The association of exposure to DREAMS on sexually acquiring or transmitting HIV amongst adolescent girls and young women living in rural South Africa: A cohort study
Date
2024-06-15
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Abstract
Objective: We investigate how risk of sexually acquiring or transmitting HIV in adolescent
girls and young women (AGYW) changed following the real-world implementation of DREAMS
(Determined, Resilient, Empowered, AIDS free, Mentored and Safe) HIV prevention programme.
Design: A representative population-based prospective cohort study of AGYW living in rural
KwaZulu-Natal.
Methods: Between 2017–2019 we interviewed a random sample of AGYW aged 13–22 annually.
We measured exposure to DREAMS as self-reported receipt of an invitation to participate and/or
participation in DREAMS activities that were provided by DREAMS implementing organizations.
HIV and Herpes Simplex Virus type 2 (HSV-2) statuses were ascertained through blood tests
on Dried Blood Spot (DBS). We used multivariable regression analysis to assess the association
between exposure to DREAMS and risk of acquiring HIV: measured as incident HSV-2 (a proxy
of sexual risk) and incident HIV; and the risk of sexually transmitting HIV: measured as being
HIV positive with a detectable HIV viral load (>=50 copies per millitre (mL)) on the last available
DBS. We adjusted for socio-demographic, sexual relationship, and migration.
Results: 2184 (86.4%) of those eligible agreed to participate and 2016 (92.3%) provided data
for at least one follow-up time-point. 1030 (54%) were exposed to DREAMS; HIV and HSV-2
incidence were 2.2/100 person-years (95% Confidence Interval [CI]: 1.66–2.86) and 17.3/100
person-years (95%CI: 15.5–19.4) respectively. There was no evidence that HSV-2 and HIV
incidence were lower in those exposed to DREAMS: adjusted rate ratio (aRR) 0.96 (95%CI:
0.76–1.23 and 0.83 (95%CI: 0.46–1.52) respectively. HIV viral load was detectable for 169 (8.9%)
respondents; there was no evidence this was lower in those exposed to DREAMS with an adjusted
risk difference, compared to those not exposed to DREAMS, of 0.99% [95%CI: −1.52–3.82].
Participants who lived in peri-urban/urban setting were more likely to have incident HIV and
transmissible HIV. Both HSV-2 incidence and the transmissible HIV were associated with older
age and ever having sex. Findings did not differ substantively by respondent age group.
Conclusions: DREAMS exposure was not associated with measurable reductions in risk of
sexually acquiring or transmitting HIV amongst a representative cohort of AGYW in rural South
Africa.
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Keywords
combination HIV prevention; HIV; Adolescent Girls and Young Women; HSV-2; HIV viral load