Does Economic Strengthening Improve Viral Suppression Among Adolescents Living with HIV? Results From a Cluster Randomized Trial in Uganda.

Journal: AIDS and behavior

Volume: 22

Issue: 11

Year of Publication: 2018

Affiliated Institutions:  Columbia University School of Social Work, Amsterdam Ave., New York, NY, , USA. lgb@columbia.edu. George Warren Brown School of Social Work, Washington University in St. Louis, Brookings Drive, St. Louis, MO, , USA. School of Medicine, University of California San Francisco, th Street, San Francisco, CA, , USA. Department of Epidemiology, Columbia University Mailman School of Public Health, West th Street, New York, NY, , USA. Department of International Health, Social and Behavioral Interventions Program, Johns Hopkins Bloomberg School of Public Health, N. Wolfe Street, Room E, Baltimore, MD, , USA. Rakai Health Sciences Program, Old Bukoba Road, , Kalisizo, Uganda. HIV Center for Clinical & Behavioral Studies, New York State Psychiatric Institute and Columbia University, Riverside Dr, New York, NY, , USA. International Center for Child Health and Development Field Office, Plot Circular Rd, Masaka, Uganda.

Abstract summary 

To assess the effect of a savings-led economic empowerment intervention on viral suppression among adolescents living with HIV. Using data from Suubi + Adherence, a longitudinal, cluster randomized trial in southern Uganda (2012-2017), we examine the effect of the intervention on HIV RNA viral load, dichotomized between undetectable (< 40 copies/ml) and detectable (≥ 40 copies/ml). Cluster-adjusted comparisons of means and proportions were used to descriptively analyze changes in viral load between study arms while multi-level modelling was used to estimate treatment efficacy after adjusting for fixed and random effects. At 24-months post intervention initiation, the proportion of virally suppressed participants in the intervention cohort increased tenfold (Δ = + 10.0, p = 0.001) relative to the control group (Δ = + 1.1, p = 0.733). In adjusted mixed models, simple main effects tests identified significantly lower odds of intervention adolescents having a detectable viral load at both 12- and 24-months. Interventions addressing economic insecurity have the potential to bolster health outcomes, such as HIV viral suppression, by improving ART adherence among vulnerable adolescents living in low-resource environments. Further research and policy dialogue on the intersections of financial security and HIV treatment are warranted.

Authors & Co-authors:  Bermudez Laura Gauer LG Ssewamala Fred M FM Neilands Torsten B TB Lu Lily L Jennings Larissa L Nakigozi Gertrude G Mellins Claude A CA McKay Mary M Mukasa Miriam M

Study Outcome 

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Statistics
Citations :  UNICEF. UNICEF Data: Adolescents and Young People Current Status and Progress. 2016 http://data.unicef.org/hiv-aids/adolescents-young-people.html.
Authors :  9
Identifiers
Doi : 10.1007/s10461-018-2173-7
SSN : 1573-3254
Study Population
Male,Female
Mesh Terms
Adolescent
Other Terms
ART;Adolescents;Assets;Economic empowerment;HIV;SUUBI;Savings-led intervention
Study Design
Cohort Study,Randomized Control Trial,Case Control Trial,Cross Sectional Study
Study Approach
Mixed Methods
Country of Study
Uganda
Publication Country
United States