Evaluating the impact of DREAMS on HIV incidence among young women who sell sex: protocol for a non-randomised study in Zimbabwe
Abstract Background “Determined, Resilient, AIDS-free, Mentored and Safe” (DREAMS) is a package of biomedical, social and economic interventions offered to adolescent girls and young women aged 10–24 years with the aim of reducing HIV incidence. In four of the six DREAMS districts in Zimbabwe, DREAM...
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| Format: | Article |
| Language: | English |
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BMC
2018-01-01
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| Series: | BMC Public Health |
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| Online Access: | http://link.springer.com/article/10.1186/s12889-018-5085-6 |
| _version_ | 1818440393648242688 |
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| author | Bernadette Hensen James R. Hargreaves Tarisai Chiyaka Sungai Chabata Phillis Mushati Sian Floyd Isolde Birdthistle Joanna Busza Frances Cowan |
| author_facet | Bernadette Hensen James R. Hargreaves Tarisai Chiyaka Sungai Chabata Phillis Mushati Sian Floyd Isolde Birdthistle Joanna Busza Frances Cowan |
| author_sort | Bernadette Hensen |
| collection | DOAJ |
| description | Abstract Background “Determined, Resilient, AIDS-free, Mentored and Safe” (DREAMS) is a package of biomedical, social and economic interventions offered to adolescent girls and young women aged 10–24 years with the aim of reducing HIV incidence. In four of the six DREAMS districts in Zimbabwe, DREAMS includes an offer of oral pre-exposure prophylaxis (DREAMS+PrEP), alongside interventions to support demand and adherence, to women aged 18–24 who are at highest risk of HIV infection, including young women who sell sex (YWSS). This evaluation study addresses the question: does the delivery of DREAMS+PrEP through various providers reduce HIV incidence among YWSS Zimbabwe? We describe our approach to designing a rigorous study to assess whether DREAMS+PrEP had an impact on HIV incidence. Methods The study design needed to account for the fact that: 1) DREAMS+PrEP was non-randomly allocated; 2) there is no sampling frame for the target population for the evaluation; 3) there are a small number of DREAMS districts (N = 6), and 4) DREAMS+PrEP is being implemented by various providers. The study will use a cohort analysis approach to compare HIV incidence among YWSS in two DREAMS+PrEP districts to HIV incidence among YWSS in non-DREAMS comparison sites. YWSS will be referred to services and recruited into the cohort through a network-based (respondent-driven) recruitment strategy, and followed-up 12- and 24-months after enrolment. Women will be asked to complete a questionnaire and offered HIV testing. Additional complications of this study include identifying comparable populations of YWSS in the DREAMS+PrEP and non-DREAMS comparison sites, and retention of YWSS over the 24-month period. The primary outcome is HIV incidence among YWSS HIV-negative at study enrolment measured by repeat, rapid HIV testing over 24-months. Inference will be based on plausibility that DREAMS+PrEP had an impact on HIV incidence. A process evaluation will be conducted to understand intervention implementation, and document any contextual factors determining the success or failure of intervention delivery. Discussion HIV prevention products of known efficacy are available. Innovative studies are needed to provide evidence of how to optimise product use through combination interventions to achieve population impact within different contexts. We describe the design of such a study. |
| first_indexed | 2024-12-14T18:11:39Z |
| format | Article |
| id | doaj.art-da407f24eefa4c939eac607fb7eb5445 |
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| issn | 1471-2458 |
| language | English |
| last_indexed | 2024-12-14T18:11:39Z |
| publishDate | 2018-01-01 |
| publisher | BMC |
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| series | BMC Public Health |
| spelling | doaj.art-da407f24eefa4c939eac607fb7eb54452022-12-21T22:52:17ZengBMCBMC Public Health1471-24582018-01-0118111010.1186/s12889-018-5085-6Evaluating the impact of DREAMS on HIV incidence among young women who sell sex: protocol for a non-randomised study in ZimbabweBernadette Hensen0James R. Hargreaves1Tarisai Chiyaka2Sungai Chabata3Phillis Mushati4Sian Floyd5Isolde Birdthistle6Joanna Busza7Frances Cowan8Department of Clinical Research, Infectious and Tropical Disease, London School of Hygiene and Tropical MedicineDepartment of Social and Environmental Health Research, Public Health and Policy, London School of Hygiene and Tropical MedicineThe Centre for Sexual Health & HIV/AIDS Research (CeSHHAR) ZimbabweThe Centre for Sexual Health & HIV/AIDS Research (CeSHHAR) ZimbabweThe Centre for Sexual Health & HIV/AIDS Research (CeSHHAR) ZimbabweDepartment of Infectious Disease Epidemiology, Epidemiology and Population Health, London School of Hygiene and Tropical MedicineDepartment of Population Health, Epidemiology and Population Health, London School of Hygiene and Tropical MedicineDepartment of Population Health, Epidemiology and Population Health, London School of Hygiene and Tropical MedicineThe Centre for Sexual Health & HIV/AIDS Research (CeSHHAR) ZimbabweAbstract Background “Determined, Resilient, AIDS-free, Mentored and Safe” (DREAMS) is a package of biomedical, social and economic interventions offered to adolescent girls and young women aged 10–24 years with the aim of reducing HIV incidence. In four of the six DREAMS districts in Zimbabwe, DREAMS includes an offer of oral pre-exposure prophylaxis (DREAMS+PrEP), alongside interventions to support demand and adherence, to women aged 18–24 who are at highest risk of HIV infection, including young women who sell sex (YWSS). This evaluation study addresses the question: does the delivery of DREAMS+PrEP through various providers reduce HIV incidence among YWSS Zimbabwe? We describe our approach to designing a rigorous study to assess whether DREAMS+PrEP had an impact on HIV incidence. Methods The study design needed to account for the fact that: 1) DREAMS+PrEP was non-randomly allocated; 2) there is no sampling frame for the target population for the evaluation; 3) there are a small number of DREAMS districts (N = 6), and 4) DREAMS+PrEP is being implemented by various providers. The study will use a cohort analysis approach to compare HIV incidence among YWSS in two DREAMS+PrEP districts to HIV incidence among YWSS in non-DREAMS comparison sites. YWSS will be referred to services and recruited into the cohort through a network-based (respondent-driven) recruitment strategy, and followed-up 12- and 24-months after enrolment. Women will be asked to complete a questionnaire and offered HIV testing. Additional complications of this study include identifying comparable populations of YWSS in the DREAMS+PrEP and non-DREAMS comparison sites, and retention of YWSS over the 24-month period. The primary outcome is HIV incidence among YWSS HIV-negative at study enrolment measured by repeat, rapid HIV testing over 24-months. Inference will be based on plausibility that DREAMS+PrEP had an impact on HIV incidence. A process evaluation will be conducted to understand intervention implementation, and document any contextual factors determining the success or failure of intervention delivery. Discussion HIV prevention products of known efficacy are available. Innovative studies are needed to provide evidence of how to optimise product use through combination interventions to achieve population impact within different contexts. We describe the design of such a study.http://link.springer.com/article/10.1186/s12889-018-5085-6HIV preventionYoung women who sell sexZimbabweComplex intervention |
| spellingShingle | Bernadette Hensen James R. Hargreaves Tarisai Chiyaka Sungai Chabata Phillis Mushati Sian Floyd Isolde Birdthistle Joanna Busza Frances Cowan Evaluating the impact of DREAMS on HIV incidence among young women who sell sex: protocol for a non-randomised study in Zimbabwe BMC Public Health HIV prevention Young women who sell sex Zimbabwe Complex intervention |
| title | Evaluating the impact of DREAMS on HIV incidence among young women who sell sex: protocol for a non-randomised study in Zimbabwe |
| title_full | Evaluating the impact of DREAMS on HIV incidence among young women who sell sex: protocol for a non-randomised study in Zimbabwe |
| title_fullStr | Evaluating the impact of DREAMS on HIV incidence among young women who sell sex: protocol for a non-randomised study in Zimbabwe |
| title_full_unstemmed | Evaluating the impact of DREAMS on HIV incidence among young women who sell sex: protocol for a non-randomised study in Zimbabwe |
| title_short | Evaluating the impact of DREAMS on HIV incidence among young women who sell sex: protocol for a non-randomised study in Zimbabwe |
| title_sort | evaluating the impact of dreams on hiv incidence among young women who sell sex protocol for a non randomised study in zimbabwe |
| topic | HIV prevention Young women who sell sex Zimbabwe Complex intervention |
| url | http://link.springer.com/article/10.1186/s12889-018-5085-6 |
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