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. 2024 May 31;4(5):e0003258.
doi: 10.1371/journal.pgph.0003258. eCollection 2024.

Uptake of multi-level HIV interventions and HIV-related behaviours among young people in rural South Africa

Nondumiso Mthiyane  1   2 , Maryam Shahmanesh  1   2   3 , Andrew Copas  2 , Natsayi Chimbindi  1   2   3 , Jaco Dreyer  1 , Thembelihle Zuma  1   2   3 , Nuala McGrath  1   3   4 , Kathy Baisley  1   5 , Sian Floyd  5 , Isolde Birdthistle  5 , Lorraine Sherr  2 , Janet Seeley  1   6 , Guy Harling  1   2   7   8
Affiliations

Uptake of multi-level HIV interventions and HIV-related behaviours among young people in rural South Africa

Nondumiso Mthiyane et al. PLOS Glob Public Health. .

Abstract

Combination HIV prevention packages have reduced HIV incidence and improved HIV-related outcomes among young people. However, there is limited data on how package components interact to promote HIV-related prevention behaviours. We described the uptake of HIV prevention interventions supported by Determined, Resilient, Empowered, AIDS-free, Motivated and Safe (DREAMS) Partnership and assessed the association between uptake and HIV-related behaviours among young people in rural KwaZulu-Natal, South Africa. We analysed two cohorts followed from May 2017 to December 2019 to evaluate the impact of DREAMS, covering 13-29 year-old females, and 13-35 year-old males. DREAMS interventions were categorised as healthcare-based or social. We described the uptake of interventions and ran logistic regression models to investigate the association between intervention uptake and subsequent protective HIV-related outcomes including no condomless sex and voluntary medical male circumcision (VMMC). For each outcome, we adjusted for socio-demographics and sexual/pregnancy history and reported adjusted odds ratios (aOR) and 95% confidence intervals (CI). Among 5248 participants, uptake of healthcare interventions increased from 2018 to 2019 by 8.1% and 3.7% for males and females respectively; about half of participants reported receiving both healthcare and social interventions each year. The most utilised combinations of interventions included HIV testing and counselling, school-based HIV education and cash transfers. Participation in social interventions only compared to no intervention was associated with reduced condomless sex (aOR = 1.60, 95%CI: 1.03-2.47), while participation in healthcare interventions only was associated with increased condomless sex. The uptake of interventions did not significantly affect subsequent VMMC overall. Among adolescent boys, exposure to school-based HIV education, cash transfers and HIV testing and counselling was associated with increase in VMMC (aOR = 1.79, 95%CI: 1.04-3.07). Multi-level HIV prevention interventions were associated with an increase in protective HIV-related behaviours emphasizing the importance of accessible programs within both school and community settings for young people.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Recruitment and participation flowchart.
Fig 2
Fig 2. Causal model indicating the hypothesized exposure-outcome relationship.
Fig 3
Fig 3. Uptake of interventions, by age, gender and year of survey.
Fig 4
Fig 4. Uptake of multi-level interventions, by age and year of survey.
Fig 5
Fig 5. Uptake of combination of HIV prevention interventions in 2018.
See this image and copyright information in PMC

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