“坚定、坚韧、自主、无艾滋病、受指导且安全”（DREAMS）项目对少女和年轻女性中艾滋病毒发病率及其他健康相关结局的影响：一项系统评价和荟萃分析

The effects of the Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe (DREAMS) program on HIV incidence and other health-related outcomes among adolescent girls and young women: a systematic review and meta-analysis.

作者信息

Lavoie Marie-Claude C, Blanco Natalia, Lascko Taylor, Baumhart Caitlin, Verbeek Jos, Stoebenau Kirsten, Claassen Cassidy W, Mwango Linah K, Lindsay Brianna, Ndwapi Ndwapi, Ngeno Caroline, Koech Emily, Ludeman Emilie, Charurat Man, Stafford Kristen A

机构信息

Center for International Health, Education, and Biosecurity, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA.

Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA.

出版信息

EClinicalMedicine. 2025 Apr 3;82:103176. doi: 10.1016/j.eclinm.2025.103176. eCollection 2025 Apr.

BACKGROUND

In sub-Saharan Africa, adolescent girls and young women are twice as likely to be living with HIV as their male counterparts. This systematic review assesses the impact of the Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe (DREAMS) program on health-related outcomes, access to services, sexual risk behaviors, and HIV knowledge.

METHODS

We searched different databases and conference abstracts from January 2014 to April 2024. We included studies where DREAMS was the primary intervention. We completed meta-analyses using random effects models. Risk of bias and certainty of evidence were assessed. PROSPERO: CRD42022340294.

FINDINGS

Seven unique studies were included. The incidence rate ratio (IRR) of HIV incidence was 0.74 (95% CI: 0.63-0.87, 1 study) in DREAMS compared to the comparison group. For self-report of sexually transmitted infections (STI) symptoms, the IRR was 0.84 (95% CI: 0.71-0.98, 1 study). The odds ratio (OR) for awareness of HIV status was 2.34 (95% CI: 1.23-4.44, 1 study). The risk ratio for HIV testing was 1.17 (95% CI: 1.05-1.30, 1 study). For condom use, the OR was 1.22 (95% CI: 0.86-1.72, 1 study). For transactional sex, the OR was 0.99 (95% CI: 0.69-1.41). The OR for the number of sexual partners was 0.74 (95% CI: 0.60-0.91, 1 study).

INTERPRETATION

The evidence suggests that DREAMS results in a reduction in HIV incidence and STI symptoms. DREAMS may result in a slight increase in the uptake of HIV testing and a large increase in awareness of HIV status. DREAMS may also reduce the number of sexual partners. Developing a unified and granular evaluation framework would be beneficial in advancing research and generating evidence on DREAMS.

FUNDING

No funding source.

背景

在撒哈拉以南非洲地区，感染艾滋病毒的青春期女孩和年轻女性的人数是同龄男性的两倍。本系统评价评估了“坚定、坚韧、赋权、无艾滋病、受指导和安全”（DREAMS）项目对健康相关结果、服务获取、性风险行为和艾滋病毒知识的影响。

方法

我们检索了2014年1月至2024年4月期间的不同数据库和会议摘要。纳入以DREAMS为主要干预措施的研究。我们使用随机效应模型完成了荟萃分析。评估了偏倚风险和证据的确定性。国际前瞻性系统评价注册库（PROSPERO）注册号：CRD42022340294。

结果

纳入了7项独特的研究。与对照组相比，DREAMS组艾滋病毒感染发病率的发病率比（IRR）为0.74（95%置信区间：0.63 - 0.87，1项研究）。对于性传播感染（STI）症状的自我报告，IRR为0.84（95%置信区间：0.71 - 0.98，1项研究）。知晓艾滋病毒感染状况的优势比（OR）为2.34（95%置信区间：1.23 - 4.44，1项研究）。艾滋病毒检测的风险比为1.17（95%置信区间：1.05 - 1.30，1项研究）。对于使用避孕套，OR为1.22（95%置信区间：0.86 - 1.72，1项研究）。对于交易性行为，OR为0.99（95%置信区间：0.69 - 1.41）。性伴侣数量的OR为0.74（95%置信区间：0.60 - 0.91，1项研究）。