Top 5 Takeaways

1. Significant Reduction in HIV Diagnoses: New HIV diagnoses among adolescent girls and young women attending antenatal care decreased by 71.4% in DREAMS districts compared to 48.4% in non-DREAMS districts.
2. Broader Public Health Impact: The reduction in new HIV diagnoses is also attributed to other interventions like viral load suppression, preexposure prophylaxis, voluntary medical male circumcision, behavior change, and increased HIV diagnostic coverage.
3. Universal ART Initiation: The national HIV treatment program in Lesotho began universal initiation of antiretroviral therapy for all HIV-positive persons regardless of CD4 count, contributing to the reduction in new HIV diagnoses.
4. Limitations in Data: The study acknowledges limitations such as potential inaccuracies in measuring changes in HIV incidence through new diagnoses at ANC and differences among districts that may affect direct comparisons.
5. Need for Further Research: Similar analyses in other countries implementing DREAMS and further studies are needed to better understand the program’s impact and guide future HIV reduction strategies.

Original Article Author and Citation

Corresponding Author

Andrew R. Pelletier, arp1@cdc.gov

Suggested Citation

Pelletier AR, Derado J, Maoela L, Lekhotsa T, Sechache M, Nkuatsana K. Impact of the DREAMS Program on New HIV Diagnoses in Adolescent Girls and Young Women Attending Antenatal Care — Lesotho, 2015–2020. MMWR Morb Mortal Wkly Rep 2022;71:48–51. DOI: http://dx.doi.org/10.15585/mmwr.mm7102a3

Summary

The DREAMS program, initiated in 2016 in Lesotho, aimed to reduce HIV incidence among adolescent girls and young women. Over 3.5 years, new HIV diagnoses among this group attending antenatal care decreased significantly in both DREAMS and non-DREAMS districts, with a more pronounced reduction in DREAMS districts. This reduction is also attributed to other public health interventions such as viral load suppression, preexposure prophylaxis, and increased HIV diagnostic coverage.

Methods

Data were collected from the Elizabeth Glaser Pediatric AIDS Foundation and analyzed using a Poisson log-linear regression model. The study compared new HIV diagnoses among adolescent girls and young women in two DREAMS districts with three non-DREAMS districts over 3.5 years. The baseline data were from the first quarter of fiscal year 2016, and the analysis included data up to the second quarter of fiscal year 2020.

Discussion

The findings indicate a substantial reduction in new HIV diagnoses among adolescent girls and young women in both DREAMS and non-DREAMS districts. This suggests that while the DREAMS program had a significant impact, other factors like universal ART initiation and increased diagnostic coverage also played crucial roles. The study highlights the need for further research to understand the full impact of DREAMS and similar programs in other settings.

Conclusion

The DREAMS program has significantly reduced new HIV diagnoses among adolescent girls and young women in Lesotho. However, other public health interventions have also contributed to this reduction. Continued efforts and further research are needed to sustain and enhance these gains in HIV prevention.

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