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

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dc.contributor.authorNondumiso Mthiyane
dc.contributor.authorKathy Baisley
dc.contributor.authorNatsayi Chimbindi
dc.contributor.authorThembelihle Zuma
dc.contributor.authorNonhlanhla Okesola
dc.contributor.authorJaco Dreyer
dc.contributor.authorCarina Herbst
dc.contributor.authorTheresa Smit
dc.contributor.authorSiva Danaviah
dc.contributor.authorNuala McGrath
dc.contributor.authorGuy Harling
dc.contributor.authorLorraine Sherr
dc.contributor.authorJanet Seeley
dc.contributor.authorSian Floyd
dc.contributor.authorIsolde Birdthistle
dc.contributor.authorMaryam Shahmanesh
dc.date.accessioned2024-04-05T08:25:36Z
dc.date.available2024-04-05T08:25:36Z
dc.date.issued2024-06-15
dc.description.abstractObjective: 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.
dc.description.librarianPM2023
dc.facultyFaculty of Health Sciences
dc.identifier.urihttps://hdl.handle.net/10539/38326
dc.language.isoen
dc.schoolPublic Health
dc.subjectcombination HIV prevention; HIV; Adolescent Girls and Young Women; HSV-2; HIV viral load
dc.titleThe 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
dc.typeArticle
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