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DREAMS Intervention Uptake and Its Association with HIV Related Outcomes Among Adolescent Girls and Young Women in South Africa: Findings from a Cross Sectional Household Study
33 Pages Posted: 28 Apr 2021
More...Abstract
Background: In response to the high and sustained HIV-incidence found among adolescent girls and young women (AGYW), the Determined, Resilient, Empowered, AIDS-free, Mentored and Safe (DREAMS) interventions aims to address risk behaviours and lower the rate of HIV transmission over time in South Africa.
Methods: We undertook a cross-sectional study in two districts in Gauteng (GP), and two in KwaZulu-Natal (KZN), in South Africa. Using a stratified cluster random sampling method all AGYW, aged 12-24 years old, in the household were invited to take part in the study. Participants completed a questionnaire and provided blood samples for laboratory testing for HIV. Descriptive statistics and a series of logistic regressions were undertaken.
Findings: Between March, 2017 and June, 2018, we enrolled 10384 AGYW in GP and 7912 in KZN. The median age was 19 years [Interquartile range (IQR): 15-21]. Approximately half (49·9%) of AGYW had engaged in sexual activity, and of these, 48·1% reported condom use at last sex. KZN had a higher HIV prevalence than GP (15·1% vs. 7·8%, p < 0·001). HIV incidence was 0·87% (15-24 years old; 0·86% in GP and 0·91% in KZN). Approximately, one fifth (17·6%) were not exposed to any interventions, whereas 43·7% were exposed to three or more interventions. AGYW who accessed three or more interventions were more likely to have tested for HIV [Adjusted odd ratio (AOR): 2·54, 95% CI: 2·23-2·89, p <0.001] and were more likely to have accessed contraceptives (AOR: 1·57, 95% CI: 1·38-1·78, p <0.001) than those who did not attend. AGYW who attended two interventions scored higher on the HIV knowledge index than those who did not attend (AOR: 1·42, 95% CI: 1·26-1·63, p <0.001).
Interpretation: Self-reported exposure to DREAMS interventions was associated with positive behavioural outcomes, highlighting the importance of layered interventions to improve and sustain adolescent health.
Funding Statement: This project has been supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention (CDC) under the terms of the cooperative agreement of NU2GGH000372–05-08 formally 5U2GGH000372–05. The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the funding agencies. The CDC had no input on the design of the study, the collection and analysis of data, and the drafting of any results papers.
Declaration of Interests: We declare no competing interests.
Ethics Approval Statement: The study protocol, informed consent, and data collection forms were reviewed and approved by the University of KwaZulu-Natal Biomedical Research Ethics Committee (BFC189/16) and the Centers for Disease Control and Prevention from the United States of America (CHG 2017-031a).
Keywords: HIV/AIDS, HIV prevention, adolescent girls and young women, HIV interventions, Determined, Resilient, Empowered, AIDS-free, Mentored and Safe, South Africa
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