2025/01/01 by S N Mulwa · 1 voice
Health Professions · Medicine · Social Sciences · #Adolescent Sexual and Reproductive Health #HIV/AIDS Research and Interventions #Poverty, Education, and Child Welfare
paper · pdf · doi:10.17037/pubs.04678299
openalex publication_date 2025/01/01 · openalex created_date 2026/01/29 · openalex updated_date 2026/07/01
Background: HIV programming has shifted from single interventions to combination prevention to address multiple sources of HIV vulnerability. The DREAMS Partnership, targeting adolescent girls and young women (AGYW), offers a package of interventions with a goal of reducing HIV incidence and addressing broader health and social determinants. While evidence of DREAMS impact is growing, the mechanisms linking participation to outcomes remain unclear. This PhD explored these pathways by triangulating evidence from a systematic review and analyses of AGYW cohort data in two Kenyan settings (2016–19). Methods: Using a systematic review and meta-analysis, I synthesised evidence of the effectiveness of multi-component HIV prevention interventions among adolescents and young people (AYP; ages 10–24 years) published between 2010 and 2023. Guided by existing literature and DREAMS program framework, I developed a conceptual model proposing that DREAMS influences HIV-related outcomes (knowledge of HIV status, sexual partnerships, and condom use) by improving psychosocial and socioeconomic factors, and used causal mediation analysis to quantify these links. Results: Multi-component interventions improved knowledge of HIV status and strengthened psychosocial factors, including self-efficacy, HIV/SRH knowledge, and social support; but had little impact on sexual behaviours; and data on PrEP were limited. Some reductions in HIV incidence were observed, primarily in “before-after” evaluations over longer periods (~5–10 years). Interventions with consistent effects across outcomes often engaged the community and used multiple strategies to reach AYP. In the AGYW cohort in Kenya, analyses indicated that DREAMS modestly improved psychosocial factors, particularly knowledge of HIV prevention, control over condom use, social support, and personal safety; but had limited effects on socioeconomic factors. Although these psychosocial factors were associated with one or more HIV outcomes, there was no clear statistical evidence of indirect effects through them. Conclusions: The review indicates that multi-component interventions for AYP improve a range of health and social outcomes, though impacts on sexual behaviours remain limited, highlighting the need for innovative strategies. DREAMS analyses provide preliminary evidence that positive shifts in psychosocial factors among AGYW are possible at scale in real-world settings. However, the associations with outcomes may not have been sufficient to produce clear mediated effects.