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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

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
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
Background: We investigate how the 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) combination HIV prevention. Methods: We recruited a randomly selected population-based cohort of AGYW aged 13 to 22 years (at baseline) living in rural KwaZulu-Natal whom we interviewed annually (2017 to 2019). We measured exposure to DREAMS as self-reported receipt of an invitation to participate and/or participation in DREAMS activities. HIV status was ascertained through blood tests on Dried Blood Spot. We used multivariable regression to assess the association between exposure to DREAMS and risk of acquiring HIV (incident HIV) or having transmissible HIV (being HIV positive with a detectable HIV viral load of >50 copies per millilitre) on the last available DBS. We adjusted for socio-demographic, sexual relationship and migration. Results: A total of 2184 (86.4%) of those eligible agreed to participate and 2016 (92.3%) participants provided data for at least one follow-up time-point. 1030 (54%) were exposed to DREAMS; HIV incidence was 2.2/100 person-years (95% Confidence Interval [CI]: 1.66 to 2.86). There was no evidence that HIV incidence was lower in those exposed to DREAMS: adjusted rate ratio (aRR) 0.83 (95% CI: 0.46 to 1.52). HIV viral load was detectable for 169 (8.9%) respondents one to two years following enrolment; 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 to 3.82]. Participants who lived in peri-urban/urban setting were more likely to have incident HIV and transmissible HIV. Detectable HIV viral load was also associated with older age and ever having sex. Findings did not differ substantively by respondent age group. Conclusions: DREAMS exposure was not associated with reductions in risk of sexually acquiring or transmitting HIV among a representative cohort of AGYW in rural South Africa.
0269-9370
S39-S49
Mthiyane, Nondumiso
690c6e97-3df8-4d43-8d9d-9ab580369fd4
Baisley, Kathy
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Chimbindi, Natsayi
c518d13f-6c0b-4eb2-92f5-89d260eeba87
Zuma, Thembelihle
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Okesola, Nonhlanhla
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Dreyer, Jaco
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Herbst, Carina
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Smit, Theresa
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Danaviah, Siva
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Mcgrath, Nuala
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Harling, Guy
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Sherr, Lorraine
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Seeley, Janet
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Floyd, Sian
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Birdthistle, Isolde
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Shahmanesh, Maryam
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Mthiyane, Nondumiso
690c6e97-3df8-4d43-8d9d-9ab580369fd4
Baisley, Kathy
5fe8c276-d9d2-4bb6-91a3-8acd38a5151f
Chimbindi, Natsayi
c518d13f-6c0b-4eb2-92f5-89d260eeba87
Zuma, Thembelihle
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Okesola, Nonhlanhla
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Dreyer, Jaco
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Herbst, Carina
1e518f7a-15e3-4efc-9a3a-d890ba212f78
Smit, Theresa
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Danaviah, Siva
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Mcgrath, Nuala
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Harling, Guy
0403b83a-0afe-472c-a184-7a6357afe29a
Sherr, Lorraine
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Seeley, Janet
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Floyd, Sian
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Birdthistle, Isolde
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Shahmanesh, Maryam
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Mthiyane, Nondumiso, Baisley, Kathy, Chimbindi, Natsayi, Zuma, Thembelihle, Okesola, Nonhlanhla, Dreyer, Jaco, Herbst, Carina, Smit, Theresa, Danaviah, Siva, Mcgrath, Nuala, Harling, Guy, Sherr, Lorraine, Seeley, Janet, Floyd, Sian, Birdthistle, Isolde and Shahmanesh, Maryam (2022) 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. AIDS, 36 (S1), S39-S49. (doi:10.1097/QAD.0000000000003156).

Record type: Article

Abstract

Background: We investigate how the 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) combination HIV prevention. Methods: We recruited a randomly selected population-based cohort of AGYW aged 13 to 22 years (at baseline) living in rural KwaZulu-Natal whom we interviewed annually (2017 to 2019). We measured exposure to DREAMS as self-reported receipt of an invitation to participate and/or participation in DREAMS activities. HIV status was ascertained through blood tests on Dried Blood Spot. We used multivariable regression to assess the association between exposure to DREAMS and risk of acquiring HIV (incident HIV) or having transmissible HIV (being HIV positive with a detectable HIV viral load of >50 copies per millilitre) on the last available DBS. We adjusted for socio-demographic, sexual relationship and migration. Results: A total of 2184 (86.4%) of those eligible agreed to participate and 2016 (92.3%) participants provided data for at least one follow-up time-point. 1030 (54%) were exposed to DREAMS; HIV incidence was 2.2/100 person-years (95% Confidence Interval [CI]: 1.66 to 2.86). There was no evidence that HIV incidence was lower in those exposed to DREAMS: adjusted rate ratio (aRR) 0.83 (95% CI: 0.46 to 1.52). HIV viral load was detectable for 169 (8.9%) respondents one to two years following enrolment; 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 to 3.82]. Participants who lived in peri-urban/urban setting were more likely to have incident HIV and transmissible HIV. Detectable HIV viral load was also associated with older age and ever having sex. Findings did not differ substantively by respondent age group. Conclusions: DREAMS exposure was not associated with reductions in risk of sexually acquiring or transmitting HIV among a representative cohort of AGYW in rural South Africa.

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Table 1 Revised oct 2021_forPure - Accepted Manuscript
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Table 3 - AIDS paper - Accepted Manuscript
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DREAMS HIV incidence paper revised 25_10_2021_no tables_forPure
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Table 2 Revised oct 21_forPure
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More information

Accepted/In Press date: 7 January 2022
e-pub ahead of print date: 15 June 2022

Identifiers

Local EPrints ID: 454855
URI: http://eprints.soton.ac.uk/id/eprint/454855
ISSN: 0269-9370
PURE UUID: 1c35caca-8f23-4193-988d-c72dc345948f
ORCID for Nuala Mcgrath: ORCID iD orcid.org/0000-0002-1039-0159

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Date deposited: 25 Feb 2022 18:03
Last modified: 17 Mar 2024 07:07

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Contributors

Author: Nondumiso Mthiyane
Author: Kathy Baisley
Author: Natsayi Chimbindi
Author: Thembelihle Zuma
Author: Nonhlanhla Okesola
Author: Jaco Dreyer
Author: Carina Herbst
Author: Theresa Smit
Author: Siva Danaviah
Author: Nuala Mcgrath ORCID iD
Author: Guy Harling
Author: Lorraine Sherr
Author: Janet Seeley
Author: Sian Floyd
Author: Isolde Birdthistle
Author: Maryam Shahmanesh

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