Meghan Duffy

The Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe (DREAMS) program delivers community- and clinic-based interventions to reduce HIV vulnerability among adolescent girls and young women (AGYW) aged 15–24 years. We conducted a retrospective programmatic financial cost analysis from the implementing partner perspective using financial and programmatic records from October 2022 to June 2023. We estimated the total costs and cost per AGYW enrolled (cost/AGYW) of DREAMS components in Gaza and Inhambane, Mozambique. A total of 19,477 AGYW were enrolled in Gaza and 3320 in Inhambane from October 2022 to June 2023. Clinic-based components cost US$189,047 in Gaza and US$67,826 in Inhambane, which amount to US$10 and US$20 per AGYW enrolled, respectively. Inhambane’s community component cost US$128,344, and US$39 per AGYW enrolled without Siyakha (an economic package that prepares AGYW to enter the job market). Among Siyakha recipients, the combined community and Siyakha cost was US$466 for 59 AGYW receiving the light package without internship and US$551 for 54 AGYW receiving the full package with internship. Human resources were the largest cost category across components, indicating that staffing requirements are a major determinant of DREAMS implementation costs. Human resources were the main cost driver in both components, highlighting the need to optimize staffing models.

Introduction: Sexual violence (SV) affects millions globally and has a well‐documented bidirectional association with HIV. Post‐exposure prophylaxis (PEP) is a critical, yet often underutilized, HIV prevention tool in post‐SV care. Despite its potential impact to reduce HIV transmission, SV care remains an overlooked service delivery point for HIV prevention. The U.S. Centers for Disease Control and Prevention (CDC), as part of the President's Emergency Plan for AIDS Relief (PEPFAR), supports PEP provision within broader post‐violence care (PVC) services. Understanding PEP utilization is crucial for optimizing service delivery and HIV prevention efforts.Methods: Using Monitoring Evaluation and Reporting data from fiscal years 2018–2023, we conducted a descriptive analysis of clients who received PVC and SV services through CDC‐supported programming in 14 sub‐Saharan African countries.Results: From 2018 to 2023, the annual number of clients receiving any PVC, and specifically SV, services increased by 233% (in 2018, n = 206,764; in 2023, n = 689,349) and 163% (in 2018, n = 42,848; in 2023, n = 112,838), respectively. Fewer than half of SV clients completed PEP (38% in 2018, n = 16,103; 31% in 2023, n = 35,118). Across all years combined, most SV clients (female: 185,414; male: 59,618) were aged 15–19 years. The age band and sex with the lowest proportion of clients completing PEP were males aged 15–19 (4%, n = 2296).Conclusions: The findings underscore a critical gap between the scaling of SV services and the completion of PEP within violence response programmes. Innovative implementation science approaches may help to identify and address barriers inhibiting effective PEP delivery and uptake within PVC service delivery programmes. Enhancing PEP uptake and completion can support mitigating the bidirectional relationship between violence and HIV acquisition, particularly among vulnerable populations like adolescents and young adults. Low PEP coverage also reflects missed opportunities, particularly among adolescent girls and young women, who experience disproportionate rates of HIV acquisition.

Introduction: In Mozambique, post‐exposure prophylaxis (PEP) to prevent HIV is offered as part of the essential package of post‐violence care services at 1450 health facilities. However, HIV PEP access and adherence continue to be a challenge. Healthcare providers were interviewed to identify and synthesize their recommendations for improving PEP access and adherence.Methods: We conducted semi‐structured, in‐depth interviews with 20 adolescent and adult healthcare providers (3 men and 17 women) who had a range of 2−15 years of experience from 20 health facilities across seven provinces during March–August 2023. Data were analysed using inductive and theoretical thematic analysis. We analysed how frequently health providers mentioned specific recommendations.Results: Regarding PEP access, healthcare providers recommended community education as the most effective strategy (10 mentions). In particular, providers cited the importance of palestras [community health talks]. Providers also commonly highlighted the need to have PEP kits prepared (7 mentions) and PEP readily available at health facilities (6 mentions). Regarding PEP adherence, providers recommended client counselling/education (13 mentions) to ensure clients understand the importance of taking PEP, how to properly take PEP and the potential side effects, which can often deter clients from adhering. Additionally, providers highlighted chamadas preventivas [follow‐up telephone calls] within 2 weeks or so after the initial visit (9 mentions) as the best means to ensure clients complete the full, 28‐day regimen and return for retesting after 3 months. Healthcare providers explained that follow‐up telephone calls, despite the client living far from the health facility, can create a bond that supports clients. Providers recommended the institutionalization of follow‐up telephone calls for consistent implementation in all healthcare facilities that offer PEP.Conclusions: Interviewed healthcare providers offered valuable insights and recommendations to improve PEP access and adherence, which could be considered for implementation in Mozambique and other sub‐Saharan African countries.