title: Comparing patterns of sexual risk among adolescent and young women in a mixed-method study in Tanzania: implications for adolescent participation in HIV prevention trials.
abstract: BACKGROUND
  Despite the disproportionate impact of HIV on women, and adolescents in particular, those below age 18 years are underrepresented in HIV prevention trials due to ethical, safety and logistical concerns. This study examined and compared the sexual risk contexts of adolescent women aged 15-17 to young adult women aged 18-21 to determine whether adolescents exhibited similar risk profiles and the implications for their inclusion in future trials.
  
  
  METHODS
  We conducted a two-phase, mixed-method study to assess the opportunities and challenges of recruiting and retaining adolescents (aged 15-17) versus young women (18-21) in Tanzania. Phase I, community formative research (CFR), used serial in-depth interviews with 11 adolescent and 12 young adult women from a range of sexual risk contexts in preparation for a mock clinical trial (MCT). For Phase II, 135 HIV-negative, non-pregnant adolescents and young women were enrolled into a six-month MCT to assess and compare differences in sexual and reproductive health (SRH) outcomes, including risky sexual behaviour, incident pregnancy, sexually transmitted infections (STIs), reproductive tract infections (RTIs) and HIV.
  
  
  RESULTS
  In both research phases, adolescents appeared to be at similar, if not higher, risk than their young adult counterparts. Adolescents reported earlier sexual debut, and similar numbers of lifetime partners, pregnancy and STI/RTI rates, yet had lower perceived risk. Married women in the CFR appeared at particular risk but were less represented in the MCT. In addition, adolescents were less likely than their older counterparts to have accessed HIV testing, obtained gynaecological exams or used protective technologies.
  
  
  CONCLUSIONS
  Adolescent women under 18 are at risk of multiple negative SRH outcomes and they underuse preventive services. Their access to new technologies such as vaginal microbicides or pre-exposure prophylaxis (PrEP) may similarly be compromised unless greater effort is made to include them in clinical trial research.
authors.affiliation: Social and Behavioral Health Sciences, FHI 360, Durham, NC, USA; btolley@fhi360.org.
authors.forename: Elizabeth E
authors.initials: EE
authors.lastname: Tolley
authors.affiliation: Muhimbili University of Health and Allied Services, Dar es Salaam, Tanzania.
authors.forename: Sylvia
authors.initials: S
authors.lastname: Kaaya
authors.affiliation: Muhimbili University of Health and Allied Services, Dar es Salaam, Tanzania.
authors.forename: Anna
authors.initials: A
authors.lastname: Kaale
authors.affiliation: Muhimbili University of Health and Allied Services, Dar es Salaam, Tanzania.
authors.forename: Anna
authors.initials: A
authors.lastname: Minja
authors.affiliation: Muhimbili University of Health and Allied Services, Dar es Salaam, Tanzania.
authors.forename: Doreen
authors.initials: D
authors.lastname: Bangapi
authors.affiliation: Muhimbili University of Health and Allied Services, Dar es Salaam, Tanzania.
authors.forename: Happy
authors.initials: H
authors.lastname: Kalungura
authors.affiliation: Social and Behavioral Health Sciences, FHI 360, Durham, NC, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Headley
authors.affiliation: Social and Behavioral Health Sciences, FHI 360, Durham, NC, USA.
authors.forename: Joy Noel
authors.initials: JN
authors.lastname: Baumgartner
mesh_terms: D000293:Adolescent; D018562:Disease Transmission, Infectious; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D018570:Risk Assessment; D012309:Risk-Taking; D012725:Sexual Behavior; D012749:Sexually Transmitted Diseases / Q000453:epidemiology*; D013636:Tanzania; D055815:Young Adult
keywords: HIV prevention; Tanzania; adolescents; clinical trials research; sexual and reproductive health