Maximizing combination HIV prevention, uptake and retention by adolescent girls and young women

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PROJECT SUMMARY Our overarching goal is to arrest the HIV epidemic and its negative impact on young people in sub-Saharan African (SSA) through improving the uptake, retention, and adherence of multi-level combination HIV prevention by Adolescent Girls and Young Women and male partners. South Africa has an estimated 7.8 million people living with HIV. Despite having the largest HIV treatment program in the world, HIV incidence in Adolescent Girls and Young Women (AGYW aged 15-24) remains high. Whilst there have been significant innovations in HIV prevention, e.g., universal test and treat (UTT) and Pre-exposure prophylaxis (PrEP), this has far outpaced the ability to deliver them. To control the HIV epidemic here is an urgent to significantly improve uptake and retention of HIV care and prevention by AGYW and male partners. In this project we had a unique opportunity to leverage time-sensitive events in a poor and rural hyperendemic area of KwaZulu-Natal: The roll out of eight new youth-focused multi-level HIV prevention interventions for AGYW and their male partners by PEPFAR’s Determined, Resilient, Empowered, AIDS free, Mentored, and Safe (DREAMS) program in the context of a state of the art demographic and health surveillance, where data on individual HIV biomarkers, sexual behaviors, HIV prevention and ART exposure are linked to public-sector clinical records for HIV. We achieved this through three aims. Specific aim 1: We quantified how multiple levels of social dynamics interact to predict uptake of DREAMS components. Specific aim 2: We elucidated how individuals’ life-course and exposure to DREAMS affect retention and adherence to HIV care and prevention. We found that: a) Despite high coverage, DREAMS did not accelerate decline in HIV incidence. b) HIV incidence decline were explained by increases in men’s access to HIV treatment, although barriers remain for young men. c) There is a high unmet sexual health need and self-testing, and self-sampling were popular. d) Targeted Pre-Exposure prophylaxis (PrEP) didn’t reach AGYW most at risk, whilst peer- navigators did. Specific aim 3: Ascertain whether family- and peer-network strategies improve uptake and adherence to combination prevention interventions by young people. We worked with youth to interrogate the findings and co-create an intervention. The result, Thetha Nami, (Talk to Me) consists of trained and supervised peer-navigators who provide health promotion to young people; youth-friendly clinical services; and peer-mentorship to improve retention in HIV prevention. We are currently testing the acceptability and feasibility of this approach on improving adolescents and youth uptake and retention of HIV care and prevention. Our multidisciplinary team includes HIV epidemiologists, a biostatistician, social scientists, psychologist, and intervention development expertise in South Africa. Moving forward, this will provide answers to: ‘Can peers and community-level interventions harness the full mortality and HIV incidence reducing potential of HIV prevention for adolescents and young people in rural SSA?’