Awareness and uptake of layered HIV prevention programming for young women: analysis of population-based surveys in three DREAMS settings in Kenya and South Africa

Abstract

BackgroundThe DREAMS Partnership is an ambitious effort to deliver combinations of biomedical, behavioural and structural interventions to reduce HIV incidence among adolescent girls and young women (AGYW). To inform multi-sectoral programming at scale, across diverse settings in Kenya and South Africa, we identified who the programme is reaching, with which interventions and in what combinations.MethodsRandomly-selected cohorts of 606 AGYW aged 10–14 years and 1081 aged 15–22 years in Nairobi and 2184 AGYW aged 13–22 years in uMkhanyakude, KwaZulu-Natal, were enrolled in 2017, after ~ 1 year of DREAMS implementation. In Gem, western Kenya, population-wide cross-sectional survey data were collected during roll-out in 2016 (n = 1365 AGYW 15–22 years). We summarised awareness and invitation to participate in DREAMS, uptake of interventions categorised by the DREAMS core package, and uptake of a subset of ‘primary’ interventions. We stratified by age-group and setting, and compared across AGYW characteristics.ResultsAwareness of DREAMS was higher among younger women (Nairobi: 89%v78%, aged 15-17v18–22 years; uMkhanyakude: 56%v31%, aged 13-17v18–22; and Gem: 28%v25%, aged 15-17v18–22, respectively).HIV testing was the most accessed intervention in Nairobi and Gem (77% and 85%, respectively), and school-based HIV prevention in uMkhanyakude (60%). Among those invited, participation in social asset building was > 50%; > 60% accessed ≥2 core package categories, but few accessed all primary interventions intended for their age-group. Parenting programmes and community mobilisation, including those intended for male partners, were accessed infrequently.In Nairobi and uMkhanyakude, AGYW were more likely to be invited to participate and accessed more categories if they were: aged < 18 years, in school and experienced socio-economic vulnerabilities. Those who had had sex, or a pregnancy, were less likely to be invited to participate but accessed more categories.ConclusionsIn representative population-based samples, awareness and uptake of DREAMS were high after 1 year of implementation. Evidence of ‘layering’ (receiving multiple interventions from the DREAMS core package), particularly among more socio-economically vulnerable AGYW, indicate that intervention packages can be implemented at scale, for intended recipients, in real-world contexts. Challenges remain for higher coverage and greater ‘layering’, including among older, out-of-school AGYW, and community-based programmes for families and men.

Directed and target focused multi‐sectoral adolescent HIV prevention: Insights from implementation of the ‘DREAMS Partnership’ in rural South Africa

“…In response, the US Presidents' Emergency Plan for AIDS Relief (PEPFAR) with others, supported the 'DREAMS Partnership', a multi-sectoral package of interventions targeting multiple sources of HIV risk and vulnerability for AGYW [9,10]. The aim of DREAMS was to reduce HIV incidence through strengthening existing interventions and the introduction of new packages for genderbased violence, family and caregiving, social asset building, economic empowerment/cash transfers and pre-exposure prophylaxis (PrEP) ( Figure 1) [9,11,12]. DREAMS in South Africa was implemented with high-level oversight by government and funders, through local implementing partners who were resourced to deliver defined and target-focused packages of interventions to AGYW in selected geographic areas over two years.…”

“…social protection), which in turn were organized by levels (e.g. "strengthen families") ( Figure 1) [12] that were expected to be layered in order to accelerate benefits in AGYW. Layering also included contextual interventions that were not delivered directly to the individual, but benefitted the AGYW [11][12]21].…”

“…"strengthen families") ( Figure 1) [12] that were expected to be layered in order to accelerate benefits in AGYW. Layering also included contextual interventions that were not delivered directly to the individual, but benefitted the AGYW [11][12]21]. In the absence of an existing co-ordinating mechanism, several donor-led steering committee meetings were organized to bring all the players on-board, mapping out geographical working boundaries and ensuring the "layering" approach was understood [21].…”

Thetha Nami: Participatory development of a peer-navigator intervention to deliver biosocial HIV prevention for adolescents and young men and women in rural South Africa

“…The evaluation data arose from: (i) surveys with a representative sample of 13-35-year-old-males and females (n = 4918); (ii) rapid ethnographic community mapping (n = 4); (iii) provider and user interviews (n = 22 and n = 58 respectively); and (iv) group discussions (n = 29). Detailed methods and ndings of the contextual factors that drive risk and create barriers to effective HIV testing, care and prevention have been previously reported [1,6,9,15,[25][26][27][28]. For the purposes of the intervention development the ndings were summarised and converted into vignettes, case-studies and simple infographics by a team of social scientists, statisticians and clinicians who had been engaged in the data collection and peernavigator training.…”

“…Societal, familial, intimate-partnerships, individual behavioural, and biological [5]. This ultimately leads them to carry the dual burden of high HIV incidence and high mortality and morbidity due to delayed access to HIV testing and care [6]. Concern about young people's vulnerability to HIV-infection has led to the launch of initiatives, such as the DREAMS (determined, resilient, empowered, mentored and safe) partnership that combine social and behavioural interventions to reduce adolescent and youth vulnerability [7].…”