) currently on Tenofovir/Lamivudine/Dolutegravir (TLD). Virological suppression was high, median latest viral load (VL): 20 copies/mL, IQR: 19\u0026ndash;20. However, only 12(13.0%) had ever disclosed their status to anyone.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThis cohort demonstrates successful virological control attributable to high adherence to modern ART regimens. However, critical gaps remain in status awareness, comprehensive knowledge of HIV transmission, and disclosure. These findings highlight the need for targeted multi-sectoral AYA-friendly interventions that address psychosocial needs and disclosure counseling, comprehensive sexual health education.\u003c/p\u003e","manuscriptTitle":"Characteristics of Adolescents and Young Adults Living with HIV in a Care and Treatment Centre in a Tertiary Care Facility in Owerri, Nigeria: A Cross-Sectional Survey.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-25 10:18:32","doi":"10.21203/rs.3.rs-8370188/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-01-07T05:46:06+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-06T20:45:25+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-05T15:17:19+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-05T10:07:02+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-28T19:07:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"32143861506430604848937079590830087033","date":"2025-12-28T13:58:43+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-27T10:11:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"58333361480857971602797831393899118640","date":"2025-12-26T09:21:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"198480506273641791076044065235189388143","date":"2025-12-23T14:40:14+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"248295690701212001055001574436875280688","date":"2025-12-23T12:26:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"175905083632697667647263169906366007099","date":"2025-12-23T11:12:55+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-23T10:50:21+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-23T06:46:10+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-23T06:44:50+00:00","index":"","fulltext":""},{"type":"submitted","content":"Egyptian Pediatric Association Gazette","date":"2025-12-15T22:18:06+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"egyptian-pediatric-association-gazette","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"epag","sideBox":"Learn more about [Egyptian Pediatric Association Gazette](https://epag.springeropen.com)","snPcode":"43054","submissionUrl":"https://submission.springernature.com/new-submission/43054/3?","title":"Egyptian Pediatric Association Gazette","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"201ea323-545b-4ca5-b588-22fda46b4fa8","owner":[],"postedDate":"December 25th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-04-07T16:05:56+00:00","versionOfRecord":{"articleIdentity":"rs-8370188","link":"https://doi.org/10.1186/s43054-026-00535-2","journal":{"identity":"egyptian-pediatric-association-gazette","isVorOnly":false,"title":"Egyptian Pediatric Association Gazette"},"publishedOn":"2026-03-30 15:59:01","publishedOnDateReadable":"March 30th, 2026"},"versionCreatedAt":"2025-12-25 10:18:32","video":"","vorDoi":"10.1186/s43054-026-00535-2","vorDoiUrl":"https://doi.org/10.1186/s43054-026-00535-2","workflowStages":[]},"version":"v1","identity":"rs-8370188","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8370188","identity":"rs-8370188","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}