PT  - JOURNAL ARTICLE
AU  - Isolde Birdthistle
AU  - Daniel J Carter
AU  - Nondumiso T Mthiyane
AU  - Benedict O Orindi
AU  - Sheru Muuo
AU  - Natsayi Chimbindi
AU  - Abdhalah Ziraba
AU  - Maryam Shahmanesh
AU  - Kathy Baisley
AU  - Sian Floyd
TI  - Early impact of the DREAMS partnership on young women’s knowledge of their HIV status: causal analysis of population-based surveys in Kenya and South Africa
AID  - 10.1136/jech-2020-216042
DP  - 2021 Sep 12
TA  - Journal of Epidemiology and Community Health
PG  - jech-2020-216042
4099  - http://jech.bmj.com/content/early/2021/09/12/jech-2020-216042.short
4100  - http://jech.bmj.com/content/early/2021/09/12/jech-2020-216042.full
AB  - 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.Data are available on reasonable request.