A new Morbidity and Mortality Weekly Report from the CDC shows positive results in the fight against HIV in Lesotho, in Africa. From 2016 through 2020, the report bears out significant reductions in new infections among adolescent girls and young women attending antenatal care, some of whom participated in the Determined, Resilient, Empowered, AIDS-Free, Mentored, and Safe (DREAMS) program.

Lesotho is known for having the second highest prevalence of HIV worldwide, and statistics from 2017 show just how tough the fight against HIV and AIDS is there: More than a quarter of persons aged 15 to 59 years were living with HIV, 11.7% of females aged 15 to 24 were living with HIV, and 3.4% of males aged 15 to 24 were living with HIV.

Following the October 2016 introduction of DREAMS in the country—the program covers biomedical, behavioral, and structural interventions—there was a 71.4% drop in new HIV diagnoses among adolescent girls and young women who participated in the program within 3.5 years. In addition, a 48.4% reduction was seen in non-DREAMS participants (P = .002) receiving antenatal care.

“For this report, aggregate data for adolescent girls and young women in the 2 adjacent DREAMS districts (Berea and Maseru) were compared with aggregate data for adolescent girls and young women in 3 non-DREAMS districts (Leribe, Mafeteng, and Mohale’s Hoek),” the authors wrote. “Data for women aged ≥25 years in the 2 DREAMS districts were also examined.”

Breaking down the above total for the DREAMS districts, the 71.4% drop in new HIV diagnoses occurred from the first quarter of fiscal year (FY) 2016, when the new diagnoses rate was 11.4%, through the second quarter of FY 2020, when the new diagnoses rate was 3.3%. For the non-DREAMS districts for the same time period, the 48.4% drop is seen in total new diagnoses that fell from 7.7% to 4.0%. The investigators categorized HIV test results as negative, known positive, and newly test positive.

In addition, for the DREAMS districts, there was a 54.6% decrease in new HIV diagnoses among women 25 years and older: from 16.6% to 7.5%.

The authors of the report attribute these drops to not only the program, but also increased rates of viral suppression and the implementation of preexposure prophylaxis, voluntary medical male circumcision, behavior change, and increased HIV diagnostic coverage. In addition, at the time DREAMS was implemented, Lesotho had initiated universal antiretroviral treatment regardless of CD4 count and was already showing progress toward meeting 90-90-90 goals: 81% of persons living with HIV knew their status, 92% were on treatment, and 88% were virally suppressed. Meanwhile, among adolescent girls and young women, mixed results were seen regarding meeting 90-90-90 goals: 61% of those living with HIV knew their status, 90% were on treatment, and 76% were virally suppressed.

“The reductions in new HIV diagnoses at antenatal care among adolescent girls and young women in the 3 non-DREAMS comparison districts and among women aged ≥25 years in the 2 DREAMS districts suggests that much of the decline was attributable to factors other than DREAMS,” the authors determined, “because these women were not eligible for the program, either because of where they lived or their age.”

They suggest that other countries evaluate the DREAMS program’s results, because their findings may not be generalizable.

“Results of these studies might better clarify the impact of DREAMS and help guide future decisions on how best to reduce HIV incidence among adolescent girls and young women in Africa,” they concluded.

Reference

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(2):48-51. doi:10.15585/mmwr.mm7102a3