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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

See all articles by Kaymarlin Govender

Kaymarlin Govender

University of KwaZulu-Natal - Health Economics and HIV/AIDS Research Division (HEARD)

Sean Beckett

University of KwaZulu-Natal - Health Economics and HIV/AIDS Research Division (HEARD)

Tarylee Reddy

South African Medical Research Council - Biostatistics Research Unit ; University of KwaZulu-Natal

Richard Cowden

Harvard University - Human Flourishing Program

Cherie Cawood

Epicentre AIDS Risk Management (Pty) Limited

David Khanyile

Epicentre AIDS Risk Management (Pty) Limited

Ayesha Kharsany

University of KwaZulu-Natal - Centre for the AIDS Programme of Research in South Africa

Gavin George

University of KwaZulu-Natal - Health Economics and HIV/AIDS Research Division (HEARD)

Adrian Puren

National Health Laboratory Services (NHLS) - National Institute for Communicable Diseases

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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

Suggested Citation

Govender, Kaymarlin and Beckett, Sean and Reddy, Tarylee and Cowden, Richard and Cawood, Cherie and Khanyile, David and Kharsany, Ayesha and George, Gavin and Puren, Adrian, 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. Available at SSRN: https://ssrn.com/abstract=3835828 or http://dx.doi.org/10.2139/ssrn.3835828

Kaymarlin Govender

University of KwaZulu-Natal - Health Economics and HIV/AIDS Research Division (HEARD)

Westville Campus
J block, Level 4, University Road
Durban
South Africa

Sean Beckett (Contact Author)

University of KwaZulu-Natal - Health Economics and HIV/AIDS Research Division (HEARD)

Westville Campus
J block, Level 4, University Road
Durban
South Africa

Tarylee Reddy

South African Medical Research Council - Biostatistics Research Unit

296 Umbilo Rd.
Durban 4000
South Africa

University of KwaZulu-Natal ( email )

Umbilo Road
Durban 4000, KZN 4000
South Africa

Richard Cowden

Harvard University - Human Flourishing Program ( email )

1875 Cambridge Street
Cambridge, MA 02138
United States

Cherie Cawood

Epicentre AIDS Risk Management (Pty) Limited

South Africa

David Khanyile

Epicentre AIDS Risk Management (Pty) Limited

South Africa

Ayesha Kharsany

University of KwaZulu-Natal - Centre for the AIDS Programme of Research in South Africa ( email )

Durban
South Africa

Gavin George

University of KwaZulu-Natal - Health Economics and HIV/AIDS Research Division (HEARD) ( email )

Westville Campus
J block, Level 4, University Road
Durban
South Africa

Adrian Puren

National Health Laboratory Services (NHLS) - National Institute for Communicable Diseases

Johannesburg
South Africa