Title

Comparison of new HIV diagnosis and teenage pregnancy in DREAMS and non-DREAMS districts, Malawi 2017−2022

Presenter

Masford Banda

Authors

M. Banda¹, A. Wang¹, A. Kabaghe¹, N. Wadonda-Kabondo¹, L. Malilo², F. Zulu¹, D. Payne¹, E. Mlanga², F. Matchere³, V. Kanje², V. Singano¹, W. Msungama¹

Institutions

¹Centers for Disease Control and Prevention, Lilongwe, Malawi, ²USAID, Lilongwe, Malawi, ³DoD, Lilongwe, Malawi

BACKGROUND: The Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe (DREAMS) program provides a package of core interventions to address key factors that make adolescent girls and young women (AGYW) vulnerable to HIV. DREAMS was introduced in Malawi in 2016 and scaled up in three districts by 2018, with implementation by the President’s Emergency Plan for AIDS Relief (PEPFAR) partners. The objective of this analysis is to evaluate the impact of DREAMS on reducing HIV new infections and teenage pregnancies among AGYW after over half a decade of implementation in Malawi.
DESCRIPTION: Using PEPFAR Measure Evaluation and Reporting data, a two-sample test of proportions on new HIV diagnosis and teenage pregnancy (among 15-19 years) for DREAMS districts (Blantyre, Machinga, Zomba) compared to non-DREAMS (Chikwawa, Mangochi, Lilongwe) was conducted to determine if proportions between timepoints (2017 quarter 2 (baseline) and 2022 quarter 3 (endline)) or populations (DREAMS and non-DREAMS districts) had changed.
LESSONS LEARNED: Among AGYW aged 15-19 in the DREAMS districts (117,472), the percentage of new HIV diagnoses decreased from 2.8% at baseline to 0.6% at endline, representing a percentage change of 77.8% (p<0.001). A decline of 58.1% occurred among AGYW in non-DREAMS districts (140,000), from 1.6% to 0.7% (p<0.001). The difference in the percentage change among AGYW aged 15-19 in DREAMS versus non-DREAMS districts was statistically significant (p=0.003). The percentage of teenage pregnancies among AGYW attending antenatal care (ANC) in the DREAMS districts decreased from 25.4% to 22.3% (percentage change 12.2%; (p<0.001). A decline of 6.5% occurred among women attending ANC visits in non-DREAMS districts, from 24.7% to 23.1% (p<0.001). The difference in the percentage change of AGYW attending ANC visits in DREAMS versus non-DREAMS districts was not statistically significant.
CONCLUSIONS: If scaled up intensely, the DREAMS comprehensive package of interventions could have a greater impact on HIV transmission among vulnerable AGYW.

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