Temporal shifts in HIV-related risk factors among cohorts of adolescent girls and young women enrolled in DREAMS programming: evidence from Kenya, Malawi and Zambia

Mathur, Sanyukta; Heck, Craig J; Patel, Sangram Kishor; Okal, Jerry; Chipeta, Effie; Mwapasa, Victor; Chimwaza, Wanangwa; Mahapatra, Bidhubhusan; Pulerwitz, Julie; Pilgrim, Nanlesta

doi:10.1136/bmjopen-2020-047843

Cited by 9 publications

(8 citation statements)

References 56 publications

(103 reference statements)

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“…56 In our urban sample, high proportions of AGYW were in school; it is possible the small infusion of educational support offered by DREAMS propelled school continuation among AGYW. 15 Finally, any AG pathway that featured Educ social protection, respondent characteristics displayed most lost one or both parents; thus, educational interventions may be particularly relevant for orphans. Further investigation of these investigational, sociodemographic, and societal factors will improve the targeting and delivery of AGYW's HIV prevention interventions.…”

Section: Discussionmentioning

confidence: 99%

“…This analysis includes data from enrolled AGYW that we were able to reinterview after 12–14 months of DREAMS exposure (83.2% of the original sample). 15 Although the program and research team made repeated attempts to recontact interviewees, the most common reason for attrition was extended or permanent out-migration from the study communities.…”

Section: Methodsmentioning

confidence: 99%

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

Mathur,

Mahapatra,

Mishra

et al. 2023

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Introduction: Intersecting behavioral, social, and structural factors increase adolescent girls' (AG) and young women's (YW) HIV vulnerability. Yet, understanding of optimal intervention synergies remains limited. We identified intervention combinations that statistically maximized reductions in AGYW's HIV-related risk. Methods: Using data collected in 2018 with Zambian AG (n = 487, aged 15–19 years) and YW (n = 505, aged 20–25 years) after 12–14 months exposure to Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe (multisectoral HIV program), we used classification and regression trees to explore relationships between interventions (safe space/social asset building [SAB] and provision of/linkage to youth-friendly health services [YFHS], education social protection [Educ], economic social protection [Econ]) and HIV-related outcomes (HIV testing, consistent condom use, transactional sex, and sexual violence experience from partners and nonpartners). Results: Overall, 59.9% completed SAB and 81.5%, 35.4%, and 29.6% received YHFS, Educ, and Econ, respectively. For AG, HIV testing improved (from 73% to 83%) with exposure to all interventions, condom use improved with Econ (from 33% to 46%), transactional sex reduced with SAB + Educ, and sexual violence from partners and nonpartners reduced with Educ and SAB, respectively. For YW, HIV testing increased with Educ (from 77% to 91%), condom use increased with SAB + YFHS (from 36% to 52%), transactional sex reduced with combinations of all interventions, and sexual violence from partners reduced with YFHS and from nonpartners with SAB + Econ. Conclusions: Tailored interventions might be more effective than uniform combination intervention packages in reducing AGYW's HIV risk. AG benefitted most from SAB and/or Educ while YFHS, Educ, and/or SAB reduced YW's HIV-related risk. Educational and asset-building interventions could have the greatest impact on AGYW's HIV risk.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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

Mathur,

Mahapatra,

Mishra

et al. 2023

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…From October 2016 to February 2017, 914 AGYW were interviewed in the first round of data collection. Between April and June 2018, after 14–16 months of DREAMS program engagement, 736 AGYW were re-interviewed (analytical sample for this analysis) [26]. Despite repeated attempts to recontact participants, loss to follow-up occurred because of out-migrations of respondents from the study setting.…”

Section: Methodsmentioning

confidence: 99%

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

Mathur

Mishra

Mahapatra

et al. 2022

Aids

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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.

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“…21 Studies have also attributed increased HIV testing coverage and reductions in sexual violence victimization among AGYW to DREAMS implementation in Zambia. 22…”

Section: Dreams Rollout and Scale-up In Zambiamentioning

confidence: 99%

“…Findings from the parent study's quantitative component have been published elsewhere. 8,22,24,25 This study was conducted in 2 urban districts with ongoing DREAMS implementation: Lusaka (Lusaka Province) and Ndola (Copperbelt Province). AGYW in these districts are disproportionately affected by numerous health and development challenges, including high HIV incidence, adolescent pregnancy, and school attrition.…”

Section: Study Settingmentioning

confidence: 99%

Multisectoral, Combination HIV Prevention for Adolescent Girls and Young Women: A Qualitative Study of the DREAMS Implementation Trajectory in Zambia

Rosen

Mulenga²,

Namukonda³

et al. 2022

Glob Health Sci Pract

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The DREAMS Partnership is a combination HIV prevention approach in sub-Saharan Africa to reduce risk in adolescent girls and young women (AGYW), but its multisectoral approach poses challenges for implementing partners. n Comprehensive coordination systems between implementing partner organizations are needed in multisectoral programming to build the necessary infrastructure for effective implementation. n Securing financial commitments, for both primary interventions directed toward AGYW and secondary interventions directed toward their male partners and parents, is important for engaging these stakeholders and addressing structural drivers of HIV risk among AGYW. n Real-time adaptation of implementation strategies helped address challenges with recruiting AGYW with the highest risk and retaining AGYW in the program.

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Temporal shifts in HIV-related risk factors among cohorts of adolescent girls and young women enrolled in DREAMS programming: evidence from Kenya, Malawi and Zambia

Cited by 9 publications

References 56 publications

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

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

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

Multisectoral, Combination HIV Prevention for Adolescent Girls and Young Women: A Qualitative Study of the DREAMS Implementation Trajectory in Zambia

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