Impact of the DREAMS interventions on educational attainment among adolescent girls and young women: Causal analysis of a prospective cohort in urban Kenya

Abstract

Background DREAMS promotes a comprehensive HIV prevention approach to reduce HIV incidence among adolescent girls and young women (AGYW). One pathway that DREAMS seeks to impact is to support AGYW to stay in school and achieve secondary education. We assessed the impact of DREAMS on educational outcomes among AGYW in Nairobi, Kenya. Methods and findings In two informal settlements in Nairobi, 1081 AGYW aged 15−22 years were randomly selected in 2017 and followed-up to 2019. AGYW reporting invitation to participate in DREAMS during 2017–18 were classified as “DREAMS beneficiaries”. Our main outcome was being in school and/or completed lower secondary school in 2019. We used multivariable logistic regression to quantify the association between being a DREAMS beneficiary and the outcome; and a causal inference framework to estimate proportions achieving the outcome if all, versus no, AGYW were DREAMS beneficiaries, adjusting for the propensity to be a DREAMS beneficiary. Of AGYW enrolled in 2017, 79% (852/1081) were followed-up to 2019. In unadjusted analysis, DREAMS beneficiaries had higher attainment than non-beneficiaries (85% vs 75% in school or completed lower secondary school, Odds Ratio (OR) = 1.9; 95%CI: 1.3,2.8). The effect weakened with adjustment for age and other confounders, (adjusted OR = 1.4; 95%CI: 0.9,2.4). From the causal analysis, evidence was weak for an impact of DREAMS (estimated 83% vs 79% in school or completed lower secondary school, if all vs no AGYW were beneficiaries, difference = 4%; 95%CI: -2,11%). Among AGYW out of school at baseline, the estimated differences were 21% (95%CI: -3,43%) among 15−17 year olds; and 4% (95%CI: -8,17%) among 18−22 year olds. Conclusions DREAMS had a modest impact on educational attainment among AGYW in informal settlements in Kenya, by supporting both retention and re-enrolment in school. Larger impact might be achieved if more AGYW were reached with educational subsidies, alongside other DREAMS interventions.

Social support and very young adolescent girl’s knowledge on sexual relationships: A comparative qualitative study of Girl Only Clubs’ participants and non-participants in rural Malawi

“…The asset-building framework posits that adolescent girls need a combination of social, health, cognitive, and economic assets to make a safe and healthy transition from childhood to adulthood [50,64,65]. Social asset building intervention have been found to increase agency in VYAs thereby reducing their vulnerability to HIV [50,64,65]. Our findings have SRH programming implications for VYAs who are not yet sexually active.…”

“…Moreover, social asset-building could include empowering parents and other adults on how to talk about SH issues with VYAs. The asset-building framework posits that adolescent girls need a combination of social, health, cognitive, and economic assets to make a safe and healthy transition from childhood to adulthood [50,64,65]. Social asset building intervention have been found to increase agency in VYAs thereby reducing their vulnerability to HIV [50,64,65].…”

Childhood and adolescent factors shaping vulnerability to underage entry into sex work: a quantitative hierarchical analysis of female sex workers in Nairobi, Kenya

“…Consistent with the findings of our study, other research has shown that years of education are significantly correlated with the timing of entry into sex work, with underage sex work initiators reporting fewer completed years. 7 14 16 AGYWs from impoverished backgrounds in SSA are less likely to complete school due to a lack of resources and sociocultural gender norms, 24 25 49 but interventions such as Determined, Resilient, Empowered, AIDS-free, Mentored and Safe programme (DREAMS) 50 in Nairobi, Kenya, and Samata 51 in Karnataka, India have shown some evidence in improving secondary school completion among adolescent girls.…”

Qualitative evaluation of an edutainment intervention to prevent age-disparate transactional sex in Tanzania: Changes in educational aspirations and gender equitable attitudes towards work

“…Some of the most promising are the multi-component DREAMS intervention and Stepping Stones . DREAMS was found to be effective at moderately increasing adolescent girl and young women’s educational aspirations, as well as school retention and reenrolment in Nairobi, Kenya [ 39 ], but did not find any impacts on gender equitable norms [ 40 ]. The Stepping Stones study in Karnataka, India found that intervention participants had more gender equitable attitudes around girl’s education compared to non-intervention participants [ 41 ], but did not measure school retention or reenrolment as behavioural outcomes.…”