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Table 3 Outcomes, mediators of change in the outcomes, and uptake of DREAMS interventions, to be captured via nested DREAMS cohorts of adolescent girls and young women (in Kenya and South Africa) and young women who sell sex (in Zimbabwe)

From: Evaluating the impact of the DREAMS partnership to reduce HIV incidence among adolescent girls and young women in four settings: a study protocol


AGYW (South Africa and Kenya)

YWSS (Zimbabwe)

13–17 yearsb

18–22 yearsb

18–24 years


n/a a

HIV incidence

Secondary Outcomes

Knows HIV status

Number of lifetime pregnancies


Reduced experience of violence

Incidence & prevalence of HSV-2/other STI

HIV prevalence

Aware of partners’ HIV status

Number of sexual partners

Engaged in transactional sex for economic reasons

Age at first sex

Number of sexual partners in the last 12 months

Use of condoms & PrEP with regular/transactional sex partners

Age at first /subsequent pregnancies

Age at first / subsequent pregnancies

Adherence to HIV treatment and care services

Condom use

Reduced food insecurity

Unmet need for contraception


Age-disparity with sexual partners

HIV risk of sexual partners (to be defined a priori)

No/less transactional sex

Stay in school

In employment or completed vocational / microfinance training

Age at first marriage or first long-term/live-in partner

Mediators of change

(Sample measures of constructs that DREAMS aims to improve, specifically: social assets, personal safety, self-efficacy, common mental disorders, empowerment, gender equitable norms, and sexual relationship power)

Have at least one trusted female friend they can confide in

Have at least one trusted female friend they can confide in

Meet regularly in a safe place with peers

Meet regularly at community mobilization sessions with peers and has increased sense of social cohesion

Know a woman, other than mother/guardian, to turn to if have a serious problem

Can access HIV prevention services including condoms, STI treatment & PrEP (as measure of self-efficacy) and contraceptives


Is supported to adhere to PrEP, and economically able to adhere/access PrEP

Able to avoid / refuse sex if sex is not wanted

Has comprehensive knowledge of HIV prevention

Able to refuse sex if partner will not use a condom (or confident they can use a condom with all sex partners)

Have access to money in an emergency

Confident they could get a HIV test

Is confident she can negotiate condom use with sexual partners (including clients)

Confident they can access health services when they need them (sexual and reproductive health services in particular)

Able to avoid violent relationships

Have access to their own savings


Have access to money in an emergency


Believes a man and woman should decide together whether to use a condom / what type of contraception to use


Uptake of DREAMS interventions

• Invited to participate / enrolled in DREAMS

• Received at least one DREAMS intervention

• Received multiple intervention categories in the DREAMS core package

• Received DREAMS primary or secondary interventions (depending on age and need)

Intervention sites (versus comparison sites)

Within intervention sites, measures of individual uptake will include:

• Received at least one DREAMS intervention

• Received DREAMS package for key populations (‘KP_Prev’c)

• Received KP_Prev + educational subsidies or vocational training

• Received KP_Prev + PrEP

  1. aIn South Africa and Gem, Kenya, HIV incidence will be estimated from the larger population-level studies (see Table 2), for adequate statistical power (see ‘Sample Sizes’ below)
  2. b Age at enrolment, to be followed over two years
  3. c‘KP_Prev’ is the PEPFAR indicator used to measure DREAMS package for key populations and includes condom promotion, HIV testing services, and social asset building [22]