| DREAMS was ‘a big lift’–requiring a huge effort to get it off the ground |
This has mobilised multiple sectors, ministries, and organisations to work together. DREAMS was generally well received and highlighted AGYW as a priority group (although there were concerns about those perceived to be excluded, especially boys and young men) |
| Expectations are ambitious and bold to implement and achieve impact in a quick timeframe |
This created a momentum and urgency to find solutions to challenges and make DREAMS happen. The shared commitment fostered collaboration. |
| Coordinating multiple components of the DREAMS Core Package—at institutional level was challenging |
New structures and strategies were used to coordinate multiple implementers and interventions; these can be strengthened and sustained for multi-sectoral collaboration and better communications going forward |
| A ‘new way of working’ was difficult given lack of existing systems, structures or incentives for organisations to link their services for AGYW |
| Delivering all interventions in the Core Package in one geographic area was untenable in the time allocated |
DREAMS led to the expansion of existing HIV services and strengthened health system delivery |
| Creation of new programmes, including the introduction or expansion of PrEP availability, and improved human resource capacity for interventions promoting social norms, social assets and structural drivers. In some cases, this created new HIV prevention services where few existed before. |
| Creative solutions emerged to adapt the PEPFAR guidance to each context. Further analysis can explore whether this strengthens or hinders the impact of DREAMS. |
| Layering services in the DREAMS Core Package–at individual AGYW level |
Better integration of services–with tested models that can be applied to other population groups (beyond AGYW) and services (beyond HIV prevention). |
| Strengthened screening and referral protocols; formalised linkages between organisations; use of passports, and badges were innovations that emerged from the opportunities DREAMS presented |
| Recognition of high-risk populations (the highest risk), and appreciation for the unique and comprehensive needs of AGYW. |
| Tracking the layering of services |
The use of a unique ID has strengthened information systems to monitor DREAMS services, but could be improved to track layering and primary packages, and services by individual risk profiles, e.g., to gauge whether higher risk AGYW and male partners are reached, and ‘elite capture’ can be avoided. |
