Study shows PEPFAR program for adolescent girls should be modified

Study findings presented at CROI showed that a United States-funded program designed to reduce the risk for HIV infection in adolescent girls and young women in high-burden countries had some impact among teenagers in Uganda, but several interventions produced no effects and researchers said the program needs to be modified.

The study evaluated a program initiated by the President’s Emergency Plan for AIDS Relief called Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe (DREAMS). It was conducted in Rakai, Uganda, a rural community with a high HIV prevalence where the first HIV cases in East Africa were identified in the 1980s.

Hadijja Nakawooya, a data management officer from the Rakai Health Sciences Program, and colleagues identified 1,945 adolescent girls and young women aged between 15 and 24 years who participated in the Rakai community cohort study survey between June 2018 and August 2019.

They assessed DREAMS interventions that included combined socioeconomic approaches, HIV testing and counseling, and the stepping stones program, a participatory intervention for HIV prevention and strengthening relationship skills.

“After the implementation of programs in 22 committee cohort study areas, the tests were completed by adolescent girls and young women who were tested for HIV, cancer and provided services and information on HIV risk behaviors” such as sexual debut, being sexually active, having nonmarital sexual partners, transactional sex, alcohol use and condom use with nonmarital partners. Nakawooya said during her CROI presentation.

According to findings, girls aged 15 to 19 years who participated in at least 10 stepping stones sessions experienced a “significant” reduction in nonmarital sexual partners (adjusted prevalence rate ratio [PRR] = 0.54; 95% CI, 0.36-0.93), sexual debut (aPRR = 0.61; 95% CI, 0.42-0.86) and being sexually active (aPRR = 0.55; 95% CI, 0.37-0.81). Those who participated in at least five stepping stones sessions had a reduction in alcohol use (aPRR = 0.23; 95% CI, 0.1-0.52.).

“Overall, we see a reduction in risk behaviors with the increasing number of sessions,” Nayawooya said. “Receiving 10 or more sessions of stepping stones [was] associated with significant reduction in the sexual risk behaviors.”

However, the other two interventions showed no effect in this cohort, and none of the DREAMS interventions had any impact among study participants aged 20 to 24 years, the researchers reported. – by Ken Downey Jr.

Reference:
Nakawooya H, et al. Abstract 94. Presented at: Conference on Retroviruses and Opportunistic Infections; March 8-11, 2020; Boston.

Disclosures: The authors report no relevant financial disclosures.