Evaluating the impact of the DREAMS partnership to reduce HIV incidence among adolescent girls and young women in four settings: a study protocol

Abstract

BackgroundHIV risk remains unacceptably high among adolescent girls and young women (AGYW) in southern and eastern Africa, reflecting structural and social inequities that drive new infections. In 2015, PEPFAR (the United States President’s Emergency Plan for AIDS Relief) with private-sector partners launched the DREAMS Partnership, an ambitious package of interventions in 10 sub-Saharan African countries. DREAMS aims to reduce HIV incidence by 40% among AGYW over two years by addressing multiple causes of AGYW vulnerability. This protocol outlines an impact evaluation of DREAMS in four settings.MethodsTo achieve an impact evaluation that is credible and timely, we describe a mix of methods that build on longitudinal data available in existing surveillance sites prior to DREAMS roll-out. In three long-running surveillance sites (in rural and urban Kenya and rural South Africa), the evaluation will measure: (1) population-level changes over time in HIV incidence and socio-economic, behavioural and health outcomes among AGYW and young men (before, during, after DREAMS); and (2) causal pathways linking uptake of DREAMS interventions to ‘mediators’ of change such as empowerment, through to behavioural and health outcomes, using nested cohort studies with samples of ~ 1000–1500 AGYW selected randomly from the general population and followed for two years. In Zimbabwe, where DREAMS includes an offer of pre-exposure HIV prophylaxis (PrEP), cohorts of young women who sell sex will be followed for two years to measure the impact of ‘DREAMS+PrEP’ on HIV incidence among young women at highest risk of HIV. In all four settings, process evaluation and qualitative studies will monitor the delivery and context of DREAMS implementation. The primary evaluation outcome is HIV incidence, and secondary outcomes include indicators of sexual behavior change, and social and biological protection.DiscussionDREAMS is, to date, the most ambitious effort to scale-up combinations or ‘packages’ of multi-sectoral interventions for HIV prevention. Evidence of its effectiveness in reducing HIV incidence among AGYW, and demonstrating which aspects of the lives of AGYW were changed, will offer valuable lessons for replication.Electronic supplementary materialThe online version of this article (10.1186/s12889-018-5789-7) contains supplementary material, which is available to authorized users.

The Political, Research, Programmatic, and Social Responses to Adolescent Sexual and Reproductive Health and Rights in the 25 Years Since the International Conference on Population and Development

“…The DREAMS initiative supports the application of a core package of evidence-based interventions addressing adolescent girls and young women, their sexual partners, their families, and their wider communities to address HIV risk behaviors, socioeconomic vulnerabilities, and gender-based violence (GBV). Impact evaluation activities are ongoing, but important implementation lessons are emerging [76,77].…”

Consistent Provisions Mitigate Exposure to Sexual Risk and HIV Among Young Adolescents in South Africa

“…These longitudinal data provide additional evidence that can shape current and future programming for HIV prevention for adolescents in South Africa and similar HIV risk contexts. It capitalizes on two large-scale prospective surveys of early adolescents to draw lessons on factors that shape the onset of exposure to sexual risk and HIV, in the transition from early to middle adolescence, which are critical for programming for this early age group [50]. Most adolescent-focused research and programming targets older adolescents, particularly 15-to 24-year-old girls and young women, but these new findings suggest an additional impact of providing such programs to younger girls and boys.…”

Antiretroviral Therapy Based Hiv Prevention Targeting Young Female-Sex Workers: A Mixed Method Approach to Understand the Implementation of Prep in a Rural Area of Kwazulu-Natal, South Africa

“…We used data from the mixed-method process evaluation for the implementation of DREAMS in this area (21). The evaluation collected qualitative data from a range of stakeholders (service users, service providers and community members) during participatory community-mapping and quantitative data from a population-representative cohort of AGYW in 2017 and 2018.…”

“…The quantitative aspect of the evaluation consisted of a random sample of 2184 AGYW aged [13][14][15][16][17][18][19][20][21][22] years, strati ed by age and residential location, to measure the level of access to PrEP, PrEP awareness and uptake at population level in those who are eligible and followed them up in 2018 (21). We assessed PrEP awareness based on a question asking if the respondent had ever heard of PrEP and uptake based on two questions asking if they have ever been offered or were currently taking PrEP.…”