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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
Primary 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]