DREAMS PROJECT Zandile Mthembu Programme Manager AWACC 2016 06 October 2016
Presentation outline Background and Objectives Implementation Approach Interventions/Tools Progress Conclusion
QUIZ QUESTION 1 DREAMS is an acronym for: 1. Determined, Resilient, Empowered, Matured and Safe AGYW 2. Determined, Resilient, Empowered, Mentored and Strong AGYW 3. Determined, Resilient, Empowered, Mentored and Safe AGYW
Background Partnership between PEPFAR, Bill & Melinda Gates Foundation, and Girl Effect Announced on WAD 2014 10 eligible countries in Southern & Eastern Africa (ESA) were selected based on HIV burden Plan for DREAMS in SA was developed jointly by PEPFAR, SAG and UNAIDS Coordination by SANAC & DACs
Determined Resilient Empowered AIDS-free Mentored Safe DREAMS Countries: Kenya Lesotho Malawi Mozambique South Africa Swaziland Tanzania Uganda Zambia Zimbabwe
HIV Leading Cause of Death among AGYW in SSA In Eastern and Southern Africa, HIV is the leading cause of death in girls aged 15-19 16.9 Source: Global Burden of Disease 2010
HIV prevalence (%) HIV Prevalence by Age, Gender (2012) in South Africa 45 40 35 30 25 20 15 10 5 0 2.32.4 0.7 5.6 17.4 5.1 17.3 Males Females 36.0 31.6 28.4 28.8 25.6 15.8 28.0 19.7 15.5 13.4 14.8 9.7 5.5 4.6 0-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60+ Age group (years) Adolescent girls 15-19 are up to 8 times, while young women 20-24 are more than 3 times, more likely to be infected with HIV than their male peers. 2.4
Aim and Goals Aim Reach the most vulnerable adolescent girl and young woman (AGYW) and their sexual partners. Goal Reduce new HIV infections in 15-24 year old AGYW 25% by end of 2016 Reduce new HIV infections in 15-24 year old AGYW 40% by end of 2017
Objective Project Objective Improve the lives of AGYW by empowering them and decreasing their risk for HIV Increasing secondary school enrolment, attendance and completion Decreasing violence Decreasing unintended pregnancy
Target populations Adolescent girls 10 14yrs In and out of school Adolescent girls 15 19yrs, In and out of school Young women 20 24yrs, Including female sex workers Male sex partners 20 49yrs
How are we addressing HIV among AGYW? Right Places Focus on finding the most vulnerable in the highest burden areas Right Things Core package of interventions to prevent HIV infection and address comprehensive needs of girls and young women Right Time (Now)!! The population of AGYW growing rapidly NOW Right Way
Coordination & synergistic: Efficient use of resources through partnership and engagement of affected communities. DREAMS Approach: Combination Prevention Systematic implementation (layering) of evidence based biomedical, behavioral & structural change interventions Level of intervention: Individual, familial, community and societal Relevance and dosage: Respond to the specific needs of particular audience, Specificity and sensitivity: Modes and risks of HIV transmission, and
QUIZ QUESTION 2 Combination prevention refers to; 1. Combining Western and Traditional approaches 2. Strategic simultaneous use of different classes of evidence-based prevention interventions/tools that operate on multiple levels. 3. Combined HIV prevention programming for young and old in a given setting.
12.0 10.0 How is DREAMS Different? The Importance of Layering Interventions 10.4 FEMALES: % PROBABILITY OF INCIDENCE OF TRANSACTIONAL SEX (modeled percentage probabilities using multivariate logistic regression coefficients) 8.0 6.0 4.0 5.1 4.6 2.0 2.2 0.0 No intervention Child grant Free school Both interventions Cluver, Orkin, Yakubovich
DREAMS Interventions/Tools Category & Code Empower Girls and Young Women Intervention Condom promotion and provision (male and female) HTS with active referral & linkages PrEP (demonstration project) Post-violence care Expand and improve the contraceptive method mix (Comprehensive SRHR Services & strengthen AYFS) Social Asset Building Mobilize Communities School-based HIV and violence prevention Community mobilization and norms change Strengthen Families Parenting/Caregiver programs Social protection Cash transfers Educational subsidies Combination socio-economic approaches Decrease risk in sex partners Characterization of male partners Targeted HTS for male partners (and active linkages) Condom promotion and provision for male partners 16
DREAMS requires a multi-sectoral approach Psycho- Social Education Economic Health Community/ Civil Society
DREAMS Core Package Community Mobilization & Norms Change Mobilize Communitie s for change School-Based Interventions Parenting/ caregiver Programs Reduce Risk of Sex Partners Characterization of male partners to target highly effective interventions (ART, VMMC) Youth-friendly sexual and reproductive health care (Condoms, HTC, PrEP, Contraceptive Mix, Post-violence care) Empower Girls & Young Women and reduce risk Social Asset Building Strengthen Families Social Protection (Cash Transfers, Education Subsidies, Combination Socio-Economic Approaches)
Partnerships for Layering Communitybased structures: FBOs, CBOs, other NPOs interventions Parenting & Caregiver programming: AFSA (Umlazi), NACOSA & FHI-CDS School based HIV and violation prevention: EDC & KI Community Mobilization & Norms change: FHI-CDS CMT (Umlazi) WHRI Social Asset Building: -NACOSA -NACCW -CMT (Umlazi) Social Protection: Education subsidies; NACOSA & NACCW; Socioeconomic approaches- FHI-ASP & NACOSA THCA: HCT, PrEP Sex Workers Empowered & resilient AGYW with reduced HIV risk MatCH: PICT, Mobile/outreach testing; Linkage to HIV Care & Treatment, Linkage to SRHR, Post Violence Care Services Condoms promotions, access & provision: EDC, THCA, FHI-CDS, M2M, Post Violence Care: -FPD: Gap Analysis of PVC; -FHI CDS- Psychosocial support for GBV survivors & families & linking to safe spaces MatCH: Capacity building & Enhancement HCT with Active Referral: MatCH, Cindi, FHI-CDS, HST (Umlazi), M2M & THCA Comprehensiv e Sexual Reproductive Health Services: MatCH & HST (Umlazi) Other HIV Initiatives
Quiz Question 3 In South Africa, DREAMS is implemented in; 1. 2 provinces, 5 districts 2. 3 provinces, 3 districts 3. 5 provinces, 5 districts 4. 1 province, 6 districts
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Criteria for District, sub-district and ward selection Epidemiological data A combination of rural and urban areas Presence of hotspots Existence of functional sub-national coordination structures (e.g. Operation Sukuma Sakhe in KwaZulu-Natal [KZN] and Tirisano in Gauteng Province [GP])1
DREAMS MER Population level surveillance through DIMES Male characterization study Impact Evaluation Implementation Science: AGYW Male Study
MatCH DREAMS Project update (1) Implementing activities in ethekwini and umkhanyakude districts 25 facilities in ethekwini Metro 16 Facilities in umkhanyakude district Mtubatuba and Hlabisa sub-districts Objective Empower Girls and Young Women Decrease risk in sex partners Intervention 1. HTS with active linkage to Pre-ART 2. Post-violence care 3. Expand and improve the contraceptive method mix (Comprehensive SRHR Services) 4. Targeted HTC for male partners (and linkages)
MatCH DREAMS Project Update (2) DREAMS pre-program implementation baseline assessment 1858 household interviews conducted to understand program barriers and enablers; HIV Testing PVC Sexual and reproductive health Capacity Building Activities Adolescents and Youth Friendly Services SGBV/Post-Violence Care Services
HTS Achievements: EThekwini EThekwini District HTS Achievements vs Assigned Targets May-August 2016 EThekwini District Positivity rate 100% 90% 80% 51 0 988 0 971 1081 3091 5137 18235 6312 21 4.4 70% 60% 50% 1152 69 5634 418 46419 17.5 10-14 in school 15-19 in school 20-24 young women Male sex partners 40% 30% 14092 64311 15.4 20% 10% 0% 412 10-14 in school 10-14 out of school 2901 15-19 in school 15-19 out of school 20-24 young women Target Achievement HIV positive Male sex partners Total 21% HIV positivity in Male Sex Partners, 17.5% Adolescent girls 15-19 ( 15.4% 20-24 Achieved linkage rate: 96%
HTS Achievements: umkhanyakude 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Achievement vs targets 80.9 0 76 94 8 41 41.4 272 664 24 58 17 30.4 335 1967 473 1557 % of target achieved Achieved Target HTS Positivity 26.4 5.3 27.8 15.8 26.4% HIV Positivity male sex partners 27.8% 20-24 15.8 15-19 in school 4.2 10-14 in school 10-14 out of school 15-19 in school 15-19 out of school 20-24 young women
Comprehensive SRHR EThekwini UMkhanyakude 100% 6 0 15.6 0 19 0 40.6 95% 90% 85% 244 23 23 56 % of target achieved Achieved 80% 1754 3486 5586 Target 75%
Clients Tracking and Linking DREAMS Passport Works similar to Road to health booklets Documents linkages DREAMS patient file identifiers Stickers: simplification of file retrieval Data clean-up process on a daily basis Real time data using tablets per provider Site level data collation on a daily basis
Conclusion Delay in program implementation Extensive mapping and stakeholder consultation conducted Lessons from DREAMS will be used to benchmark future AGYW investments and programming Expansion and sustainability??
Acknowledgements Colleagues and collaborators at MatCH Systems. DREAMS Collaborators Funding support from USAID, PEPFAR
Thank you!