Awareness and uptake of layered HIV prevention programming for young women: analysis of population-based surveys in three DREAMS settings in Kenya and South Africa
Abstract Background The DREAMS Partnership is an ambitious effort to deliver combinations of biomedical, behavioural and structural interventions to reduce HIV incidence among adolescent girls and young women (AGYW). To inform multi-sectoral programming at scale, across diverse settings in Kenya and...
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| Language: | English |
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BMC
2019-10-01
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| Series: | BMC Public Health |
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| Online Access: | http://link.springer.com/article/10.1186/s12889-019-7766-1 |
| _version_ | 1818339316763459584 |
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| author | Annabelle Gourlay Isolde Birdthistle Nondumiso Thandiwe Mthiyane Benedict O. Orindi Sheru Muuo Daniel Kwaro Maryam Shahmanesh Kathy Baisley Abdhalah Ziraba Sian Floyd |
| author_facet | Annabelle Gourlay Isolde Birdthistle Nondumiso Thandiwe Mthiyane Benedict O. Orindi Sheru Muuo Daniel Kwaro Maryam Shahmanesh Kathy Baisley Abdhalah Ziraba Sian Floyd |
| author_sort | Annabelle Gourlay |
| collection | DOAJ |
| description | Abstract Background The DREAMS Partnership is an ambitious effort to deliver combinations of biomedical, behavioural and structural interventions to reduce HIV incidence among adolescent girls and young women (AGYW). To inform multi-sectoral programming at scale, across diverse settings in Kenya and South Africa, we identified who the programme is reaching, with which interventions and in what combinations. Methods Randomly-selected cohorts of 606 AGYW aged 10–14 years and 1081 aged 15–22 years in Nairobi and 2184 AGYW aged 13–22 years in uMkhanyakude, KwaZulu-Natal, were enrolled in 2017, after ~ 1 year of DREAMS implementation. In Gem, western Kenya, population-wide cross-sectional survey data were collected during roll-out in 2016 (n = 1365 AGYW 15–22 years). We summarised awareness and invitation to participate in DREAMS, uptake of interventions categorised by the DREAMS core package, and uptake of a subset of ‘primary’ interventions. We stratified by age-group and setting, and compared across AGYW characteristics. Results Awareness of DREAMS was higher among younger women (Nairobi: 89%v78%, aged 15-17v18–22 years; uMkhanyakude: 56%v31%, aged 13-17v18–22; and Gem: 28%v25%, aged 15-17v18–22, respectively). HIV testing was the most accessed intervention in Nairobi and Gem (77% and 85%, respectively), and school-based HIV prevention in uMkhanyakude (60%). Among those invited, participation in social asset building was > 50%; > 60% accessed ≥2 core package categories, but few accessed all primary interventions intended for their age-group. Parenting programmes and community mobilisation, including those intended for male partners, were accessed infrequently. In Nairobi and uMkhanyakude, AGYW were more likely to be invited to participate and accessed more categories if they were: aged < 18 years, in school and experienced socio-economic vulnerabilities. Those who had had sex, or a pregnancy, were less likely to be invited to participate but accessed more categories. Conclusions In representative population-based samples, awareness and uptake of DREAMS were high after 1 year of implementation. Evidence of ‘layering’ (receiving multiple interventions from the DREAMS core package), particularly among more socio-economically vulnerable AGYW, indicate that intervention packages can be implemented at scale, for intended recipients, in real-world contexts. Challenges remain for higher coverage and greater ‘layering’, including among older, out-of-school AGYW, and community-based programmes for families and men. |
| first_indexed | 2024-12-13T15:25:04Z |
| format | Article |
| id | doaj.art-42f25a6f1e804c019dee642e7093a925 |
| institution | Directory Open Access Journal |
| issn | 1471-2458 |
| language | English |
| last_indexed | 2024-12-13T15:25:04Z |
| publishDate | 2019-10-01 |
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| spelling | doaj.art-42f25a6f1e804c019dee642e7093a9252022-12-21T23:40:23ZengBMCBMC Public Health1471-24582019-10-0119111910.1186/s12889-019-7766-1Awareness and uptake of layered HIV prevention programming for young women: analysis of population-based surveys in three DREAMS settings in Kenya and South AfricaAnnabelle Gourlay0Isolde Birdthistle1Nondumiso Thandiwe Mthiyane2Benedict O. Orindi3Sheru Muuo4Daniel Kwaro5Maryam Shahmanesh6Kathy Baisley7Abdhalah Ziraba8Sian Floyd9Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical MedicineFaculty of Epidemiology and Population Health, London School of Hygiene & Tropical MedicineAfrica Health Research InstituteAfrica Population and Health Research CenterAfrica Population and Health Research CenterCentre for Global Health Research, Kenya Medical Research InstituteAfrica Health Research InstituteFaculty of Epidemiology and Population Health, London School of Hygiene & Tropical MedicineAfrica Population and Health Research CenterFaculty of Epidemiology and Population Health, London School of Hygiene & Tropical MedicineAbstract Background The DREAMS Partnership is an ambitious effort to deliver combinations of biomedical, behavioural and structural interventions to reduce HIV incidence among adolescent girls and young women (AGYW). To inform multi-sectoral programming at scale, across diverse settings in Kenya and South Africa, we identified who the programme is reaching, with which interventions and in what combinations. Methods Randomly-selected cohorts of 606 AGYW aged 10–14 years and 1081 aged 15–22 years in Nairobi and 2184 AGYW aged 13–22 years in uMkhanyakude, KwaZulu-Natal, were enrolled in 2017, after ~ 1 year of DREAMS implementation. In Gem, western Kenya, population-wide cross-sectional survey data were collected during roll-out in 2016 (n = 1365 AGYW 15–22 years). We summarised awareness and invitation to participate in DREAMS, uptake of interventions categorised by the DREAMS core package, and uptake of a subset of ‘primary’ interventions. We stratified by age-group and setting, and compared across AGYW characteristics. Results Awareness of DREAMS was higher among younger women (Nairobi: 89%v78%, aged 15-17v18–22 years; uMkhanyakude: 56%v31%, aged 13-17v18–22; and Gem: 28%v25%, aged 15-17v18–22, respectively). HIV testing was the most accessed intervention in Nairobi and Gem (77% and 85%, respectively), and school-based HIV prevention in uMkhanyakude (60%). Among those invited, participation in social asset building was > 50%; > 60% accessed ≥2 core package categories, but few accessed all primary interventions intended for their age-group. Parenting programmes and community mobilisation, including those intended for male partners, were accessed infrequently. In Nairobi and uMkhanyakude, AGYW were more likely to be invited to participate and accessed more categories if they were: aged < 18 years, in school and experienced socio-economic vulnerabilities. Those who had had sex, or a pregnancy, were less likely to be invited to participate but accessed more categories. Conclusions In representative population-based samples, awareness and uptake of DREAMS were high after 1 year of implementation. Evidence of ‘layering’ (receiving multiple interventions from the DREAMS core package), particularly among more socio-economically vulnerable AGYW, indicate that intervention packages can be implemented at scale, for intended recipients, in real-world contexts. Challenges remain for higher coverage and greater ‘layering’, including among older, out-of-school AGYW, and community-based programmes for families and men.http://link.springer.com/article/10.1186/s12889-019-7766-1HIV preventionAdolescent girlsImplementationEvaluationComplex intervention |
| spellingShingle | Annabelle Gourlay Isolde Birdthistle Nondumiso Thandiwe Mthiyane Benedict O. Orindi Sheru Muuo Daniel Kwaro Maryam Shahmanesh Kathy Baisley Abdhalah Ziraba Sian Floyd Awareness and uptake of layered HIV prevention programming for young women: analysis of population-based surveys in three DREAMS settings in Kenya and South Africa BMC Public Health HIV prevention Adolescent girls Implementation Evaluation Complex intervention |
| title | Awareness and uptake of layered HIV prevention programming for young women: analysis of population-based surveys in three DREAMS settings in Kenya and South Africa |
| title_full | Awareness and uptake of layered HIV prevention programming for young women: analysis of population-based surveys in three DREAMS settings in Kenya and South Africa |
| title_fullStr | Awareness and uptake of layered HIV prevention programming for young women: analysis of population-based surveys in three DREAMS settings in Kenya and South Africa |
| title_full_unstemmed | Awareness and uptake of layered HIV prevention programming for young women: analysis of population-based surveys in three DREAMS settings in Kenya and South Africa |
| title_short | Awareness and uptake of layered HIV prevention programming for young women: analysis of population-based surveys in three DREAMS settings in Kenya and South Africa |
| title_sort | awareness and uptake of layered hiv prevention programming for young women analysis of population based surveys in three dreams settings in kenya and south africa |
| topic | HIV prevention Adolescent girls Implementation Evaluation Complex intervention |
| url | http://link.springer.com/article/10.1186/s12889-019-7766-1 |
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