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Authors: Nguku, Julius N. 1;Gathogo,Janet W. 1 ;Kamau,Faith W.1; Nganga,Gibson W. 1 ; Makau,Joseph 2 ; Koech,Emily 2; Wangusi, Rebecca N. 2 ; Kenyatta,Wyckliffe O.3; Mutisya,Immaculate 3 ; Ngunu,Caroline 4 ;Wafula, Samuel2

Presenting Author: Dr Julius N. Nguku

HOPE worldwide Kenya

Affiliations: 1-HOPE worldwide Kenya; 2-CIHEB-Kenya; 3-CDC-Kenya;

4-Nairobi City County Department of Preventive and Promotive Health

Track D7-Adolescents, Young People and HIV

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Introduction

  • Adolescent Girls and Young Women (AGYW) aged between 9 and 24 years are twice as likely to be infected with HIV and 3 times more likely to be newly HIV infected as compared with males of similar age
  • Determined, Resilient, Empowered AIDS-free, Mentored and Safe (DREAMS) Program aims to reduce rates of HIV infection among AGYW through ‘layered’ evidence-based interventions.
  • The program defines ‘Layering’ as the “Age-appropriate provision of multiple interventions or services from the DREAMS core package to each DREAMS recipient aged 9-24 years”
  • HOPE worldwide Kenya is implementing DREAMS project in Nairobi as part of the County Ownership and Networks to maintain Nairobi Epidemic Control (CONNECT) Program as a sub-grant of CIHEB-Kenya, funded by CDC

​

​

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DREAMS Theory of Change

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Method

Geographical coverage of the CONNECT DREAMS Program

44 wards, 15 sub counties in 18 sites in Nairobi’s Informal Settlements

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DREAMS primary package of services provided

10-14 years

15-17 years

18-24 years

  1. Social Asset Building
  2. Financial Literacy/Capability Training
  3. Healthy Choices For a Better a Future (HCBF)-violence and HIV prevention
  4. HIV risk screening
  5. GBV screening
  1. Social Asset Building
  2. Financial Literacy/Capability Training
  3. Violence and HIV prevention-My Health My Choice (MHMC)
  4. HIV risk screening
  5. GBV screening
  6. HIV testing and/or linkage to testing
  7. Condom, PrEP and FP education
  8. STI Screening
  1. Social Asset Building
  2. Financial Literacy/Capability Training
  3. Violence and HIV prevention-SHUGA for 18-19 years.
  4. HIV risk screening
  5. GBV screening
  6. STI screening
  7. HIV testing and/or linkage to testing
  8. Condom, PrEP and FP education
  9. Entrepreneurship Training

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DREAMS secondary package of services provided

Intervention

Services

Biomedical services

HTS testing, PrEP, PEP, STI treatment, TB treatment, Family planning, HPV, cervical cancer screening

Post Violence Care (PVC)

  • PSS/trauma counselling
  • Biomedical: ECP, STI screening/treatment, HTS,PEP
  • Linkage to legal services, rescue/shelter, examination/treatment of major injuries.
  • Others: Social protection including economic strengthening

Education Subsidies

  • School fees
  • Education materials
  • Annual supply of dignity pack

Comprehensive Economic Strengthening

  • Business Start-up.
  • Apprenticeship.
  • Entrepreneurship Support.
  • Vocational Skills Training.
  • Linkage to Micro finance
  • Linkage to employment/internship

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Data collection and Analyses

  • Study participants
    • The Project served 21,616 AGYW in four sites in Nairobi: Savannah, Kayole, Kitusuru, Kiambiu.
    • We examined layering status of the AGYW served during the 6-month period, April-Sep 2022

​

  • Study variables
    • Independent variable-Layering Status
    • Dependent variables: age, number of contact days SAB sessions, time since enrolment in months, site type (high volume versus low volume), schooling status, and level of education.

​

  • Data Analyses
    • Routine program data was abstracted in an excel and exported to analytic SPSS version 26 software
    • The results were presented as proportions and OR with 95% C.I calculated to determine the differences in layering status of the AGYW with the different dependent variables.

​

  • Ethical Issues
    • Study involved scrutiny of routine data, thus no invasive procedures requiring human subject participation. Analytic data was stripped of all personal identifiers.
    • CIHEB-Kenya has obtained non-research determination approval from tthe Centers of Disease Control.

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Results

Age of the AGYW

​

Site Type

​

Time Since Enrollment

​

Level of Education

​

Schooling Status

​

Contact Days at SABs

10-14 yrs

15-19 yrs

20-24 yrs

​

Low Volume

High Volume

​

0-6 months

7-12 months

13-24 months

​

Primary and Below

Secondary and Above

​

In School

Out-of-School

​

>10 days

10 or less days

6,742

9,137

5,737

​

5,471

16,145

​

129

7,410

11,759

​

12,840

8,776

​

17,294

4,322

​

4,817

16,799

31%

42%

27%

​

25%

75%

​

1%

34%

54%

​

59%

41%

​

80%

20%

​

22%

78%

Social Demographic and Programmatic Factors of AGYW in the 4 DREAMS CONNECT project sites (n=21,616)

  • The average age of the AGYW was 16.8 years(IQR 12.9-20.7) years
  • 16,799, 78% of the AGYW had attended 10 or less SAB sessions compared to 4,817 (22%) who had attended more than 10 SAB session during the 6-month period.
  • The median number of SAB contact days was 8 (IQR 4-10) days

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Bivariate Analyses-Associations between programmatic and demographic characteristics with layering status of AGYW

​

​

​

Layered

Not Layered

OR

95% CI

p-value

Contact days at SAB

>10 contact days

4,817

3,935

82%

882

18%

2.758

2.548-2.986

p<0.0001**

<=10 contact days

16,799

10,381

62%

6418

38%

Age of AGYW

10-14 yrs

6,742

4,550

68%

2,192

32%

1.201

1.115-1.293

p<0.0001**

15-19 yrs

9,137

6,322

69%

2,815

31%

1.299

1.212-1.396

p<0.0001**

20-24 yrs

5,737

3,634

63%

2,103

37%

ref

Site Type

Low volume

5,471

4,525

83%

946

17%

3.104

2.875-3.352

p<0.0001**

High Volume

16,145

9791

61%

6,354

39%

ref

Predictors of being layered:more than 10 contact days at SABs, younger than 20 years, being in a low volume site

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​

​

​

Layered

Not Layered

OR

95% CI

p-value

Time since enrolment

0-6

months

129

64

50%

65

50%

ref

​

7-12 months

7,410

4,480

61%

2,930

39%

1.553

1.096-2.199

p=0.013

13-24 months

11,759

7,881

67%

3,878

33%

2.064

1.458-2.921

p<0.0001

25+

months

2,318

2,081

90%

237

10%

8.912

6.158-12.916

p<0.0001

​

Level of Education of AGYW

Primary and below

12,840

8047

62.7%

4,793

37.3%

ref

Secondary and above

​

8,776

​

6459

​

74%

​

2,317

​

26%

​

1.146

​

1.660-1.762

p<0.0001

Schooling Status

In school

17,294

9,338

54%

7,956

46%

ref

Out of School

​

4,322

​

2,722

​

63%

​

1,600

​

37%

​

1.449

​

1.353-1.552

p<0.0001

Bivariate Analyses-Associations between programmatic and demographic characteristics with layering status of AGYW (Contd)

Predictors of being layered: older than 6 months in the program, secondary school education, being out-of-school

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Layering Status by time since enrolment of the AGYW. The results show that the longer an AGYW stays on the Program, the more likely she is to be layered. O.Rs and p-values comparing with AGYW in the program for 0-6 months are inset

Layering with Time since Enrolment

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Pearson’s correlation coefficients showing associations between pairs of variables

​

Age in years

Level of Schooling

Time since enrolment

Number of SAB Contact days

Layered Status

Age in years

Pearson Correlation

1

Sig. (2-tailed)

Level of Schooling

Pearson Correlation

0.466**

1

Sig. (2-tailed)

p<0.0001

Time since enrolment

Pearson Correlation

0.169**

-0.010

1

Sig. (2-tailed)

p<0.0001

P=0.137

Number of SAB Contact days

Pearson Correlation

-0.253**

0.041**

-0.231**

1

Sig. (2-tailed)

p<0.0001

p<0.0001

p<0.0001

Layered Status

Pearson Correlation

-0.011

0.114**

0.263**

0.416**

1

Sig. (2-tailed)

p=0.095

p<0.0001

p<0.0001

p<0.0001

​

Positive and significant correlations between: level of schooling, Time since enrolment, and No. of SAB contact days with layering status

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Multivariate Analyses-Age, Duration in Program and Project Site with Layered Status

AGE

Total this category

Layered

Not Layered

Odds Ratio

95% CI

P-value

10-14 yrs'

>10 contact days

2,445

36%

1,957

80%

488

20%

2.604

2.318-2.925

p<0.0001**

<= contact days

4,306

64%

2,632

61%

1,715

39%

Ref

15-19yrs'

>10 contact days

1,607

17%

1,289

83%

268

17%

2.424

2.107-2.788

p<0.0001**

<= contact days

7,521

83%

5,010

67%

2,520

33%

Ref

20-24 yrs'

>10 contact days

815

14%

689

85%

126

15%

2.278

1.871-2.773

p<0.0001**

<= contact days

4,922

86%

2,839

58%

2,083

42%

ref

​

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Multivariate Analyses-Age, Duration in Program and Project Site with Layered Status(cntd)

Time since enrolment

Total this category

​

Layered

​

Not Layered

​

Odds Ratio

95% CI

P-value

0-12 mnths

>10 contact days

4,495

69%

2,909

53%

2,586

47%

ref

<= contact days

2,044

31%

1,635

80%

409

20%

3.554

3.149-4.009

p<0.0001

13-24 mnths

>10 contact days

9,828

91%

6,286

64%

3,542

36%

<= contact days

1931

9%

1,595

83%

336

17%

2.675

2.361-3.029

p<0.0001

more than 24months

>10 contact days

2078

89%

1848

89%

230

11%

<= contact days

240

11%

233

97%

7

3%

4.143

1.929-8.895

p=0.0003

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Multivariate Analyses-Age, Duration in Program and Project Site with Layered Status(cntd)

Project Site

Total

​

Layered

Not layered

OR

95% C.I

p-value

Savannah

>10 contact days

6786

3,255

48%

3,531

52%

Ref

<= contact days

1518

1,057

70%

461

30%

2.487

2.208-2.803

p<0.0001

Kayole

>10 contact days

5430

3,442

63%

1,988

36%

Ref

<= contact days

2411

2,037

85%

374

15%

3.171

2.802-3.589

p<0.0001

Kibagare

>10 contact days

2463

1,786

73%

677

27%

Ref

<= contact days

103

86

84%

17

16%

1.916

1.1313-3.250

p=0.0156

Kiambiu

>10 contact days

2120

1,898

90%

222

10%

Ref

<= contact days

783

755

96%

30

4%

2.943

1.992-4.349

p<0.0001

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Discussions and Recommendations

Our study shows that factors associated with being layered for AGYW being served by CONNECT DREAMS Program include:

  • Having more than 10 contact days at SABs within a semi-annual period
  • At least a secondary school level of education
  • Being out-of-school
  • Being served within a low-volume program site

​

We recommend that to improve layering:

  • Programs may emphasize enhancing the number of SAB contact days for the AGYWs
  • Design strategies to reach In-school AGYW

​

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Acknowledgements

  • AGYW being served by the CONNECT DREAMS program
  • HWWK CONNECT DREAMS Staff
  • CIHEB-K
  • Nairobi County Health Management Team
  • Co-authors
  • CDC-Kenya

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