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

Shahmanesh, Maryam; Okesola, Nonhlanhla; Chimbindi, Natsayi; Zuma, Thembelihle; Mthiyane, Nondumiso; Adeagbo, Oluwafemi; Dreyer, Jaco; Herbst, Carina; Mdl, Sakhile; McGrath, Nuala; Harling, Guy; Sherr, Lorraine; Seeley, Janet

doi:10.21203/rs.3.rs-42209/v2

Cited by 6 publications

(9 citation statements)

References 47 publications

(73 reference statements)

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“…Lessons identified from early efforts to offer PrEP in nontrial conditions include that it is important to simplify, differentiate, decentralize, and destigmatize PrEP provision [26,27], and evidence has accumulated from a range ofsettings and populations on various ways to achieve this [23,[28][29][30][31][32][33][34]. In the context of DREAMS and AGYW's access to PrEP, it may be key to integrate PrEP provision into wider youth-friendly and accessible SRH services, and to address common misconceptions about PrEP, while peer-support interventions can help to identify and refer AGYW who are eligible for PrEP [35]. Moreover, the existing infrastructure ofDREAMS could contribute to expanding PrEP delivery, through its safe spaces, social mobilization, DREAMS mentors, and PrEP ambassadors [32].…”

Section: Interpretation and Implications Of Findingsmentioning

confidence: 99%

DREAMS impact on HIV status knowledge and sexual risk among cohorts of young women in Kenya and South Africa

Floyd

Mulwa

Magut

et al. 2022

Aids

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Objectives:We sought evidence of DREAMS’ impact on uptake of services and sexual risk among adolescent-girls-and-young-women (AGYW).Design:Cohorts of AGYW aged 13–22 years were randomly selected in 2017–2018 and followed-up to 2019; 1081 in Nairobi, Kenya;1171 in Gem, western Kenya;and 2184 in uMkhanyakude, South Africa.Methods:Outcomes were knowledge of HIV status, condomless sex (past 12 months), lifetime partners, transactional sex (past 12 months), and awareness and use of condoms and pre-exposure-prophylaxis (PrEP). Using a causal inference framework, we estimated the proportions with each outcome if all vs. none were DREAMS invitees by 2018.Results:Among AGYW followed up in 2019, the percentage invited to DREAMS by 2018 was 74, 57, and 53% in Nairobi, Gem, and uMkhanyakude, respectively. By 2018, the estimated percentages of AGYW who would know their HIV status, comparing the scenarios that all vs. none were DREAMS invitees, were 86 vs. 56% in Nairobi, 80 vs. 68% in Gem, and 56 vs. 49% in uMkhanyakude. By 2019, awareness of condoms and PrEP was high among DREAMS invitees, but recent participation in condom promotion activities was less than 50% and recent PrEP use was around 0–10%. In Gem, there was evidence of a reduction attributable to DREAMS in condomless sex, and among younger AGYW in the number of lifetime partners;in Nairobi evidence of a reduction in condomless sex among sexually active older AGYW;and in uMkhanya-kude no evidence that DREAMS changed these outcomes.Conclusion:Alongside sustaining high levels of knowledge of HIV status, more is needed to link AGYW into prevention methods such as PrEP and condoms.Comprehensive HIV prevention promotes safer sexual partnerships, but poverty, social norms, and inequalities limit AGYW's prevention choices.

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Section: Interpretation and Implications Of Findingsmentioning

confidence: 99%

DREAMS impact on HIV status knowledge and sexual risk among cohorts of young women in Kenya and South Africa

Floyd

Mulwa

Magut

et al. 2022

Aids

Self Cite

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“…Safe Spaces are not always referred to as such, however the concept of safe physical and social space has been conceptualized as a key delivery mechanism in HIV programmes in East and Southern Africa that focus on social protection interventions for young women vulnerable to HIV [7]. In sub-Saharan Africa, hundreds of Safe Spaces have been set up as a structure to deliver interventions and services to AGYW as part of the USAID and PEPFAR-funded DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored and Safe) program [8], as a part of AGYW programmes funded by the Global Fund [9], and by other programmes [10]. They have been set up to address sexual violence, gender equality, limited economic opportunities [5], and to provide PrEP services [11].…”

Section: Introductionmentioning

confidence: 99%

Safe spaces for beneficiaries of a combination HIV prevention intervention for adolescent girls and young women in South Africa: access, feasibility, and acceptability

et al. 2022

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Background Safe Spaces are a feature of combination HIV prevention interventions for adolescent girls and young women (AGYW) in South Africa. We investigated whether AGYW at risk for adverse sexual and reproductive health (SRH) outcomes accessed Safe Spaces that were part of an intervention, as well as their feasibility and acceptability. Methods In December 2020 to February 2021, as part of a process evaluation of a combination HIV prevention intervention, we randomly sampled 2160 AGYW intervention beneficiaries aged 15–24 years from 6 of the 12 intervention districts. We invited them to participate in a phone survey, with questions about their vulnerability to adverse SRH outcomes, and participation in intervention components including Safe Spaces. We examined factors associated with use of Safe Spaces using bivariate analyses and Pearson’s chi squared tests. We also conducted in-depth interviews with 50 AGYW beneficiaries, 27 intervention implementers, 4 health workers, 7 social workers, and 12 community stakeholders, to explore perceptions and experiences of the intervention. Thematic analysis of the qualitative data was performed. Results At least 30 Safe Spaces were established across 6 districts. Five hundred fifteen of two thousand one hundred sixty sampled AGYW participated in the survey of whom 22.6% visited a Safe Space, accessing HIV testing (52.2%), mobile health services (21.2%) and counselling for distress (24.8%) while there. Beneficiaries of lower socioeconomic status (SES) were less likely to have visited a Safe Space, compared with those of higher SES (13.6% versus 25.3%; p < 0.01). Implementers described political, structural and financial challenges in identifying and setting up Safe Spaces that were safe, accessible and adequately-resourced, and challenges with AGYW not utilising them as expected. AGYW shared positive views of Safe Spaces, describing benefits such as access to computers and the internet, support with homework and job and education applications, and a space in which to connect with peers. Conclusion AGYW are attracted to Safe Spaces by educational and employment promoting interventions and recreational activities, and many will take up the offer of SRH services while there. The poorest AGYW are more likely to be excluded, therefore, an understanding of the obstacles to, and enablers of their inclusion should inform Safe Space intervention design.

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“… 15 Community-derived and participatory approaches can improve responsiveness to the HIV prevention needs of key populations. 16 …”

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confidence: 99%

Global HIV efforts need to focus on key populations in LMICs

et al. 2021

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

Cited by 6 publications

References 47 publications

DREAMS impact on HIV status knowledge and sexual risk among cohorts of young women in Kenya and South Africa

DREAMS impact on HIV status knowledge and sexual risk among cohorts of young women in Kenya and South Africa

Safe spaces for beneficiaries of a combination HIV prevention intervention for adolescent girls and young women in South Africa: access, feasibility, and acceptability

Global HIV efforts need to focus on key populations in LMICs

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