Mthiyane Nondumiso, Shahmanesh Maryam, Copas Andrew, Chimbindi Natsayi, Dreyer Jaco, Zuma Thembelihle, McGrath Nuala, Baisley Kathy, Floyd Sian, Birdthistle Isolde, Sherr Lorraine, Seeley Janet, Harling Guy
Africa Health Research Institute, Durban, KwaZulu-Natal, South Africa.
Institute for Global Health, University College London, London, United Kingdom.
PLOS Glob Public Health. 2024 May 31;4(5):e0003258. doi: 10.1371/journal.pgph.0003258. eCollection 2024.
Combination HIV prevention packages have reduced HIV incidence and improved HIV-related outcomes among young people. However, there is limited data on how package components interact to promote HIV-related prevention behaviours. We described the uptake of HIV prevention interventions supported by Determined, Resilient, Empowered, AIDS-free, Motivated and Safe (DREAMS) Partnership and assessed the association between uptake and HIV-related behaviours among young people in rural KwaZulu-Natal, South Africa. We analysed two cohorts followed from May 2017 to December 2019 to evaluate the impact of DREAMS, covering 13-29 year-old females, and 13-35 year-old males. DREAMS interventions were categorised as healthcare-based or social. We described the uptake of interventions and ran logistic regression models to investigate the association between intervention uptake and subsequent protective HIV-related outcomes including no condomless sex and voluntary medical male circumcision (VMMC). For each outcome, we adjusted for socio-demographics and sexual/pregnancy history and reported adjusted odds ratios (aOR) and 95% confidence intervals (CI). Among 5248 participants, uptake of healthcare interventions increased from 2018 to 2019 by 8.1% and 3.7% for males and females respectively; about half of participants reported receiving both healthcare and social interventions each year. The most utilised combinations of interventions included HIV testing and counselling, school-based HIV education and cash transfers. Participation in social interventions only compared to no intervention was associated with reduced condomless sex (aOR = 1.60, 95%CI: 1.03-2.47), while participation in healthcare interventions only was associated with increased condomless sex. The uptake of interventions did not significantly affect subsequent VMMC overall. Among adolescent boys, exposure to school-based HIV education, cash transfers and HIV testing and counselling was associated with increase in VMMC (aOR = 1.79, 95%CI: 1.04-3.07). Multi-level HIV prevention interventions were associated with an increase in protective HIV-related behaviours emphasizing the importance of accessible programs within both school and community settings for young people.
艾滋病综合预防方案降低了年轻人中的艾滋病毒感染率，并改善了与艾滋病毒相关的结果。然而，关于方案组成部分如何相互作用以促进与艾滋病毒相关的预防行为的数据有限。我们描述了由“坚定、坚韧、赋权、无艾滋病、积极和安全”（DREAMS）伙伴关系支持的艾滋病毒预防干预措施的采用情况，并评估了南非夸祖鲁-纳塔尔农村地区年轻人中干预措施的采用与艾滋病毒相关行为之间的关联。我们分析了两个队列，从2017年5月持续到2019年12月，以评估DREAMS的影响，涵盖13至29岁的女性和13至35岁的男性。DREAMS干预措施分为基于医疗保健的或社会的。我们描述了干预措施的采用情况，并运行逻辑回归模型来研究干预措施的采用与随后的与艾滋病毒相关的保护性结果之间的关联，包括无无保护性行为和男性自愿医学包皮环切术（VMMC）。对于每个结果，我们对社会人口统计学和性/怀孕史进行了调整，并报告了调整后的优势比（aOR）和95%置信区间（CI）。在5248名参与者中，2018年至2019年，男性和女性接受医疗保健干预的比例分别增加了8.1%和3.7%；每年约有一半的参与者报告同时接受了医疗保健和社会干预。最常用的干预措施组合包括艾滋病毒检测和咨询、基于学校的艾滋病毒教育和现金转移。仅参与社会干预与无无保护性行为减少相关（aOR = 1.60，95%CI：1.03 - 2.47），而仅参与医疗保健干预与无保护性行为增加相关。干预措施的采用总体上对随后的VMMC没有显著影响。在青少年男孩中，接受基于学校的艾滋病毒教育、现金转移以及艾滋病毒检测和咨询与VMMC增加相关（aOR = 1.79，95%CI：1.04 - 3.07）。多层次的艾滋病毒预防干预与与艾滋病毒相关的保护性行为增加相关，强调了在学校和社区环境中为年轻人提供可及方案的重要性。
