Exploring the mental health and wellbeing of adolescent parent families affected by HIV in South Africa

Africa's adolescent population (10-19 years; WHO,2017) are the fastest growing the in world - projected to reach 435 million by 2050 (United Nations,2019). Consequently, the health of adolescents, of which mental health is a fundamental component, is becoming increasingly important to promote individual potential, and ensure the prosperity of the region, and future generations. Poor mental health within adolescence has broad negative implications for individuals and wider society (United Nations Population Fund,2014). Yet, the mental health of children and adolescents remains an overlooked global health priority. Both experiencing adolescent pregnancy and living with HIV have been found to be associated with poor mental health (Vreeman,2017; Dahmen,2019). However, there is a dearth of literature (beyond the candidate's thesis) exploring mental health when both phenomena co-occur. Adolescents and their children living with and affected by HIV are a core population in both the future prosperity of the sub-Saharan Africa region and the HIV response. However, adolescent parent families living with and affected by HIV remain understudied, and thus underserved with regard to intervention and prevention.

The HEY BABY study is a cohort study of over 1000 adolescent mothers (both living with and not living with HIV) and their children residing in the Eastern Cape province, South Africa. Four components of data are collected within the study: (i) a health and wellbeing questionnaire (including validated mental health measures), (ii) a parenting questionnaire (giving detail on parenting experience), (iii) a direct assessment of child cognitive development, and (iv) child health records. Cross-sectional analyses of these data (undertaken by the candidate) have highlighted elevated poor mental health among adolescent mothers living with HIV compared to mothers not living with HIV, lower child development scores among children born to adolescent mothers compared to adult mothers within the sub-Saharan African region, and lower developmental scores among children living with HIV and HIV exposed uninfected children compared to children unexposed to HIV. These analyses have also identified an association between maternal posttraumatic stress and lower child cognitive development scores, and low paternal engagement within the care of their children (<20%). Violence exposure and lack of social support were found to be correlates of poor mental health among adolescent mothers in the sample, however longitudinal analyses is required to further understand such findings.

The proposed fellowships aims to allow the candidate to:
1. Consolidate the works within the candidate's PhD and extending these works to include longitudinal follow-up data. These works will focus on identifying amenable factors that could be integrating into policy and programming to improve the mental health of adolescent parents (both mothers and fathers) affected by HIV, and the development of their children. These works will also on developing a greater understanding the experience of fathers of children born to adolescent mothers (an often-overlooked group)
2. Develop analyses and manuscripts for publication and dissemination
3. Attend conferences, and stakeholder meetings to allow for knowledge transition and networking
4. Develop the foundations for future possible collaborations focusing on the mental health of adolescent parent families from both sub-Saharan Africa and high-income countries with the aim of extend the application of findings from both the thesis and postdoctoral activities
5. Undertake further training to build skills relating to methodology, and to establish a career in academia
6. Develop funding applications to advance the works undertaken as part of this postdoctoral fellowship, and to further address the need for data to allow for the effective development of meaningful policy and programming to serve current and future generations