On World AIDS Day 2014, PEPFAR launched a bold new initiative – ‘DREAMS’ – to reduce new HIV infections by 40 percent among the highest risk adolescent girls and young women in 10 high-burden countries. With an initial commitment of US$385 million, quickly supplemented with $85 million for a DREAMS Innovation Fund, DREAMS partners – PEPFAR, Bill & Melinda Gates Foundation, Girl Effect, Johnson & Johnson, ViiV Healthcare and Gilead Sciences – aim to promote empowerment and prevent HIV acquisition through a core package of interventions for young women, their families, communities and male partners.
The Bill & Melinda Gates Foundation has awarded LSHTM a 4-year grant to lead a portfolio of evaluation studies designed to track the impact of DREAMS in Kenya, South Africa and Zimbabwe. Led by Isolde Birdthistle and Sian Floyd, the evaluation draws on LSHTM expertise in HIV, adolescent health and evaluation across all faculties, and close research partnerships with experienced institutes in each country: the Africa Health Research Institute (AHRI) in Durban, South Africa, the African Population and Health Research Centre (APHRC) in Nairobi, Kenya; the Kenya Medical Research Institute (KEMRI) in Siaya, Kenya; and the Centre for Sexual Health HIV and AIDS Research (CeSHHAR) in Harare, Zimbabwe.
- London School of Hygiene & Tropical Medicine (LSHTM), UK
It is a pleasure to lead the independent evaluation of DREAMS with excellent partner institutes in Kenya, South Africa and Zimbabwe. I work closely with Sian to oversee the scientific management, and with Antonio, to manage the financial aspects of the grant from BMGF. There are many lessons to be learned from DREAMS, about whether and how scaled-up integrated programs can improve the health and welfare of adolescent girls. It is exciting to see data from different disciplines and designs, contributing answers to the evaluations questions. A particularly enriching aspect of the project is engaging regularly with researchers from all sites via thematic working groups – these are virtual peer groups that share analyses in progress, to harmonise analyses and boost all of our analytical skills.
My role on the DREAMS IE is as Principal Investigator and I work closely with Isolde to coordinate the Impact Evaluation work across the four settings in which we are evaluating DREAMS. I trained as a biostatistician, and together with Isolde I have provided oversight and guidance on design of the impact evaluation studies and how to analyse the quantitative data to estimate the causal effect of DREAMs on outcomes across the themes of biological, behavioural, and social protection. One thing that I have learned is that while the analysis of the effect of complex interventions is challenging when the interventions are allocated/received in a way that is non-randomised and outside the control of the evaluation team, it is possible so long as effort is made to understand the way in which interventions have been targeted/prioritised and to carefully measure what has actually been delivered/received and how this evolves over time.
I am a co-investigator on the grant and Chair of the DREAMS IE Publications and Presentations (P&P) Group. The aim of this group is to ensure and enhance the quality of all outputs from the grant. Multisite collaborations such as this are inspiring and worthwhile, despite the huge amounts of work involved.
In my role as Project Coordinator, I am in charge of the financial and administrative side of things. I support the PI in the financial management of the project, work with our partners for the allocation of funds, submit finance reports for the funder, as well as deal with project recruitment, dissemination, etc.
It is extremely rewarding to be involved in such a multidisciplinary, international project.
My work revolves around quantifying the uptake of DREAMS interventions in Nairobi - Kenya, as well as assessing factors that affect uptake. I am also a member of the Data Analysis Working Group, a platform where we discuss various methodologies relating to analysis of observational data. To better understand how the implementation is being done on the ground and the different contextual factors that can explain participation in DREAMS activities (or lack thereof), I also participate in the Social Science Working Group.
There are many lessons one can learn by being part of such a multi-disciplinary team like DREAMS IE. What I enjoy the most are the numerous opportunities to learn new methods through sharing lessons, ideas and potential solutions to some of the challenges the team may face.
I chair the Data Analysis Working Group, including epidemiologists, statisticians and data managers from each of our partner organisations in Kenya, South Africa and Zimbabwe, as well as colleagues at LSHTM. Recent work has included summarising early awareness and uptake of DREAMS, using population-wide data platforms and/or nested cohorts of AGYW in each setting. I also participate in the Social Science Working Group to keep up-to-date with progress on the process evaluation and facilitate my understanding of the implementation of DREAMS, to help contextualise the quantitative findings.I have learned that it is very complex to define and measure ‘exposure’ to DREAMS, and that this is a very challenging package of interventions to implement. However, there are encouraging signs from the early analyses and some interesting synergies across settings, despite the different contexts in which DREAMS is being implemented. I’ve also learned that we have a great team of researchers!
My role on the DREAMS IE involves supporting the evaluation of DREAMS among young women who sell sex in Zimbabwe. Working with colleagues at the Centre for Sexual Health, HIV/AIDS Research (CeSHHAR) and LSHTM, I support the collection and analysis of data from a cohort of young women. We are aiming to follow-up a cohort of the most vulnerable young women in two DREAMS and four non-DREAMS site to help us understand whether DREAMS has had an impact on the health and well-being of this population. I have learnt so much through working on the DREAMS IE. One of these is that, although challenging, it is possible to identify and reach the most vulnerable young women who sell sex to men in exchange for money or other material support through their networks.
I contribute to the impact and process evaluations of DREAMS in Zimbabwe. I work closely with the Centre for Sexual Health, HIV/AIDS Research (CeSHHAR) to track inclusion in and experiences of DREAMS activities among the most vulnerable adolescent girls and young women, those involved in exchanging sex for money or other material goods. We are following girls who benefit from different parts of the DREAMS package to try to understand how it affects their lives, particularly in regard to protecting them from risks. Young women’s perceptions of the programme, such as which components work well and which less so, will help answer questions about whether DREAMS is being implemented as planned, whether it is acceptable to those it aims to reach, and what challenges participants face. I have been impressed with how quickly young women see a change in themselves, particularly in terms of feeling a greater sense of purpose in their present lives and hope for the future. It remains to be seen whether relatively short exposure to DREAMS activities will be able to deliver on young women’s growing expectations.
- Africa Health Research Institute (AHRI), South Africa
I am the project manager on the Africa Health Research Institute (AHRI) DREAMS Impact Evaluation.
One thing I have learnt so far is that HIV prevention interventions for young people are complex and require time for scale up and adaptation to context for them to be a good fit. Personally, I have advanced working in a multi-disciplinary team from different sites – the exposure and experience has been enriching.
My role is to analyze quantitative data. What I have learned is that working together with fieldworkers gives you a better understanding of the population which you are analyzing the data for.
I am the Data Manager on this Evaluation project and responsible for setting up tools to collect the data and export data to datasets for analysis.I have seen that going into field with a small team that is focused on a specific set of questions is more effective than sending a big team that is trying to combine your questions with the questions from other projects.
I am working on the Social Science component of the IE, assessing how communities in Umkhanyakude, one of the DREAMS sites in South Africa are experiencing, perceiving and understanding Dreams.To reduce HIV incidence among AGYW, multicomponent interventions such as DREAMS are essential, however, AGYW do not exist in isolation, interventions should also have a strong focus on their parents, partners, and spaces they interact with.
Senior Social Scientist
I'm a social anthropologist by training and faculty lead for Social Science and
Research Ethics at the Africa Health Research Institute in KwaZulu-Natal, South Africa. I'm a co-investigator on the DREAMS evaluation team.
- African Population and Health Research Centre (APHRC), Kenya
I am the DREAMS Impact Evaluation project manager at the African Population and Health Research Center (APHRC). I oversee the technical (tools, field operations and data) and other management aspects including reporting and anchoring our participation in the consortium. I also serve on the Publications and Presentation working group.
I have learned that even the most complex of health and social interventions can be assessed for impact. Complex health challenges such as HIV/AIDS require complex interventions whose implementation is not straight forward and so is the measurement of impact attributable to such responses. Innovating to address and overcome some of these challenges is a big take away for me from this project.
I provide statistical support – in terms of sampling, data processing and statistical analysis – to the DREAMS IE site at APHRC in Nairobi, Kenya. In addition, I represent the African Population and Health Research Centre in the DREAMS IE Data Analysis Working Group.
Whereas I apply statistics in a wide variety of fields, my main areas of interest are Bayesian inference, factor analytic methods, complex data, healthcare experiences and infectious diseases. I developed interest in HIV/AIDS research, with a particular interest in knowledge gaps that result from statistical challenges.
Social Science Research Officer
My role on the DREAMS Impact Evaluation involves oversight on project activities at the field level. I am responsible for logistics for the quantitative and qualitative data collection which involves community sensitization on project related activities, preparation of data collection teams through training and field logistics, supervision of data collection activities and data monitoring and quality control. I am also involved in the process evaluation activities through which the progress of the DREAMS implementation gets monitored. I participate in the qualitative data analysis and interpretation and support scientific writing for the quantitative and qualitative arms of the evaluation.
Evaluating the intervention has taught me that despite the efforts to support the most vulnerable in the communities new challenges arise but the work still goes on.
My main role in the DREAMS IE involves supporting activities targeting the 10 – 14 age cohort, including data collection and analysis. I am also a member of the DREAMS IE Data Analysis Working Group.
Working with very young adolescents in the DREAMS IE project, I have learnt it is possible to reach this cohort with interventions – at a time when they are learning to adapt to societal norms - laying grounds for improved sexual and reproductive health outcomes.
My role in the DREAMS impact evaluation at the African Population and Health Research Centre site involves project management, supporting project implementation activities, data quality assurance, management and analysis. I am an active member of the data analysis working group and participate in scientific writing for the project.
I have learnt that evaluation of complex interventions for a complex phenomenon such as HIV among adolescent girls and young women (influenced by multiple contextual factors) invites innovative and multi-pronged approaches so as to best capture the effects of the intervention. The project also sheds light and reiterates the importance of quality assurance during data collection which ultimately leads to quality data for the evaluation.
- Centre for Sexual Health and HIV/AIDS Research (CeSHHAR), Zimbabwe and Liverpool School of Tropical Medicine (LSTM), UK
- Kenya Medical Research Institute (KEMRI), Kenya and Liverpool School of Tropical Medicine (LSTM), UK
PI, KEMRI - LSTM
Learned: diversity of exposures and risks for adolescent girls and young women in seemingly similar ‘impoverished’ settings – which strengthens the justification for implementing a variety of different interventions to address these factors across the causal pathway
As the study coordinator I have been assisting with the day–to-day survey implementation and work with the PI in developing an in-depth understanding of the study design and goals, and fully participate in the successful implementation and execution of the study. I have Participated in both county and community engagement which involves stakeholder consultation and community mobilization to discuss the study objectives and implications. I have ensured that the field staffs are well trained on the study protocol to enable them execute the field activities as required.The lesson learnt so far is that before the study is commenced, holding meetings with various stakeholders both at the County and Community level to comprehensively discuss the aims and objectives is very crucial to avoid creating unrealistic expectations. Through this we have seen a positive response from the sampled participants and stakeholders where they are voluntarily participating in the study.
I provide statistical support at the KEMRI DREAMS IE site in Gem-Western Kenya. I also oversee the overall data processing, management and analysis. I am also part of the DREAMS IE Data Analysis Working Group.
I have been greatly impressed by the ability of this multidisciplinary group to dig deep into the data and come up with different and important initial findings that not only inform the overall DREAMS objective but also increase our individual skills in complex data analysis.
I work as a data analyst at the KEMRI DREAMS IE site in Gem-Western Kenya. Besides data analysis, I also manage the data in preparation for analysis. I am also part of the DREAMS IE Data Analysis Working Group.
There are many good lessons learnt from the work so far. The ability to incorporate complex analysis in our analysis with focus on details in order to draw conclusions has been the most important one. The platform has also helped gaining new and improving analytical skills and sharing ideas in order to achieve the objectives.
My role in DREAMS impact evaluation is to provide support in data preparation and statistical analyses of different outcomes in GEM Western Kenya.
I am part of DREAMS IE Data Analysis Working Group. I have had an opportunity to learn quite a lot majorly on the impact of DREAMS on the population of interest. The lessons learnt through the Data Analysis Working Group that majorly revolves around complex analysis has largely boosted my analytical skills. Working with such a great team is wonderful and very impactful.
Despoina Xenikaki - LSHTM Daniel Carter - LSHTM Ekua Yankah - LSHTM Sheru Muuo - APHRC Caroline Kabiru - APHRC Joyce Mumah - APHRC Maquins Sewe - KEMRI-LSTM
This Special Issue in TMID will highlight solutions to accelerate declines in HIV infections among young women and men in the coming decade.
The Special Issue is now open for submission. Research articles, review articles as well as short communications are invited.
AIDS 2020 Conference (https://www.aids2020.org)
Presentations by the DREAMS IE team
- The impact of the DREAMS package on HIV incidence among young women who sell sex in Zimbabwe: a non-randomised plausibility study
- What is the impact of DREAMS on HSV-2 acquisition among young women in rural KwaZulu-Natal, South Africa?
Presentations by the DREAMS IE team:
- HIV-related vulnerabilities and awareness & uptake of DREAMS prevention interventions in young females in rural KwaZulu-Natal
- HIV PrEP for female-sex-workers in the context of combination HIV prevention: Impact on community-wide awareness, uptake and perceptions in a rural area KwaZulu-Natal, South Africa
- Promoting Resilience in the context of multilevel HIV prevention: Experiences of Adolescents and young adults in rural KwaZulu Natal, South Africa
London, 29-31 July 2019
Presentations by the DREAMS IE team:
- Impact of HIV-PrEP for female-sex-workers on community-wide awareness, uptake and perceptions in a rural area KwaZulu-Natal, South Africa
- Must the evaluation of complex interventions be complex? Learning from the impact evaluation of DREAMS
- Cascade of HIV prevention: A powerful tool to improve the implementation of multi-level HIV prevention in rural South Africa
Vancouver, 14-17 July 2019
DREAMS IE Data Analysis Workshop
Nairobi & Kisumu, 13 - 17 May 2019
HIV Research for Prevention (HIV4RP) Conference 2018
Madrid, 21-25 October 2018
PEPFAR Meeting and 22nd International AIDS Conference 2018
Amsterdam, 20-27 July 2018
A PEPFAR 2018 Meeting focusing on Solutions and Innovations for Reaching HIV/AIDS Epidemic Control was held in Amsterdam prior to the International AIDS Conference. Dr Isolde Birdthistle presented on the DREAMS Impact Evaluation.
Fighting HIV by Empowering Adolescent Girls and Young Women: A Learning Event on PEPFAR’s DREAMS Partnership
Washington DC, 1 June 2018
A discussion on lessons learned from the DREAMS program was held in Washington DC with representatives from the DREAMs partners, PEPFAR, the Bill & Melinda Gates Foundation, Population Council and Centre for Global Development.
Dr Isolde Birdthistle, Project Director of DREAMS Impact Evaluation presented some of the data collected in Kenya and South Africa.
A short blog on what makes teams bond, inspired by the London Writing Workshop.
Meetings in South Africa & AIDS Impact Conference 2017
Stellenbosch and Cape Town, 10-15 November 2017
The DREAMS IE team attended a 3 day meeting in Stellenbosch, South Africa to discuss current progress of the study. Representatives of all 4 partners shared progress reports from the implementation of DREAMS IE in Kenya, South Africa and Zimbabwe with the coordinating team from the London School of Hygiene and Tropical Medicine.
Following the meetings in Stellenbosch, the DREAMS IE team attended the AIDS Impact Conference in Century City, Cape Town.
Contributions of the DREAMS IE teams to the conference are listed here.
London Writing Workshop
London, 22-26 May 2017
Partners from the DREAMS Impact Evaluation teams from Zimbabwe, Kenya and South Africa met in London to collaborate in a writing workshop to prepare manuscripts for publication in the journal PLoS One.
DREAMS M&E Planning Meeting
Durban, 23 July 2016
DREAMS IE participating organizations met in South Africa with members of the IE/IS working group for M&E of DREAMS as well as representatives of the South African government and partners in uMkhanyakude to identify measures & methods to help align the BMGF-funded impact evaluation of DREAMS in South Africa.
Protocol Development and Data Planning Workshop
London, 7-11 March 2016
Participants from the DREAMS Impact Evaluation teams met with the coordinating team and representatives of the Bill & Melinda Gates Foundation in London to discuss protocol development and data planning.
DREAMS IE collaborates with the following partners:
- Africa Health Research Institute
- African Population and Health Research Centre
- Liverpool School of Tropical Medicine
- Kenya Medical Research Institute
- Centre for Sexual Health and HIV/AIDS Research
DREAMS IE collaborates closely with the following LSHTM Centres and research groups: