{"doi":"10.1371/journal.pgph.0005272","title":"What combination of interventions can optimise HIV prevention for adolescent girls and young women? Cohort analysis of DREAMS participation in urban and rural Kenya","abstract":"Comprehensive intervention packages are recommended to address multiple sources of HIV risk for adolescent girls and young women (AGYW). DREAMS is a multi-component HIV prevention program designed to reduce HIV incidence among AGYW. We conducted a prospective cohort study among AGYW aged 13-22 years, randomly selected in rural Gem and urban Nairobi informal settlements followed from 2017/2018-2019. AGYW were classified into three groups: (1) invited to DREAMS and received a \"complete\" package, (2) invited and received a \"partial\" package, or (3) not invited to DREAMS. We defined the \"complete\" package as 4-5 primary interventions in Gem and 5 in Nairobi: the \"partial\" package as 3 specific interventions in Gem and any 3-4 interventions in Nairobi. We used propensity score-adjusted logistic regression to estimate the causal effect of DREAMS on outcomes under three counterfactual scenarios: all AGYW accessed the complete package, all accessed a partial package, or none were invited. In Nairobi, 1081 AGYW were enrolled. By 2019, 26% accessed the complete package and 32% accessed the partial package. Among those receiving the complete package, there was increase in HIV status knowledge(24.8% [95%CI:16.4,32.6]),social support(13.9% [95%CI:3.3,23.6]) and self-efficacy(10.3% [95%CI:0.5,20.4]) and a decrease in the proportion with ≥2 lifetime partners(-8.0% [95%CI:-15.9,0.0]). In Gem, 1171 AGYW were enrolled. By 2019, 24% received the complete package and 21% received the partial package. We found evidence of an increase in HIV status knowledge(10.0% [95%CI:4.5,15.2]), social support(27.2% [95%CI:19.2,35.5]) and a decrease in condomless sex(-9.1% [95%CI:-13.6,-4.1]), and the proportion with ≥2 lifetime partners(-7.6% [95%CI:-12.4,-2.2]) for the complete package. Among those receiving the partial package, there was a decrease in condomless sex(-12.2% [95%CI: -17.0,-6.4]), and an increase in self-efficacy(8.0% [95%CI:0.0,17]). A package of 4-5 primary DREAMS interventions had positive impacts on multiple HIV-related outcomes in both settings. A partial package was effective in Gem, but not in Nairobi, suggesting the need for context-specific intervention strategies.","journal":"PLOS Global Public Health","year":2025,"id":577127,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9588,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":869988,"name":"Sarah Mulwa","orcid":"0000-0003-0934-6780","position":1,"is_corresponding":false},{"id":869990,"name":"Annabelle Gourlay","orcid":"0000-0003-4387-1925","position":2,"is_corresponding":false},{"id":870625,"name":"Vivienne Kamire","orcid":null,"position":3,"is_corresponding":false},{"id":869991,"name":"Jane Osindo","orcid":"0000-0002-4843-5586","position":4,"is_corresponding":false},{"id":1051796,"name":"Elvis Omondi Achach Wambiya","orcid":"0000-0002-4149-3417","position":5,"is_corresponding":false},{"id":869992,"name":"Moses Otieno","orcid":"0000-0002-9977-8220","position":6,"is_corresponding":false},{"id":299795,"name":"Elona Toska","orcid":"0000-0002-3800-3173","position":7,"is_corresponding":false},{"id":981328,"name":"Jane Ferguson","orcid":"0000-0002-3736-0603","position":8,"is_corresponding":false},{"id":304704,"name":"Isolde Birdthistle","orcid":"0000-0001-5742-6588","position":9,"is_corresponding":false},{"id":454821,"name":"Daniel Kwaro","orcid":"0000-0002-0929-8072","position":10,"is_corresponding":false},{"id":869993,"name":"Abdhalah Ziraba","orcid":"0000-0002-3417-6536","position":11,"is_corresponding":false},{"id":257501,"name":"Sian Floyd","orcid":"0000-0002-8615-7601","position":13,"is_corresponding":false},{"id":869989,"name":"Faith Magut","orcid":"0000-0002-9758-2697","position":0,"is_corresponding":true}],"reference_count":26,"raw_metadata":null,"created_at":"2026-07-19T02:58:04.622308Z","pmid":"41056303","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}