Socio-demographic and programmatic factors associated with access to ‘layered’ interventions among adolescent girls and young women in selected sites in Nairobi, Kenya

Julius N. Nguku; Sam W. Wafula; Janet W. Gathogo; Faith W. Kamau; Gibson W. Nganga; Joseph N. Makau; Emily C. Koech; Rebecca N. Wangusi; Immaculate Mutisya; Carol Ngunu

doi:10.18203/2394-6040.ijcmph20250297

Authors

Julius N. Nguku HOPE worldwide Kenya, CONNECT DREAMS, Nairobi, Kenya
Sam W. Wafula Center for International Health, Education, and Biosecurity (CIHEB), Kenya, Nairobi, Kenya
Janet W. Gathogo HOPE worldwide Kenya, CONNECT DREAMS, Nairobi, Kenya
Faith W. Kamau HOPE worldwide Kenya, CONNECT DREAMS, Nairobi, Kenya
Gibson W. Nganga HOPE worldwide Kenya, CONNECT DREAMS, Nairobi, Kenya
Joseph N. Makau Center for International Health, Education, and Biosecurity (CIHEB), Kenya, Nairobi, Kenya
Emily C. Koech Center for International Health, Education, and Biosecurity (CIHEB), Kenya, Nairobi, Kenya
Rebecca N. Wangusi Center for International Health, Education, and Biosecurity (CIHEB), Kenya, Nairobi, Kenya
Immaculate Mutisya US Centres for Disease Control and Prevention (CDC), Global Health Centre, Kenya, Division of Global HIV and TB, Nairobi, Kenya
Carol Ngunu Promotive and Preventive Health Department, County Government of Nairobi, Nairobi, Kenya

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20250297

Keywords:

AGYW, DREAMS, Kenya

Abstract

Background: Adolescent girls and young women (AGYW) aged 9-24 years are three times more likely to be newly infected with human immunodeficiency virus (HIV) as compared to their male counterparts. Determined, resilient, empowered AIDS-free, mentored, and safe (DREAMS) program aims to reduce rates of HIV infection among AGYW. This study aimed to identify socio-demographic and programmatic factors associated with access to a minimum package of evidence-based interventions to which AGYW are exposed (referred to as ‘layering’ in the program).

Methods: Retrospective cross-sectional routine program data abstraction was done for 21,616 AGYW receiving DREAMS services in four DREAMS program sites in Nairobi County between April 2022 to September 2022. Study variables were age, time since DREAMS enrolment, level of education, and number of social asset building (SAB) sessions attended. Logistic regression was used to determine the net factors associated with access to the interventions.

Results: The mean age of the respondents was 16.8 and the median number of SAB sessions attended was 8. Attending ten or more SAB sessions was associated with increased odds of accessing multiple evidence-based interventions (AOR=3.828; CI: 3.492-4.196; p<0.001). Similarly, attaining secondary education and staying in the program for more than 12 months were significantly (p<0.0001) associated with being layered. Being layered was associated with having more than ten SAB sessions irrespective of the age of the AGYW or duration in the DREAMS program.

Conclusions: To improve access to multiple evidence-based interventions, it may be important to emphasize increasing the number of SAB sessions for the AGYWs.

Metrics

Metrics Loading ...

References

UNAIDS. Global AIDS Update. 2022. Available at: https://www.unaids.org/en/resources/documents/2022/in-danger-global-aids-update. Accessed on 03 August 2024.

Murewanhema G, Musuka G, Moyo P, Moyo E, Dzinamarira T. HIV and adolescent girls and young women in sub‐Saharan Africa: A call for expedited action to reduce new infections. IJID Regions. 2022;5:30-2. DOI: https://doi.org/10.1016/j.ijregi.2022.08.009

UNAIDS data book. 2022. Available at: https://www.unaids.org/sites/default/files/media_asset/data-book-2022_en.pdf. Accessed on 03 August 2024.

AIDS info team. UNAIDS Estimates. 2022. Available at: https://aidsinfo.unaids.org/?did=5f010 acb629b296603d55aa6&r=world&t=2021&tb=d&bt=dnli&ts=0,0&tr=world&aid=5f010bcf629b296603d55aa9&sav=Population. Accessed on 18 July 2024.

National Syndemic Diseases Control Council. World AIDS Day 2022 Progress Report: It’s a race against time. 2023. Available at: https://nsdcc.go.ke/wp-content/uploads/2022/12/WAD-Report_F4-1.pdf. Accessed on 18 July 2024.

Mthiyane N, Baisley K, Chimbindi N, Zuma T, Okesola N, Dreyer J, et al. The association of exposure to DREAMS on sexually acquiring or transmitting HIV amongst adolescent girls and young women living in rural South Africa. AIDS. 2022;36(1):S39-49. DOI: https://doi.org/10.1097/QAD.0000000000003156

Ziraba A, Orindi B, Muuo S, Floyd S, Birdthistle J, Mumah J, et al. Understanding HIV risks among adolescent girls and young women in informal settlements of Nairobi, Kenya: Lessons for DREAMS. PloS One. 2018;13(5):e0197479. DOI: https://doi.org/10.1371/journal.pone.0197479

Karim Q, Baxter C, Birx D. Prevention of HIV in adolescent girls and young women: Key to an AIDS-free generation. JAIDS J Acquired Immune Deficiency Syndromes. 2017;75:S17-26. DOI: https://doi.org/10.1097/QAI.0000000000001316

Saul J, Bachman G, Allen S, Toiv NF, Cooney C, Beamon T. The DREAMS core package of interventions: a comprehensive approach to preventing HIV among adolescent girls and young women. PLoS One. 2018;13(12):e0208167. DOI: https://doi.org/10.1371/journal.pone.0208167

Office of the U.S. Global AIDS Coordinator and Health Diplomacy. DREAMS layering guidance. Washington D.C: United States President’s Emergency Plan for AIDS Relief. 2017.

Mathur S, Mishra R, Mahapatra B, Heck C, Okal J. Assessing layered HIV prevention programming: Optimizing outcomes for adolescent girls and young women. AIDS. 2022;36(1):S75-83. DOI: https://doi.org/10.1097/QAD.0000000000003242

Hallman K, Nentsha E. Siyakha: Building economic, health, and social capabilities among highly vulnerable adolescents in KwaZulu-Natal, South Africa Population Council. 2011. DOI: https://doi.org/10.31899/pgy12.1015

Pettifor A, Stoner M, Pike C, Bekker LG. Adolescent lives matter: preventing HIV in adolescents. Curr Opin HIV AIDS. 2018;13(3):265-73. DOI: https://doi.org/10.1097/COH.0000000000000453

Norusis M. SPSS 26.0 statistical procedures companion. Prentice Hall Press. 2019.

Yamanis TN, Mulawa MI, Kilonzo MN, Maman S, Singh B, Kajula L. Reaching Out-of-school Adolescent Girls and Young Women at Risk for HIV Through Their Social Networks. AIDS Behavior. 2024;28(5):1457-68. DOI: https://doi.org/10.1007/s10461-023-04168-z

Kamire V, Magut F, Khagayi S, Kambona C, Muttai H, Nganga L, et al. HIV risk factors and risk perception among adolescent girls and young women: results from a population-based survey in Western Kenya, 2018. JAIDS J Acquired Immune Deficiency Syndromes. 2022;91(1):17-25. DOI: https://doi.org/10.1097/QAI.0000000000003021

Wodon Q, Male C, Montenegro C, Nguyen H, Onagoruwa A. Educating girls and ending child marriage: A priority for Africa. The cost of not educating girls notes series. Washington, DC: The World Bank. 2018.

Mee P, Fearon E, Hassan S, Hensen B, Acharya X, Rice BD, Hargreaves JR. The association between being currently in school and HIV prevalence among young women in nine eastern and southern African countries. PloS One. 2018;13(6):e0198898. DOI: https://doi.org/10.1371/journal.pone.0198898

Legarth R, Omland LH, Kronborg G, Larsen CS, Gerstoft J, Obel N. Educational attainment and risk of HIV infection, response to antiretroviral treatment, and mortality in HIV-infected patients. AIDS. 2014;28(3):387-96. DOI: https://doi.org/10.1097/QAD.0000000000000032

Phiri MM, Hensen B, Sigande LM, Floyd S, Schaap AJ, Simuyaba M, et al. Factors associated with use of community-based, peer-led sexual and reproductive health services by adolescent boys and young men aged 18–24 in Lusaka, Zambia: A case control study nested in the Yathu Yathu trial. PLOS Global Public Health. 2023;3(11):e0002446. DOI: https://doi.org/10.1371/journal.pgph.0002446

McClinton A, Duby Z, Jonas K, Dietrich J, Maruping K, Abdullah F, et al. Factors influencing adolescent girls and young women’s participation in a combination HIV prevention intervention in South Africa. BMC Public Health. 2021;21:1-7. DOI: https://doi.org/10.1186/s12889-021-10462-z