Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, UK
Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK.
J Epidemiol Community Health. 2022 Feb;76(2):158-167. doi: 10.1136/jech-2020-216042. Epub 2021 Sep 13.
Knowledge of one's HIV status is the gateway to treatment and prevention, but remains low among young people. We investigated the early impact (2016-2017) of Determined, Resilient, Empowered, AIDS-free, Mentored and Safe (DREAMS), a multisectoral HIV prevention package, on knowledge of HIV status among adolescent girls and young women (AGYW).
In 2017, randomly selected AGYW were enrolled into surveys, N=1081 aged 15-22 years in Nairobi slum settlements, and N=2174 aged 13-22 years in rural KwaZulu-Natal. We estimated the causal effect of being a DREAMS beneficiary on knowledge of HIV status (those who self-reported as HIV-positive or tested HIV-negative in the past year), accounting for an AGYW's propensity to be a DREAMS beneficiary.
In Nairobi, knowledge of HIV status was higher among DREAMS beneficiaries compared with non-beneficiaries (92% vs 69%, adjusted OR=8.7; 95% CI 5.8 to 12.9), with DREAMS predicted to increase the outcome by 28%, from 65% if none were a DREAMS beneficiary to 93% if all were beneficiaries. The increase attributable to DREAMS was larger among younger participants: 32% and 23% among those aged 15-17 and 18-22 years, respectively. In KwaZulu-Natal, knowledge of status was higher among DREAMS beneficiaries aged 13-17 years (37% vs 26% among non-beneficiaries), with a 9% difference due to DREAMS (95% CI 4.8% to 14.4%), and no evidence of effect among 18-22 years (-2.8%; 95% CI -11.1% to 5.7%).
DREAMS substantially increased knowledge of HIV status among AGYW in Nairobi, and among younger but not older AGYW in KwaZulu-Natal. Adolescent girls can be reached early (before age 18) with community-based HIV testing programmes in diverse high-prevalence settings, with a large impact on the proportion who know their HIV status.
了解自己的 HIV 状况是接受治疗和预防的关键，但年轻人中这方面的知识仍然很低。我们调查了 Determined, Resilient, Empowered, AIDS-free, Mentored and Safe（DREAMS），一个多部门 HIV 预防方案，对青少年女孩和年轻女性（AGYW）对 HIV 状况的认识的早期影响（2016-2017 年）。
2017 年，随机选择 AGYW 参加调查，内罗毕贫民窟的 1081 名年龄在 15-22 岁的参与者，以及夸祖鲁-纳塔尔省农村地区的 2174 名年龄在 13-22 岁的参与者。我们估计了成为 DREAMS 受益者对 HIV 状况知识的因果效应（那些自我报告为 HIV 阳性或在过去一年中 HIV 检测呈阴性的人），并考虑了 AGYW 成为 DREAMS 受益者的倾向。
在内罗毕，与非受益者相比，DREAMS 受益者对 HIV 状况的了解程度更高（92%对 69%，调整后的 OR=8.7；95%CI 5.8 至 12.9），DREAMS 预计将使该结果增加 28%，如果没有受益者，该结果为 65%，如果所有受益者都是受益者，则为 93%。在年龄较小的参与者中，DREAMS 的影响更大：15-17 岁和 18-22 岁的参与者分别为 32%和 23%。在夸祖鲁-纳塔尔省，13-17 岁的 DREAMS 受益者对 HIV 状况的了解程度更高（37%对非受益者的 26%），由于 DREAMS 而产生的差异为 9%（95%CI 4.8%至 14.4%），而在 18-22 岁的参与者中没有证据表明有影响（-2.8%；95%CI-11.1%至 5.7%）。
DREAMS 在内罗毕显著提高了 AGYW 对 HIV 状况的认识，在夸祖鲁-纳塔尔省也提高了年龄较小的 AGYW（13-17 岁）的认识，但对年龄较大的 AGYW（18-22 岁）没有影响。在高流行地区，社区为基础的 HIV 检测方案可以尽早（在 18 岁之前）接触到青少年女孩，对了解自己 HIV 状况的比例有很大影响。
