RT Journal Article
SR Electronic
T1 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
JF Journal of Epidemiology and Community Health
JO J Epidemiol Community Health
FD BMJ Publishing Group Ltd
SP jech-2020-216042
DO 10.1136/jech-2020-216042
A1 Isolde Birdthistle
A1 Daniel J Carter
A1 Nondumiso T Mthiyane
A1 Benedict O Orindi
A1 Sheru Muuo
A1 Natsayi Chimbindi
A1 Abdhalah Ziraba
A1 Maryam Shahmanesh
A1 Kathy Baisley
A1 Sian Floyd
YR 2021
UL http://jech.bmj.com/content/early/2021/09/12/jech-2020-216042.abstract
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.