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Predicators of uptake of high impact HIV services by adolescents and young women. Findings from Eswatini

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BACKGROUND: Pact implements the DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored and Safe) program in Eswatini to reduce HIV vulnerability and new infections among Adolescent Girls and Young Women (AGYW). Once assessed and enrolled in the program, AGYW have access to interventions across health, education, protection and livelihoods based on needs and mentorship plans. The uptake of services (HTS, FP, PrEP, Condoms), however, has not been consistent among participants. To increase coverage, the program conducted analysis of programmatic data to understand predictors of these service uptake.
METHODS: A cross-sectional analysis was conducted using Stata for the April 2018 ' September 2021 implementation period. Researchers analyzed data from vulnerability assessments and access to service. Bivariate analysis was conducted using Logistic Regression to predict the uptake of HTS, FP, PrEP, and Condoms (dependent variables), against age-groups, education, duration in DREAMS program, vulnerability criteria (independent variables). Multicollinearity was tested using spearman command with less than 0.7 result. Postestimations of margins were also plotted at sample means with age-groups and duration in DREAMS as covariates.
RESULTS: The Logistic Regression model revealed that duration in DREAMS program predicts uptake of PrEP, FP, and condoms but not HTS. Education predicted HTS and condoms while vulnerability criteria (pregnancy) was a predictor for HTS uptake. Age group predicted PrEP and condoms but not HTS and FP Commodities.

CONCLUSIONS: The results suggest that service delivery should be sensitive to increased chances of uptake or attrition based on socio demographic characteristics of participants. This means designing interventions to ensure increased access to PrEP and FP commodities at the first six months of enrolment. The design should also consider HTS validation to eliminate confirmatory retests of known positives. Flexible approaches that consider needs and constraints of participants to incentivize retention.