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. 2025 Apr 3:82:103176.
doi: 10.1016/j.eclinm.2025.103176. eCollection 2025 Apr.

The effects of the Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe (DREAMS) program on HIV incidence and other health-related outcomes among adolescent girls and young women: a systematic review and meta-analysis

Marie-Claude C Lavoie  1   2   3 , Natalia Blanco  1   2 , Taylor Lascko  1   2 , Caitlin Baumhart  1   2 , Jos Verbeek  4 , Kirsten Stoebenau  5 , Cassidy W Claassen  1   2   6 , Linah K Mwango  7 , Brianna Lindsay  1   2 , Ndwapi Ndwapi  8 , Caroline Ngeno  9 , Emily Koech  10 , Emilie Ludeman  11 , Man Charurat  1   2   3 , Kristen A Stafford  1   2   3
Affiliations

The effects of the Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe (DREAMS) program on HIV incidence and other health-related outcomes among adolescent girls and young women: a systematic review and meta-analysis

Marie-Claude C Lavoie et al. EClinicalMedicine. .

Abstract

Background: In sub-Saharan Africa, adolescent girls and young women are twice as likely to be living with HIV as their male counterparts. This systematic review assesses the impact of the Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe (DREAMS) program on health-related outcomes, access to services, sexual risk behaviors, and HIV knowledge.

Methods: We searched different databases and conference abstracts from January 2014 to April 2024. We included studies where DREAMS was the primary intervention. We completed meta-analyses using random effects models. Risk of bias and certainty of evidence were assessed. PROSPERO: CRD42022340294.

Findings: Seven unique studies were included. The incidence rate ratio (IRR) of HIV incidence was 0.74 (95% CI: 0.63-0.87, 1 study) in DREAMS compared to the comparison group. For self-report of sexually transmitted infections (STI) symptoms, the IRR was 0.84 (95% CI: 0.71-0.98, 1 study). The odds ratio (OR) for awareness of HIV status was 2.34 (95% CI: 1.23-4.44, 1 study). The risk ratio for HIV testing was 1.17 (95% CI: 1.05-1.30, 1 study). For condom use, the OR was 1.22 (95% CI: 0.86-1.72, 1 study). For transactional sex, the OR was 0.99 (95% CI: 0.69-1.41). The OR for the number of sexual partners was 0.74 (95% CI: 0.60-0.91, 1 study).

Interpretation: The evidence suggests that DREAMS results in a reduction in HIV incidence and STI symptoms. DREAMS may result in a slight increase in the uptake of HIV testing and a large increase in awareness of HIV status. DREAMS may also reduce the number of sexual partners. Developing a unified and granular evaluation framework would be beneficial in advancing research and generating evidence on DREAMS.

Funding: No funding source.

Keywords: Adolescent girls and young women; DREAMS; HIV; Pre-exposure prophylaxis.

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Conflict of interest statement

MCL, NB, TL, CB, KS, CWC, LKM, BL, NN, CN, EK, MC, and KAS have received grants from the US Centers for Disease Control and Prevention (CDC), the National Institutes of Health (NIH), and/or The United States Agency for International Development (USAID) for work not directly related to this project. CWC has received consulting fees for Gilead for work unrelated to this project. CN has served in a leadership or fiduciary unpaid role for Spur Afrika Board. EK received support for attending meetings and/or travel from NIH. MC reports unpaid data safety monitoring boards for NIH (UH3HD096929) and the Institute of Human Virology. MC serves in a leadership or fiduciary unpaid role for several boards (Ciheb-Kenya, Ciheb-Zambia, Ciheb-Tanzania, Ciheb-Malawi, Bummhi). KAS reports unpaid data safety monitoring board at the Institute of Human Virology. KAS serves in a leadership or fiduciary unpaid role for MGIC-Nigeria. JV and EL report no conflict of interest.

Figures

Fig. 1
Fig. 1
Study diagram.
Fig. 2
Fig. 2
HIV incidence forest plot.
Fig. 3
Fig. 3
STI Self-reported symptoms forest plot.
Fig. 4
Fig. 4
Awareness of HIV status forest plots.
Fig. 5
Fig. 5
Uptake of HIV testing forest plot for A) prospective cohorts and B) UCBA.
Fig. 6
Fig. 6
Condom use forest plots for A) prospective cohorts and B) UCBA.
Fig. 7
Fig. 7
Transactional sex forest plots for A) prospective cohorts and B) UCBA.
Fig. 8
Fig. 8
Lifetime sexual partners forest plots for A) prospective cohorts and B) UCBA.
See this image and copyright information in PMC

References

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