Article Text
Abstract
Background Knowledge of one’s HIV status is the gateway to treatment and prevention, but remains low among young people. We investigated the early impact (2016–2017) of Determined, Resilient, Empowered, AIDS-free, Mentored and Safe (DREAMS), a multisectoral HIV prevention package, on knowledge of HIV status among adolescent girls and young women (AGYW).
Methods In 2017, randomly selected AGYW were enrolled into surveys, N=1081 aged 15–22 years in Nairobi slum settlements, and N=2174 aged 13–22 years in rural KwaZulu-Natal. We estimated the causal effect of being a DREAMS beneficiary on knowledge of HIV status (those who self-reported as HIV-positive or tested HIV-negative in the past year), accounting for an AGYW’s propensity to be a DREAMS beneficiary.
Results In Nairobi, knowledge of HIV status was higher among DREAMS beneficiaries compared with non-beneficiaries (92% vs 69%, adjusted OR=8.7; 95% CI 5.8 to 12.9), with DREAMS predicted to increase the outcome by 28%, from 65% if none were a DREAMS beneficiary to 93% if all were beneficiaries. The increase attributable to DREAMS was larger among younger participants: 32% and 23% among those aged 15–17 and 18–22 years, respectively. In KwaZulu-Natal, knowledge of status was higher among DREAMS beneficiaries aged 13–17 years (37% vs 26% among non-beneficiaries), with a 9% difference due to DREAMS (95% CI 4.8% to 14.4%), and no evidence of effect among 18–22 years (−2.8%; 95% CI −11.1% to 5.7%).
Conclusion DREAMS substantially increased knowledge of HIV status among AGYW in Nairobi, and among younger but not older AGYW in KwaZulu-Natal. Adolescent girls can be reached early (before age 18) with community-based HIV testing programmes in diverse high-prevalence settings, with a large impact on the proportion who know their HIV status.
- adolescent
- epidemiology
- HIV
- inequalities
- sexual health
Data availability statement
Data are available on reasonable request. Anonymised data are available upon reasonable request. Requests can be made to the LSHTM Data Compass Repository: researchdatamanagement@lshtm.ac.uk.
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Data availability statement
Data are available on reasonable request. Anonymised data are available upon reasonable request. Requests can be made to the LSHTM Data Compass Repository: researchdatamanagement@lshtm.ac.uk.
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Footnotes
Contributors IB and SF conceived the study and IB wrote the first draft. DJC and SF conceptualised the methodological approach and DJC wrote the first draft of the methods. DJC and NTM conducted the analyses, with supervision by KB and SF. AZ and MS oversaw the data collection, with coordination and data management by NC, SM and BOO. IB, SF, AZ and MS secured the funding. All authors reviewed the manuscript and results and contributed edits and improvements.
Funding The impact evaluation of DREAMS is funded by the Bill & Melinda Gates Foundation (OPP1136774, http://www.gatesfoundation.org). Foundation staff advised the study team, but did not substantively affect the study design, instruments, interpretation of data or decision to publish.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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