Linking STI to maternal and neonatal outcomes among adolescent girls and young women: insights from the Pregnancy Exposure Registry in rural KwaZulu-Natal, South Africa
1
Africa Health Research Institute, Africa Health Research Institute, Durban, South Africa
2
Institute for Global Health, University College London, London, United Kingdom
3
Department of Medicine, University of Pretoria, Pretoria, South Africa
4
South African Medical Research Council, Cape Town, South Africa
5
Department of Medicine, University of Cape Town, Cape Town, United Kingdom
6
Division of Clinical Pharmacology, University of Cape Town, Cape Town, South Africa
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
INTRODUCTION:
HIV and STI prevalence is 27% and 29% in 15-30 years adolescent girls and young women (AGYW) in KwaZulu-Natal (KZN) Province. Among pregnant AGYW, the HIV and STI prevalence are 27% and 46% respectively. STIs syndromic management does not treat the majority of STIs which are asymptomatic. The WHO recommends aetiological STI management among pregnant women; however, there are limited data on adverse pregnancy outcomes to guide health policy makers. We aimed to establish a pregnancy registry for AGYW engaged in HIV prevention to generate longitudinal pregnancy outcome data in a rural, high-HIV-burden, and underserved setting in KwaZulu-Natal, South Africa.
METHODS:
Preparatory phase (completed): We conducted extensive stakeholder engagement with healthcare professionals, registry experts, and the NDoH to co-design the registry, CRF, establish the registry database, validate the CRF, and train data collectors (2025). Implementation phase (planned): This registry is nested within the Africa Health Research Institute Health and Demographic Surveillance System in uMkhanyakude District. We will conduct a retrospective medical records review of maternity case records of a cohort of pregnant AGYW at high risk of HIV acquisition who attended mobile SRH services for HIV PrEP and STI testing between 2022–2025. The expected sample size is ~300 pregnancies. The exposures will be defined as a GeneXpert positive test for chlamydia, gonorrhoea, trichomonas, hepatitis B, or Rapid Plasma Reagin and VDRL with confirmatory treponemal tests for syphilis. The composite outcome will include maternal miscarriage, preterm birth, stillbirths, and low birthweight. Predefined key explanatory covariates will include HIV status, time to syndromic or aetiological treatment, STI reinfections, and partner notification.
RESULTS:
We will generate the first longitudinal STI-associated pregnancy outcome data to inform WHO-recommendations and augment triple elimination targets.
CONCLUSIONS:
Our study will provide actionable evidence to guide antenatal guidelines for STI diagnosis and treatment in HIV high-burden rural settings.
HIV and STI prevalence is 27% and 29% in 15-30 years adolescent girls and young women (AGYW) in KwaZulu-Natal (KZN) Province. Among pregnant AGYW, the HIV and STI prevalence are 27% and 46% respectively. STIs syndromic management does not treat the majority of STIs which are asymptomatic. The WHO recommends aetiological STI management among pregnant women; however, there are limited data on adverse pregnancy outcomes to guide health policy makers. We aimed to establish a pregnancy registry for AGYW engaged in HIV prevention to generate longitudinal pregnancy outcome data in a rural, high-HIV-burden, and underserved setting in KwaZulu-Natal, South Africa.
METHODS:
Preparatory phase (completed): We conducted extensive stakeholder engagement with healthcare professionals, registry experts, and the NDoH to co-design the registry, CRF, establish the registry database, validate the CRF, and train data collectors (2025). Implementation phase (planned): This registry is nested within the Africa Health Research Institute Health and Demographic Surveillance System in uMkhanyakude District. We will conduct a retrospective medical records review of maternity case records of a cohort of pregnant AGYW at high risk of HIV acquisition who attended mobile SRH services for HIV PrEP and STI testing between 2022–2025. The expected sample size is ~300 pregnancies. The exposures will be defined as a GeneXpert positive test for chlamydia, gonorrhoea, trichomonas, hepatitis B, or Rapid Plasma Reagin and VDRL with confirmatory treponemal tests for syphilis. The composite outcome will include maternal miscarriage, preterm birth, stillbirths, and low birthweight. Predefined key explanatory covariates will include HIV status, time to syndromic or aetiological treatment, STI reinfections, and partner notification.
RESULTS:
We will generate the first longitudinal STI-associated pregnancy outcome data to inform WHO-recommendations and augment triple elimination targets.
CONCLUSIONS:
Our study will provide actionable evidence to guide antenatal guidelines for STI diagnosis and treatment in HIV high-burden rural settings.
| eISSN: | 2654-1459 |
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