: The psychosocial vulnerability of adolescents living with HIV, particularly in sub-Saharan Africa, where structural and psychosocial stressors are prevalent, is an important public health concern. While several studies have investigated some psychosocial factors as they predict mental well-being among adults living with HIV, little is known about the role of psychosocial (depression, personality traits and social support) predictors and sex differences in the mental well-being of adolescents living with HIV in Ibadan, Nigeria.: This study aims to examine the psychosocial predictors and gender differences in the mental well-being of adolescents living with HIV in Ibadan, Nigeria.: A cross-sectional design using purposive sampling was employed, with data collected from 144 adolescents (aged 13 to 19 years, = 16.04 years, SD = 2.02 years). Instruments included the Warwick-Edinburgh Mental Well-being Scale, the Perceived Social Support in HIV (PSS-HIV) scale, the Centre for Epidemiologic Studies Depression Scale (CESD-R) Scale, and the Big Five Personality Traits inventory. Five hypotheses were tested using hierarchical multiple regression and an independent sample -test at a significance level of 0.05.: Results showed that depression, personality traits, and social support jointly predicted mental well-being [(12, 122) = 13.77, = 0.60, = 0.36, < 0.01]. Independent predictors included agreeableness ( = 0.23, = 2.54, < 0.01), openness ( = -0.19, = -2.05, < 0.05), belonging ( = 0.22, = 2.56, < 0.01), and esteem ( = 0.38, = 3.31, < 0.001). Results also showed that there were no significant sex differences in mental well-being [(141) = -1.39, > 0.05].: Psychosocial factors significantly influenced mental well-being, and interventions should focus on strengthening social support networks and promoting adaptive personality traits to improve mental well-being.

: Stigma and discrimination against people living with HIV (PLHIV) in healthcare settings are significant barriers to achieving Egypt's 95-95-95 targets and ending AIDS as a public health threat by 2030. Misconceptions among healthcare professionals (HCPs) can negatively affect testing, treatment, and care outcomes. This study aimed to assess the knowledge, attitudes, and practices (KAP) of HCPs toward PLHIV at Cairo University Hospitals.: A cross-sectional study was conducted between March and June 2021 ( = 344 HCPs, mean age = 31.1 years, female = 52%), including physicians, nurses, and house officers, using an online, self-administered questionnaire adapted from the UNAIDS standardised tool for measuring HIV-related stigma and discrimination. The survey covered five domains: sociodemographic characteristics, knowledge, attitudes, practices, and institutional policies.: Only 30.3% of participants ( = 104) had received HIV/AIDS training in the past year. The training received had a median training duration of 12 hours (IQR: 7-21). While 86.6% ( = 298) correctly identified that a healthy-looking person can have HIV, misinformation was prevalent in other areas. Furthermore, 77.3% were unaware of the "undetectable = untransmittable" ("U=U") concept. Discriminatory attitudes and stigmatising behaviour driven by illiteracy of HIV/AIDS issues were evident. More than half of the participants strongly agreed that their facility had adequate supplies and standardised procedures to reduce HIV transmission risk, and 31.4% stated that their facility lacked written guidelines to protect patients with HIV from discrimination.: Persistent knowledge gaps, fear of occupational exposure, and moral judgments toward PLHIV were evident among HCP. Targeted stigma-reduction interventions through continuous professional education, enforcement of institutional anti-discrimination policies, and incorporation of HIV prevention principles into healthcare curricula are urgently needed.

: HIV treatment, adherence, and retention in care are fundamental in achieving viral load suppression (VLS) and fighting the HIV pandemic. The Government of Eswatini has decentralised antiretroviral treatment (ART) services and introduced differentiated HIV service delivery models to improve treatment outcomes for all people living with HIV, including young people. It is imperative to investigate the success of these initiatives in improving VLS in young people living with HIV (YPLHIV) in Eswatini.: To determine the factors associated with VLS amongst YPLHIV (15 to 24 years) who are on ART in Eswatini.: A retrospective cohort analysis of 4 334 YPLHIV on ART in Eswatini between January 2018 and December 2021 was conducted. The Statistical Package for Social Scientists version 25 was used to determine the factors associated with viral suppression through bivariate and logistic regression analysis.: The prevalence of viral suppression (< 1 000 copies/mL) was 92.9%. After adjusting for all covariates, the likelihood of viral suppression remained significantly higher among YPLHIV who were female (AOR = 2.06; CI 1.04-4.11), had enrolled on the fast-track ART care model (AOR = 2.14; CI 1.09-4.20), and were receiving 4 to 5 months' (AOR = 5.88; CI 3.14-11.02) and 6+ months' (AOR = 3.55; CI 1.67-7.53) of medication.: The national HIV treatment program in Eswatini exceeded the UNAIDS target of 90% virologic suppression for YPLHIV who are enrolled for ART for more than six months. However, to meet the revised 95% target, tailored interventions are required to strengthen long-term adherence and retention in care for YPLHIV on ART.

: South Africa has the world's highest HIV prevalence rate (12.7%), with university students disproportionately affected. While HIV Pre-Exposure Prophylaxis (PrEP) is an effective preventive measure for high-risk individuals, its uptake among university students remains low, which hinders progress toward national and global targets to end the AIDS epidemic by 2030. This study aimed to identify the factors influencing PrEP uptake in this vulnerable population, specifically among university students in Gauteng province, using Pender's Health Promotion Model.: A quantitative, descriptive cross-sectional survey was conducted among 537 university students across six universities in Gauteng province. Data were analysed using Partial Least Squares Structural Equation Modelling to identify significant predictors of PrEP use.: The study revealed a low PrEP uptake rate among students at risk of contracting HIV. The analysis identified several factors that directly influenced PrEP uptake, including knowledge ( = 0.122, = 0.001), interpersonal influence ( = 0.082, = 0.038), situational influence ( = 0.145, = 0.001), and perceived benefits ( = 0.121, = 0.003). Significant interactions were also found between condom use and knowledge ( = 0.098, = 0.004) and between condom use and perceived benefits ( = 0.127, = 0.013).: PrEP uptake is a complex process influenced by the dynamic interplay of factors consistent with Pender's Health Promotion Model, particularly interpersonal, cognitive, and situational factors. These results provide valuable evidence for developing multifaceted, youth-friendly interventions, such as a mobile health application, to promote PrEP use, reduce HIV incidence, and help achieve national and global HIV prevention targets.

: HIV self-testing has been introduced as a secondary mode of testing in most countries as a way of counteracting the barriers associated with the traditional clinic-based method of testing. As the entry point into the HIV care cascade, testing signifies a unique contribution in the fight to end HIV by 2030. However, in Uganda, the uptake of self-testing services remains contested, especially in low-skilled communities. Using the health beliefs model constructs of individual beliefs (perceived susceptibility, benefits, and barriers), the current study examined the effect of individual beliefs as a mediating factor between HIV self-testing knowledge and use.: A cross-sectional survey was conducted (July to September of 2023), with a systematic and random sample of 453 unskilled workers from Darling, Wakiso district, Uganda. The data were collected using a structured, validated, self-administered questionnaire. Data were analysed using regression mediation analysis in Process Macro Model 4 in SPSS v27.: Perceived susceptibility ( = 0.06, [0.03, 0.10]) and benefits ( = 0.06, [0.24, 0.39]) mediated HIV self-testing knowledge and HIV self-testing use. Perceived barriers ( = 0.01, [0.00, 0.03]) did not mediate HIV self-testing knowledge and HIV self-testing use.: In addition to delivering knowledge about self-testing, the benefits of using HIV self-testing and the susceptibility nature of individuals in low-skilled employment should be given more attention as a means to increase HIV self-testing.

Female university students engaging in high-risk sexual behaviours, such as transactional sex or unprotected sex, are eligible for HIV pre- and post-exposure prophylaxis (PrEP/PEP). This study aimed to determine the uptake and correlates of PEP and PrEP use among female students at a public university in Uganda. We conducted an online survey among 483 female students at Makerere University and found that 53% had ever engaged in sexual intercourse, with a median debut of 20 years (interquartile range 18 to 22 years). Overall, 20% had sex with a person with HIV or of unknown status, and 9% experienced sexual assault. Despite 32% being eligible for PEP and 20% for PrEP, uptake remained low (9% and 2%, respectively). PEP use was associated with being married/cohabiting and perceived HIV risk. Low uptake of PrEP and PEP among eligible female students highlights the need for targeted awareness and accessibility efforts in academic institutions.

: Pre-exposure prophylaxis (PrEP) is recommended as part of a comprehensive HIV prevention approach, but its uptake among women, particularly those in key populations, remains limited.: A mixed-methods community-based study was conducted in Mali, Mauritius, and Morocco to assess barriers and facilitators to PrEP implementation among cis and transgender women at high risk of HIV infection. Quantitative data collected included demographic information, awareness, willingness to use PrEP, and perceived barriers. The qualitative component included in-depth interviews with key populations, policymakers, healthcare workers, and community stakeholders to better determine the barriers to PrEP implementation and scale-up for women. Data analysis and processing were performed using software adapted to the respondent-driven sampling technique.: Between 15 February and 15 March, 2020, a survey was conducted involving 1 003 female participants. The results indicated varying levels of awareness of PrEP across different populations, with transgender women in Mauritius exhibiting the highest awareness (54%). Moreover, there was generally a high willingness to use PrEP among participants, with rates of 77% and 84% among female sex workers in Morocco and Mali, respectively, and 71% among female partners of people who inject drugs, as well as 50% among transgender women in Mauritius. Additionally, qualitative insights revealed prevailing barriers such as issues related to accessibility, stigma, and the legal frameworks in the respective countries.: This study provides critical insights into the challenges and opportunities for PrEP implementation among women in Mali, Mauritius, and Morocco. The findings underscore the importance of community-based research and the need for tailored interventions to improve PrEP awareness and uptake among women, particularly those in key populations. The results may inform advocacy efforts and the provision of adapted services within comprehensive HIV prevention programs to better address the needs of these populations.

Adolescents and young people in sub-Saharan Africa account for about a third of persons newly diagnosed with HIV. Health communication, through mobile health (mHealth) can improve access to sexual and reproductive health information, health services and reduce risky sexual behaviours among adolescents and young people. We assessed the impact of a health promotion messaging intervention on the reduction of risky sexual behaviours among HIV-negative high risk adolescent girls and young women (AGYW). Newly diagnosed and sexually active AGYW of 15-24 years old were enrolled between May 2017 and April 2018 in the HIV positive and negative cohorts of the study. We utilised SMS (short message service) and unstructured supplementary service data (USSD) technology to deliver health promotion messages quarterly to the HIV-positive cohort and six-monthly to the HIV-negative cohort over 12 months. Both cohorts completed a SMS survey at the end of their scheduled study follow-up period. We enrolled 184 AGYW in the HIV-negative cohort with a mean age of 20.8 years, 28.6% began sexual activity before 15 years old, and 8.5% tested HIV-positive. Over 12 months, reported multiple sexual partnership reduced from 33% to 12% ( < 0.001) among AGYW who had multiple partners. HIV re-testing increased from 74.2% to 81.6% ( = 0.099). Those who knew their partner's HIV status increased from 70.9% to 85.7% ( <0.001). Our findings demonstrate that mobile phone text messaging is an effective and feasible method for sexual health promotion among young people. Specifically, SMS, which is simple, cost-effective and widely accepted, could be adopted by health intervention programmes as a strategy to effectively promote safer sex behaviours and retesting among high-risk HIV-negative AGYW.

The HIV and AIDS epidemic remains a critical global health challenge. Malawi accounts for 2.5% of global HIV cases and is a focus country in the UNAIDS 95-95-95 fast-track initiative. Despite reaching 92-95-94 in 2020, there is a need to evaluate Malawi's progress as of 2023 to identify gaps and ensure success before the target period ends. This quantitative descriptive study used secondary data from Malawi's Department of HIV and AIDS Management Information System (DHAMIS) database over a 12-year period (2012-2023) and HIV spectrum estimates. It contains aggregate data from HIV service delivery points. Data included key HIV indicators disaggregated by age and gender. Numerators for the 95-95-95 are: people living with HIV (PLHIV) who know their status, PLHIV on treatment, PLHIV on treatment and virally suppressed. Denominators are: the estimated total PLHIV, PLHIV who know their status and PLHIV on treatment. Statistical analysis was performed using Excel, SPSS and Stata to assess differences between groups. Ethical approval and data access permissions were granted by the Ministry of Health. Between 2012 and 2023, the total number of PLHIV increased from 962 043 to 991 600. The percentage of PLHIV aware of their HIV status increased from 73% to 95%, and those on treatment increased from 58% to 95%. By 2023, 87% of children (under 15 years old) knew their HIV status, compared to 96% of adults. Lower percentages of ART initiation and viral load suppression were also noted among children. While both males and females improved across all indicators, men consistently lagged women in all three indicators. The viral suppression gap narrowed after 2019. Malawi has improved in the HIV treatment cascade between 2012 and 2023. Challenges remain in children ART initiation and access to care for men, requiring targeted efforts to achieve equitable treatment for all and meet the UNAIDS 95-95-95 targets.

Financial insecurity pushes female sex workers into risky sexual transactions. We piloted an economic empowerment intervention among female sex workers in Kenya to test if they could save part of their income from which to make withdrawals to avoid risky sexual encounters. We enrolled female sex workers and randomised half to the intervention arm, who were given instructions on how to save and withdraw money through a mobile platform, and half to the control arm (usual saving). Chi-square test was used to establish the association between condom use, saving and making withdrawals. We enrolled 207 female sex workers (101 in the intervention arm) aged between 18 and 24 years. Of these sex workers, 157 (75.8%) had children and 83 (40.1%) were the primary breadwinners. Of those in the intervention arm, 41 (40.6%, n=101) saved and 19 (46.3%, n=41) withdrew their savings. Withdrawing savings was significantly associated with higher condom use (=7.52; p≤0.006). Female sex workers are able to save from their income, and withdraw the savings to avoid unprotected sex.

Globally, mother-to-child transmission (MTCT) of HIV significantly contributes to paediatric HIV infections. Effective prevention of mother-to-child transmission (PMTCT) programs aim to achieve the World Health Organization's target of less than 5% transmission rates. This study evaluated the implementation of PMTCT services in Mwanza district, Malawi, focusing on antiretroviral therapy (ART) adherence and key implementation challenges. This was a retrospective study which analysed data from HIV-positive pregnant women and exposed infants enrolled in the PMTCT program (June 2020-June 2022). Logistic regression and bivariate analyses assessed factors influencing MTCT rates. Further, qualitative data from structured interviews with health workers identified implementation barriers. The MTCT rate in Mwanza was 1.7%, below Malawi's national average of 6%. ART defaulting significantly raised MTCT risk (5.56%) versus consistent adherence (0.6%; = 9.6521, = 0.002). Logistic regression indicated mothers defaulting ART had nine-fold greater odds of MTCT (OR = 9.134, 95% CI: 1.72-48.43). Key challenges included loss to follow-up, shortage of resources, insufficient healthcare worker training, and other socioeconomic factors affecting adherence. Improving ART adherence and addressing socioeconomic and systemic barriers are crucial to reducing MTCT. Enhanced training, adequate resource allocation, and most importantly, targeted adherence interventions are recommended to strengthen PMTCT program effectiveness in Malawi.

: Understanding how HIV epidemics are likely to behave in the future is key to informing HIV response strategies in low-income countries. Up-to-date HIV epidemiological estimates are important for policy decision- making, but surveillance data can be out of date. This study compared forecasts from HIV epidemiological models.: Five independent modelling groups (EMOD-HIV, Goals, HIV Synthesis, Optima and PopART-IBM) calibrated their mathematical models to datapoints provided by the Ministry of Health and produced several indicators of the HIV epidemic in Zimbabwe for the period 1990 to 2040, under a status quo scenario in which it was assumed continuation of interventions at the current level.: All models predicted a continuous decline in HIV incidence and prevalence. However, there was variability in the estimated 2023 incidence rate (range: 2.0-3.3 per 1 000 person-years) and prevalence (range: 12.1%-14.3%). Variance was even larger in 2040 for incidence (range: 1.0-3.0 per 1 000 person-years), while this was not the case for prevalence (range: 3.9%-6.0%). All the models predicted that the country would reach a target of less than 7 800 new HIV infections per year by 2025.: Five independent mathematical models fitted to the Zimbabwe Ministry of Health and Child Care's HIV surveillance data provided consistent predictions of continued decline in HIV incidence and prevalence in Zimbabwe if interventions continue to be implemented at the current levels, with prevalence predicted to be around a third of its level in 2000 by 2040.

: The role of religion and faith in the context of HIV stigma is complex. It is important to recognise the diversity of religious beliefs and practices and to work with faith communities to promote a compassionate, non-stigmatising response to HIV. This aimed to explore HIV stigma within faith communities.: The study used a quantitative approach with a cross-sectional design, recruiting 141 participants from faith communities in South Africa, mainly from the Western Cape province. Communities that were gathering together with a specific faith, religion, or spirituality were deemed "faith communities". Participants were recruited through the Desmond and Leah Tutu Legacy Foundation network and snowballing. HIV stigma awareness was measured using the People Living with HIV Stigma Index. Data were analysed using independent -tests, One-Way Analysis of Variance (ANOVA), and Simple correlation analysis.: Faith leaders who were involved in HIV ministry gave participants a better understanding of HIV stigma in their communities compared with faith leaders who were not involved in HIV ministry. Younger participants (age < 30 years) thought fewer people believed HIV stigma misinformation compared to the oldest participant group (age >51 years). Participants who witnessed HIV stigma in a community were more involved in healthcare activities ( = 0.262) but were also more likely to believe HIV is the result of immoral behaviour ( = 0.323). Communities that believed HIV was the result of immoral behaviour were more likely to believe misinformation about HIV ( = 0.244). Lastly, when the community believed facts about HIV and medicine, they were less likely to believe that HIV was the result of immoral behaviour ( = -0.246).: Faith communities have a role in diminishing HIV stigma. Active involvement of faith communities in HIV services and programs is more effective than solely educating faith communities about HIV. Given faith communities' notable role in shaping morality and stigma within their communities, activities showing the inclusion of people with HIV are vital.

: People living with HIV/AIDS (PLWHA) may experience HIV-related stigma, which could negatively impact health-related quality of life (HRQoL) and increase symptoms of depression. Self-compassion is a positive personality attribute that may protect PLWHA against stigmatisation. Previous studies have not examined the influence of self-compassion on the association between HIV-related stigma, HRQoL, and depression.: The present study aimed to examine whether self-companion can moderate the relationship between (i) HIV-related stigma and HRQoL, and (ii) HIV-related stigma and depression among PLWHA.: Participants included 371 PLWHA (mean age = 31.44 years; SD = 9.75 years) recruited from a healthcare institution in Nigeria. Participants completed relevant self-report measures.: Regression analysis results showed that self-compassion positively and significantly moderated the relationship between HIV-related stigma and all the HRQoL domains (physical health symptoms, = 0.01, < 0. 05; relationship to others, = 0.02, < 0. 05; cognitive symptoms, = 0.02, < 0. 05; and treatment impacts, = 0.02, < 0. 05). Also, the positive relationship between HIV-related stigma and depression was significantly moderated by self-compassion ( = - 0.02, < 0. 05).: We concluded that clinical efforts geared towards improving the well-being of PLWHA should consider integrating self-compassion-based therapy since it has the potential to decrease the detrimental effects of stigma on the patients' health and recovery.

Retention in care of people living with HIV (PLHIV) is a crucial public health issue in Mali. Several barriers to retention have been highlighted, including socioeconomic status, gender, sexual orientation, HIV-related stigma, as well as organisational and structural barriers, such as public insecurity and sub-optimal public services. We explored the role of community health workers (CHWs) in PLHIV retention in care in Mali.

: HIV-related stigma remains a significant barrier to well-being and access to healthcare for adolescents and young adults living with HIV in Sub-Saharan Africa. Stigma reduction interventions have been developed to address this challenge, but the effectiveness of these interventions in this population is not well-documented.: This narrative review synthesises the available evidence on the effectiveness of stigma reduction interventions for adolescents and young adults (aged 10-24 years) living with HIV in Sub-Saharan African countries.: A comprehensive literature search was conducted using multiple electronic databases to identify relevant studies evaluating stigma reduction interventions targeting internalised stigma, perceived stigma, HIV disclosure, mental health, antiretroviral therapy (ART) adherence, and viral suppression among the population of interest.: Studies were conducted in Uganda, Zimbabwe, Kenya, Malawi, South Africa, Ethiopia, Zambia, and Nigeria. Various types of stigma reduction interventions were identified, including education and awareness campaigns, peer support and mentoring, counselling and psychosocial support, and community-based approaches. The evidence demonstrates the effectiveness of these interventions in reducing internalised, perceived and enacted stigma, improving HIV disclosure, enhancing mental health and well-being, increasing ART adherence, and potentially contributing to viral suppression. Factors influencing intervention effectiveness, such as intervention design, participant characteristics, and the sociocultural context, are discussed.: Stigma reduction interventions have shown promise in improving a range of outcomes for adolescents and young adults living with HIV in Sub-Saharan Africa. However, more research is needed to identify the most effective intervention strategies and to explore the long-term impact on health outcomes.

Mozambique has the sixth highest prevalence of HIV in the world and ranks fourth in new infections. The government-owned print press has played an important role in the social construction of HIV and AIDS in the country as it was entrusted with the role of disseminating HIV and AIDS information to the public since the outbreak of the pandemic in the country in 1986. Using ' articles and frame analysis perspective, the article analyses the way has framed HIV and AIDS in the country since the late 1980s. The choice of media results from the fact that the way a phenomenon is constructed influences the way it is understood, as well as the way people may behave before it. The study found that frames on HIV and AIDS have suffered from a threefold tension: the need to maintain the Frelimo government's former centralised and grassroots-orientated socialist ideology of health services in the context of the liberal market; the need to balance the influence of the global multilateral and bilateral actors and the Frelimo government's political interest of translating HIV and AIDS response to the Mozambican context; and the need to portray a nationalist and positive image of the government's performance in HIV and AIDS response before Mozambique's non-fully plausible societal practices for an effective HIV and AIDS response. In a top-down approach, ' frames reflect not only the African post-independence ancillary and nationalist role of government-owned print press but also the power of global actors. Less is done from the societal bottom-up perspective.

Depression is a significant concern for people living with HIV and AIDS as it is associated with negative health outcomes and suboptimal adherence to antiretroviral therapy (ART). To this extent, screening for depression is essential for early detection. The CESD-R-20 is a revised four-factor questionnaire developed to assess depressive symptoms in adults. This study explored the factor structure and psychometric properties of the CESD-R-20 among 685 individuals receiving ART. Data were collected at the Infectious Diseases Clinic of a large public hospital outside Cape Town from participants who had been receiving ART for at least six months. Exploratory factor analysis (EFA) of the CESD-R-20 was performed to identify its underlying factor structure. The EFA revealed a one-factor solution termed "depressive affect," comprising 19 items that encompassed the original factors. This finding suggests that depression is a cohesive construct rather than a collection of interconnected dimensions. The scale exhibited high internal consistency (Cronbach's alpha = 0.95) among the sample of persons living with HIV and AIDS. Our findings indicate that the CESD-R-20 can effectively measure depressive affect as a one-factor scale in South Africans receiving ART. The scale demonstrated strong internal consistency and is suitable for screening for depressive symptoms among persons living with HIV and AIDS.

Low HIV testing among men, particularly highly mobile fishermen, is a persistent challenge. The Owete study (NCT#04772469) used social network-central men (Promoters) to promote testing and linkage to HIV services among social networks of fishermen in western Kenya. The Promoters and fishermen networks were randomised to intervention or control arms. We describe Owete's interactive training approach and Promoters' training experiences for implementation insights. The 146 Promoters trained (balanced across arms) were highly engaged, eager learners, and supportive of targeted health training sessions for men. Promoters felt the knowledge gained improved their understanding of health matters and elevated their social status. Promoters felt empowered knowing how to interpret self-testing results and how to address pre-exposure prophylaxis use questions and correct misconceptions. Offering capacity building for social network-central men to spearhead campaigns on health issues affecting fishermen can leverage established relationships and trust, expand knowledge, and help increase health-seeking practices among underserved, highly mobile men.

HIV testing services (HTS) enable early linkage to HIV prevention, treatment and care. A review of Chegutu District Health Information System 2 sexually transmitted infection (STI)/HIV data revealed HIV testing rates among those infected with STIs were 41%, 48%, 50%, 51% and 68%, respectively, for the period 2016-2020 against a target of 100%. We investigated factors associated with the uptake of HTS among STI clients.

This paper focused on the prevention of HIV transmission for adolescent girls and young women (AGYW), through a layered approach which included economic strengthening as a core strategy, especially for the most vulnerable. Based on multi-year data in KwaZulu-Natal, South Africa, we assessed the outcomes of an economic strengthening model developed by TB HIV Care (THC) in the Determined, Resilient, Empowered, AIDS-free, Mentored and Safe (DREAMS) HIV prevention programme. The methods used are primarily qualitative. In 2021, 2022, and 2024 DREAMS implementation staff ( = 72) and economic strengthening beneficiaries ( = 73) from four districts were interviewed on the dynamics of the model and its emerging outcomes. The qualitative data were supplemented by monitoring data. The study results showed that, while longer-term outcomes for the beneficiaries were unclear, the short and medium-term benefits of economic strengthening activities for vulnerable AGYW were highly promising. Not only did beneficiaries gain valuable technical and life skills through training, but they showed increased confidence and hope for the future, and a new sense of empowerment. They also experienced social asset building and an increase in their social, economic, and emotional efficacy. Importantly, beneficiaries also showed signs of behaviour change, away from risky behaviours towards protective ones. The paper concludes that layered economic strengthening initiatives targeted towards those most at risk AGYW, is an important pillar of efforts to reduce HIV infection; however, challenges around taking such initiatives to scale and tracking long-term outcomes remain.