BACKGROUND: Zimbabwe’s DREAMS program uses PEPFAR’s standard eligibility criteria to screen adolescent girls and young women (AGYW) 10-24 and refer those that are eligible for enrollment. Data from 448,952 screening events over two years reflected eligibility rates consistently exceeding 95% across the three DREAMS age bands, 16 districts, nine screening partners, and three entry points. However, screening and data entry are costly, requiring at least 25 full time equivalent positions each year. They also incur a psychological cost to AGYW, who are asked sensitive personal questions at first contact with partners. Screening also incurs opportunity costs for health facility staff, who must balance screening and service delivery. Here we examine whether screening improves recruitment of eligible AGYW.
METHODS: We conducted a pilot in five districts. Partners stopped screening AGYW, referred all age-eligible AGYW who have not already been in DREAMS for enrollment, and monitored eligibility using data collected at enrollment. We compared eligibility rates before and after the pilot in pilot and control districts.
RESULTS: Analysis of preliminary quarter 1 data demonstrates no significant change in eligibility rates either before or after the pilot, or between pilot and control districts after the pilot. In pilot districts, eligibility changed no more than 1 percent compared to baseline rates. The difference in eligibility in the pilot and control districts was also only 1 percent. Eligibility rates remained similar across age bands, with a 1 percent difference between the pilot and control districts in the critical 10 to 19 ages. The screening and data entry process is estimated to take between 12 and 18 minutes per AGYW. Assuming 12 minutes per AGYW, eliminating screening for just one quarter in five districts reduced labor requirements by 2.4 person/years.
CONCLUSIONS: In the Zimbabwean context of high AGYW vulnerability, screening is an unnecessary cost to the DREAMS program, AGYW, and health facility staff. Reducing the data burden and streamlining reporting systems associated with screening would improve the efficiency and sustainability of PEPFAR’s DREAMS program in Zimbabwe.

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