The impact of the DREAMS partnership on HIV incidence among young women who sell sex in two Zimbabwean cities: results of a non-randomised study
Introduction Young women who sell sex (YWSS) in Zimbabwe remain at high risk of HIV infection. Effective HIV prevention strategies are needed. Through support to access a combination of evidence-based interventions, including oral pre-exposure prophylaxis (PrEP), the Determined, Resilient, Empowered...
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BMJ Publishing Group
2021-04-01
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| Series: | BMJ Global Health |
| Online Access: | https://gh.bmj.com/content/6/4/e003892.full |
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| author | Frances M Cowan Isolde Birdthistle Sian Floyd James R Hargreaves Joanna Busza Sungai T Chabata Bernadette Hensen Tarisai Chiyaka Phillis Mushati Sithembile Musemburi Jeffrey Dirawo |
| author_facet | Frances M Cowan Isolde Birdthistle Sian Floyd James R Hargreaves Joanna Busza Sungai T Chabata Bernadette Hensen Tarisai Chiyaka Phillis Mushati Sithembile Musemburi Jeffrey Dirawo |
| author_sort | Frances M Cowan |
| collection | DOAJ |
| description | Introduction Young women who sell sex (YWSS) in Zimbabwe remain at high risk of HIV infection. Effective HIV prevention strategies are needed. Through support to access a combination of evidence-based interventions, including oral pre-exposure prophylaxis (PrEP), the Determined, Resilient, Empowered, AIDS-free, Mentored and Safe (DREAMS) partnership aimed to reduce new HIV infections among adolescent girls and young women by 40% over 24 months.Methods Non-randomised ‘plausibility’ evaluation, powered to detect a 40% HIV incidence difference between DREAMS and non-DREAMS sites. Two large cities with DREAMS funding were included, and four smaller non-DREAMS towns for comparison. In all sites, YWSS were enrolled to a cohort through peer-referral. Women were followed up for 24 months. HIV seroconversion was the primary outcome, with secondary outcomes identified through a theory of change. Outcomes were compared between YWSS recruited in DREAMS cities and non-DREAMS towns, adjusting for individual-level confounders and HIV prevalence at enrolment.Results From April to July 2017, 2431 women were enrolled, 1859 of whom were HIV negative at enrolment; 1019 of these women (54.8%) were followed up from March to May 2019 and included in endline analysis. Access to clinical services increased, but access to socioeconomic interventions promoted by DREAMS was limited. A total of 79 YWSS HIV seroconverted, with HIV incidence among YWSS in DREAMS cities lower (3.1/100 person-years) than in non-DREAMS towns (5.3/100 person-years). In prespecified adjusted analysis, HIV incidence was lower in DREAMS cities but with weak statistical evidence (adjusted rate ratio (RR)=0.68; 95% CI 0.40 to 1.19; p=0.18). Women in DREAMS cities were more likely to report ever and ongoing PrEP use, consistent condom use, fewer sexual partners and less intimate partner violence.Conclusion It is plausible that DREAMS lowered HIV incidence among YWSS in two Zimbabwean cities, but our evaluation provides weak statistical evidence for impact and suggests any reduction in incidence was lower than the anticipated 40% decline. We identified changes to some important ‘pathways to impact’ variables, including condom use. |
| format | Article |
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| institution | Kabale University |
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| language | English |
| publishDate | 2021-04-01 |
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| spelling | doaj-art-d5f16a1d20834660b3da25b7098f98a22024-12-05T16:00:09ZengBMJ Publishing GroupBMJ Global Health2059-79082021-04-016410.1136/bmjgh-2020-003892The impact of the DREAMS partnership on HIV incidence among young women who sell sex in two Zimbabwean cities: results of a non-randomised studyFrances M Cowan0Isolde Birdthistle1Sian Floyd2James R Hargreaves3Joanna Busza4Sungai T Chabata5Bernadette Hensen6Tarisai Chiyaka7Phillis Mushati8Sithembile Musemburi9Jeffrey Dirawo10Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UKDepartment of Population Health, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UKInfectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UKCentre for Evaluation, London School of Hygiene & Tropical Medicine, London, UKDepartment of Public Health, Environments and Society, The London School of Hygiene & Tropical Medicine, London, UKCentre for Sexual Health and HIV/AIDS Research (CeSHHAR) Zimbabwe, Harare, ZimbabweDepartment of Clinical Research, London School of Hygiene & Tropical Medicine, London, UKCentre for Sexual Health and HIV/AIDS Research (CeSHHAR) Zimbabwe, Harare, ZimbabweCentre for Sexual Health and HIV/AIDS Research (CeSHHAR) Zimbabwe, Harare, ZimbabweCentre for Sexual Health and HIV/AIDS Research (CeSHHAR) Zimbabwe, Harare, ZimbabweCentre for Sexual Health and HIV/AIDS Research (CeSHHAR) Zimbabwe, Harare, ZimbabweIntroduction Young women who sell sex (YWSS) in Zimbabwe remain at high risk of HIV infection. Effective HIV prevention strategies are needed. Through support to access a combination of evidence-based interventions, including oral pre-exposure prophylaxis (PrEP), the Determined, Resilient, Empowered, AIDS-free, Mentored and Safe (DREAMS) partnership aimed to reduce new HIV infections among adolescent girls and young women by 40% over 24 months.Methods Non-randomised ‘plausibility’ evaluation, powered to detect a 40% HIV incidence difference between DREAMS and non-DREAMS sites. Two large cities with DREAMS funding were included, and four smaller non-DREAMS towns for comparison. In all sites, YWSS were enrolled to a cohort through peer-referral. Women were followed up for 24 months. HIV seroconversion was the primary outcome, with secondary outcomes identified through a theory of change. Outcomes were compared between YWSS recruited in DREAMS cities and non-DREAMS towns, adjusting for individual-level confounders and HIV prevalence at enrolment.Results From April to July 2017, 2431 women were enrolled, 1859 of whom were HIV negative at enrolment; 1019 of these women (54.8%) were followed up from March to May 2019 and included in endline analysis. Access to clinical services increased, but access to socioeconomic interventions promoted by DREAMS was limited. A total of 79 YWSS HIV seroconverted, with HIV incidence among YWSS in DREAMS cities lower (3.1/100 person-years) than in non-DREAMS towns (5.3/100 person-years). In prespecified adjusted analysis, HIV incidence was lower in DREAMS cities but with weak statistical evidence (adjusted rate ratio (RR)=0.68; 95% CI 0.40 to 1.19; p=0.18). Women in DREAMS cities were more likely to report ever and ongoing PrEP use, consistent condom use, fewer sexual partners and less intimate partner violence.Conclusion It is plausible that DREAMS lowered HIV incidence among YWSS in two Zimbabwean cities, but our evaluation provides weak statistical evidence for impact and suggests any reduction in incidence was lower than the anticipated 40% decline. We identified changes to some important ‘pathways to impact’ variables, including condom use.https://gh.bmj.com/content/6/4/e003892.full |
| spellingShingle | Frances M Cowan Isolde Birdthistle Sian Floyd James R Hargreaves Joanna Busza Sungai T Chabata Bernadette Hensen Tarisai Chiyaka Phillis Mushati Sithembile Musemburi Jeffrey Dirawo The impact of the DREAMS partnership on HIV incidence among young women who sell sex in two Zimbabwean cities: results of a non-randomised study BMJ Global Health |
| title | The impact of the DREAMS partnership on HIV incidence among young women who sell sex in two Zimbabwean cities: results of a non-randomised study |
| title_full | The impact of the DREAMS partnership on HIV incidence among young women who sell sex in two Zimbabwean cities: results of a non-randomised study |
| title_fullStr | The impact of the DREAMS partnership on HIV incidence among young women who sell sex in two Zimbabwean cities: results of a non-randomised study |
| title_full_unstemmed | The impact of the DREAMS partnership on HIV incidence among young women who sell sex in two Zimbabwean cities: results of a non-randomised study |
| title_short | The impact of the DREAMS partnership on HIV incidence among young women who sell sex in two Zimbabwean cities: results of a non-randomised study |
| title_sort | impact of the dreams partnership on hiv incidence among young women who sell sex in two zimbabwean cities results of a non randomised study |
| url | https://gh.bmj.com/content/6/4/e003892.full |
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