Impact evaluation of PEPFAR’s DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe women) Initiative in Nairobi (Round 3), DREAMS

As part of a partnership led by the London School of Hygiene and Tropical Medicine, the African Population and Health Research Center (APHRC) aims to evaluate the impact of the DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe women) Initiative in two urban informal settlements (Korogocho and Viwandani), where the Center has been running the Nairobi Urban and Health Demographic Surveillance System (NUHDSS) since 2002. The overall goal of the DREAMS Initiative is to reduce new HIV infections among the most vulnerable adolescent girls and young women (AGYW) aged 10-24 years in 10 subSaharan African countries including Kenya.

The specific objectives of the evaluation were to: measure whether HIV-related outcomes change due to DREAMS interventions at a population level; to explore the pathways of protection by which DREAMS interventions influence the lives of young women and ultimately their risk for HIV; and to assess the extent to which the DREAMS interventions were delivered as intended. The non-experimental impact evaluation, which was conducted over 3 years, adopted a mixed methods approach. used data from the NUHDSS and a new DREAMS module administered to all women and men aged 15 to 49 years to assess some of the key outcomes, including timing of first sex, number of sexual partners and condom use. The information collected from other age groups in the NUHDSS served to place findings from AGYW in context.

To explore the pathways of protection by which DREAMS interventions influence the lives of young women and ultimately their HIV status, we recruited a closed cohort of approximately 1500 AGYW aged 10-22 years evenly split by age group (10-14 years, 15-17 years, 18-22 years). The cohort was a random sample drawn from the NUHDSS database and stratified by age, area of residence, and schooling status. These young people completed a DREAMS survey at three time points—in 2017, 2018 and 2019—to assess changes in the key outcomes as well as key mediators such as empowerment, self-efficacy and social support.

Finally, we conducted in-depth interviews with a purposively selected group of AGYW and focus group discussions with a range of parents and young people to explore experiences with and perceived effects of the DREAMS initiative. We also conducted key informant interviews with DREAMS implementers within the study and observations of various DREAMS activities in order to assess: 1) whether components of the DREAMS intervention are implemented as scheduled and planned; 2) the barriers and facilitators to implementation; and 3) staff members’ and beneficiaries’ perceptions and value of the interventions. Quantitative data was collected on Android-based tablets using Survey-CTO software. Qualitative interviews were audio-recorded and directly transcribed.