Assessing layered HIV prevention programming: optimizing outcomes for adolescent girls and young women

Abstract

Objective: To assess how exposure to multiple, layered interventions predicts HIV-related outcomes among adolescent girls (15–19 years) and young women (20–24 years) in Kenya. Design: Survey data from adolescent girls and young women (n = 736) with 14–16 months of engagement with DREAMS, a comprehensive HIV prevention program that provides a range of health education, life skills, social protection, and social and behaviour change interventions. Methods: Nonparametric recursive partitioning technique – classification and regression tree (CART) – to identify the best predictors (DREAMS interventions) for achieving the desired HIV-related outcomes (consistent condom use and no transactional sex or sexual violence). Results: Among adolescent girls, schooling support reduced the likelihood of engaging in transactional sex, whereas schooling support and exposure to parenting program reduced the likelihood experiencing sexual violence. Likelihood of consistent condom use increased among adolescent girls with exposure to preexposure prophylaxis (PrEP), schooling support, and the violence prevention programming. Among young women, multiple pathways reduced the likelihood of engaging in transactional sex: exposure to the male sexual partner program; exposure to the youth fund program; exposure to the violence prevention program; or exposure/engagement with schooling support, parenting programming, and the youth fund program. For young women, consistent condom use increased with schooling support and male partner engagement. Additionally, engagement in violence prevention program and male partner engagement increased the likelihood of not experiencing sexual violence among young women. Conclusion: Exposure to a combination of DREAMS interventions predicted outcomes that can reduce HIV risk among AGYW, though the pathways differed by outcome and age group.

The evolution of DREAMS: using data for continuous program improvement

“…2). As DREAMS programs have matured and adapted, the delivery of layered interventions has also improved [30,31].…”

Which Intervention Synergies Maximize AGYW's HIV Outcomes? A Classification and Regression Tree Analysis of Layered HIV Prevention Programming

“…[22][23][24] We are also one of the first to apply this approach to an AGYW HIV prevention program in sub-Saharan Africa. 20 Our approach highlights combinations of interventions that may increase or decrease the likelihood of AGYW's HIV-related outcomes. These examinations are sorely needed, as to meet global targets for HIV prevention and care, there is growing interest in reaching beyond the health sector to address the health and social determinants of health and HIV risk, particularly among AGYW.…”

“…Ultimately, the goal of CART analysis is to subdivide data into mutually exclusive, collectively exhaustive groupings to increase the management and interpretability of underlying synergies. 17 This approach has been used in other articles, [18][19][20] which describe the relative advantage of CART over multivariable regression. The main distinction between more conventional methods (eg, multivariable regression) and CARTs is the treatment of interactions in the models.…”

Adolescent Sexual Behavior in Rural Central India: Challenges and Interventions

“…In addition, sexuality-related societal and cultural norms may discourage youth from seeking support or coming out with their worries. An increased risk of unintended pregnancies, sexually transmitted diseases (STDs), and unsafe abortion can result from this [ 6 ].…”