Background: The U.S. President''s Emergency Plan for AIDS Relief''s (PEPFAR) launched the Determined, Resilient, Empowered, AIDS-Free, Mentored and Safe (DREAMS) Public-Private Partnership in 2014 with the goal of preventing HIV in adolescent girls and young women (AGYW) in ten high HIV burdened African countries. PEPFAR complemented DREAMS activities for AGYW with increased funding to ensure saturation of HIV services for young adult men in DREAMS districts, including HIV testing (HTS), treatment, and voluntary medical male circumcision (VMMC).
Here we compare DREAMS and similar non-DREAMS districts in five countries to examine changes in HTS, VMMC, and treatment results after two years of DREAMS implementation (2015-2017).
Methods: Countries were selected for inclusion if they met the following criteria: there were comparable non-DREAMS districts that were originally considered for DREAMS or will begin DREAMS implementation in 2018; and districting remained consistent from 2015-2017.
PEPFAR indicators were used to analyze total number of VMMCs completed, clients tested, and new clients on treatment for males 15-49 years in DREAMS and non-DREAMS districts. Annual results from 2015 and 2017 were compared and a percent change was calculated. A series of generalized linear mixed models, based on a Poisson distribution, were used to assess the difference between DREAMS vs. non-DREAMS districts. We controlled for false discovery rate for multiple hypothesis testing.
Results: The generalized linear mixed models showed significant positive differences (p-value < 0.001) between DREAMS vs. non-DREAMS districts in three countries for an increase in new on treatment, three countries for increase in total number tested, and two countries for an increase in VMMCs supported. Results are shown in the table.
Conclusions: Change in VMMC, HTS, and treatment results for men ages 15-49 in DREAMS vs. non-DREAMS districts varied. In DREAMS districts that showed a greater percent increase vs. non-DREAMS districts in testing and treatment indicators, data suggest that focusing on treatment as prevention for male partners during DREAMS implementation may be associated with an increase in these services. Variation in results emphasizes the need for continued efforts in reaching young adult men and in reaching AGYW with structural and combination prevention to interrupt the cycle of heterosexual HIV transmission.