Evaluating the impact of DREAMS on HIV incidence among adolescent girls and young women: A population-based cohort study in Kenya and South Africa.
Evaluating the impact of DREAMS on HIV incidence among adolescent girls and young women: A population-based cohort study in Kenya and South Africa.
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DOI：
10.1371/journal.pmed.1003837
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发表时间：
2021-10
期刊：
影响因子：
15.8
通讯作者：
Floyd S
中科院分区：
文献类型：
--
作者：
Birdthistle I;Kwaro D;Shahmanesh M;Baisley K;Khagayi S;Chimbindi N;Kamire V;Mthiyane N;Gourlay A;Dreyer J;Phillips-Howard P;Glynn J;Floyd S
通过多部门办法，梦想伙伴关系的目标是在撒哈拉以南非洲的高负担地区，在两年内将少女和年轻妇女的艾滋病毒发病率降低40%。DREAMS促进了一系列循证干预措施的组合，以减少年轻女性艾滋病毒风险增加的个人、家庭、伴侣和社区驱动因素。我们在两个环境中评估了梦想对AGYW和年轻男性中艾滋病毒发病率的影响。我们直接估计了2006年至2018年在uMkhanyakude(南非夸祖鲁-纳塔尔)参加人口和艾滋病毒血清学调查的公开人群队列中的艾滋病毒发病率，以及2010年至2019年在Gem(肯尼亚Siaya)进行的6轮以上调查。我们比较了AGYW在2016年梦想开始实施前15至24岁和梦想开始实施后3年的艾滋病毒发病率。我们调查了艾滋病毒发病率发生任何变化的时间，以及在实施DREAMS期间是否加快了任何变化的速度。对年轻男性(20岁至29岁/34岁)也进行了类似的分析。在uMkhanyakude，每年有5,000到6,000名AGYW有资格参加血清学调查，平均有85%的人被接触，同意率从37%到67%不等。在26,395人年(Py)期间，15至19岁女性在实施DREAMS期间(2016至2018)的艾滋病毒发病率低于之前5年期间(每100人年4.5例新感染病例，与之前的2.8例相比；年龄调整比率(ARR)=0.62，95%可信区间[CI]0.48至0.82)，20至24岁(20至24岁)较低(7.1/100人年与5.8例；ARR=0.82，95%可信区间0.65至1.04)。在梦引入之前，从2012年到2013年，年轻女性和老年女性分别从2012年到2013年和2014年开始下降，没有证据表明在梦境实施期间下降更快。在GEM，每轮调查符合条件的AGYW在8,515到11,428人之间，平均34%的人被联系并提供艾滋病毒检测，同意率从84%到99%不等。在10,382年期间，15至19岁青少年中艾滋病毒发病率的下降在做梦之前就开始了，在做梦之后没有改变。在Gem的20-24岁人群中，在梦境实施过程中估计的HIV发病率(0.64/100Py)低于梦前(0.94/100Py)，没有统计证据表明下降(ARR=0.69，95%CI 0.53至2.18)。在年轻男子中，艾滋病毒发病率的下降幅度比AGYW中观察到的更大，而且也是在梦想投资之前就开始了。研究的局限性包括肯尼亚的研究力量较低，以及在研究期间引入了其他干预措施，如艾滋病毒的普遍治疗。在AGYW中观察到艾滋病毒发病率大幅下降，但大多数在引入梦想之前就开始了，并且在实施梦想的头3年没有加速。就像在年轻男性中观察到的下降一样，这些下降可能是由对艾滋病毒检测和治疗的早期和持续投资推动的。需要进行更长期的执行和评估，以评估这种复杂的艾滋病毒预防干预措施的影响，并帮助加快减少年轻妇女的艾滋病毒发病率。Isolde Birdthistle和他的同事评估了一项解决撒哈拉以南非洲青春期女孩和年轻妇女感染艾滋病毒风险的计划。与其他人口群体相比，青春期女孩和年轻妇女感染艾滋病毒的风险很高，需要证据来降低新感染率。DREAMS是AGYW在15个国家联合预防艾滋病毒方面的一大笔投资，其有效性的证据可以指导正在进行的努力，以实现流行病控制和可持续发展目标3，到2030年结束艾滋病这一公共卫生威胁。通过在肯尼亚西部和南非夸祖鲁纳塔尔的人口监测点居住的大量AGYW和年轻男子公开队列，我们比较了梦之前和梦开始实施后长达3年的艾滋病毒发病率。我们调查了艾滋病毒发病率发生变化的时间，以及在实施DREAMS期间发病率是否加速下降。在实施DREAMS的前3年，我们没有观察到DREAMS对AGYW中艾滋病毒发病率降低的额外影响。艾滋病毒发病率的下降在梦想推出之前就开始了。艾滋病毒持续下降的趋势很可能是由艾滋病毒检测、治疗和男性包皮环切术方面的投资推动的，这些投资在梦引入之前并伴随着梦的引入而继续。像DREAM这样复杂的多部门方案需要时间来扩大和加强社会、结构和生物医学干预措施之间的联系，然后才能对艾滋病毒发病率产生可衡量的影响。在uMkhanyakude的AGYW中，艾滋病毒风险的绝对水平仍然很高，而且在这两个环境中，年轻女性的相对风险高于年轻男性，因此需要加强艾滋病毒预防，以加快艾滋病毒发病率的下降。
Through a multisectoral approach, the DREAMS Partnership aimed to reduce HIV incidence among adolescent girls and young women (AGYW) by 40% over 2 years in high-burden districts across sub-Saharan Africa. DREAMS promotes a combination package of evidence-based interventions to reduce individual, family, partner, and community-based drivers of young women’s heightened HIV risk. We evaluated the impact of DREAMS on HIV incidence among AGYW and young men in 2 settings. We directly estimated HIV incidence rates among open population-based cohorts participating in demographic and HIV serological surveys from 2006 to 2018 annually in uMkhanyakude (KwaZulu-Natal, South Africa) and over 6 rounds from 2010 to 2019 in Gem (Siaya, Kenya). We compared HIV incidence among AGYW aged 15 to 24 years before DREAMS and up to 3 years after DREAMS implementation began in 2016. We investigated the timing of any change in HIV incidence and whether the rate of any change accelerated during DREAMS implementation. Comparable analyses were also conducted for young men (20 to 29/34 years). In uMkhanyakude, between 5,000 and 6,000 AGYW were eligible for the serological survey each year, an average of 85% were contacted, and consent rates varied from 37% to 67%. During 26,395 person-years (py), HIV incidence was lower during DREAMS implementation (2016 to 2018) than in the previous 5-year period among 15- to 19-year-old females (4.5 new infections per 100 py as compared with 2.8; age-adjusted rate ratio (aRR) = 0.62, 95% confidence interval [CI] 0.48 to 0.82), and lower among 20- to 24-year-olds (7.1/100 py as compared with 5.8; aRR = 0.82, 95% CI 0.65 to 1.04). Declines preceded DREAMS introduction, beginning from 2012 to 2013 among the younger and 2014 for the older women, with no evidence of more rapid decline during DREAMS implementation. In Gem, between 8,515 and 11,428 AGYW were eligible each survey round, an average of 34% were contacted and offered an HIV test, and consent rates ranged from 84% to 99%. During 10,382 py, declines in HIV incidence among 15- to 19-year-olds began before DREAMS and did not change after DREAMS introduction. Among 20- to 24-year-olds in Gem, HIV incidence estimates were lower during DREAMS implementation (0.64/100 py) compared with the pre-DREAMS period (0.94/100 py), with no statistical evidence of a decline (aRR = 0.69, 95% CI 0.53 to 2.18). Among young men, declines in HIV incidence were greater than those observed among AGYW and also began prior to DREAMS investments. Study limitations include low study power in Kenya and the introduction of other interventions such as universal treatment for HIV during the study period. Substantial declines in HIV incidence among AGYW were observed, but most began before DREAMS introduction and did not accelerate in the first 3 years of DREAMS implementation. Like the declines observed among young men, they are likely driven by earlier and ongoing investments in HIV testing and treatment. Longer-term implementation and evaluation are needed to assess the impact of such a complex HIV prevention intervention and to help accelerate reductions in HIV incidence among young women. Isolde Birdthistle and co-workers evaluate a program to address risks of HIV infection in adolescent girls and young women in sub-Saharan Africa. Adolescent girls and young women (AGYW) experience high risk of HIV infection relative to other demographic groups, and evidence is needed to drive down the rate of new infections. DREAMS is a large investment in combination HIV prevention for AGYW in 15 countries, and evidence of its effectiveness can guide ongoing efforts to achieve epidemic control and Sustainable Development Goal 3 to end AIDS as a public health threat by 2030. With large open cohorts of AGYW and young men resident in demographic surveillance sites in western Kenya and KwaZulu Natal, South Africa, we compared HIV incidence before DREAMS and up to 3 years after DREAMS implementation began. We investigated the timing of any change in HIV incidence and whether any decline in incidence rates accelerated during DREAMS implementation. In the first 3 years of DREAMS implementation, we did not observe an additional effect of DREAMS on HIV incidence reductions among AGYW. Declines in HIV incidence began before DREAMS rollout. The ongoing trend in HIV decline is most likely driven by investments in HIV testing, treatment, and male circumcision that preceded DREAMS introduction and continued alongside it. A complex, multisectoral programme like DREAMS needs time to scale up and strengthen linkages between social, structural, and biomedical interventions before it can yield measurable impacts on HIV incidence rates. With absolute levels of HIV risk remaining high for AGYW in uMkhanyakude, and relative risk higher among young females than young males in both settings, strengthening of HIV prevention is needed to accelerate HIV incidence declines.
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影响因子：
3.7
作者：
Chimbindi N;Mthiyane N;Birdthistle I;Floyd S;McGrath N;Pillay D;Seeley J;Zuma T;Dreyer J;Gareta D;Mutevedzi T;Fenty J;Herbst K;Smit T;Baisley K;Shahmanesh M
通讯作者：
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影响因子：
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通讯作者：
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作者：
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影响因子：
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作者：
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通讯作者：
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