The long-term impact of family economic empowerment on viral suppression and mental health outcomes among adolescents living with HIV in low-income settings: A cluster-randomized controlled trial in Southern Uganda.

Journal: Social science & medicine (1982)

Volume: 364

Issue: 

Year of Publication: 

Affiliated Institutions:  International Center for Child Health and Development, Brown School, Washington University in St. Louis, MO, , USA. Division of Prevention Science, University of California, San Francisco, CA, , USA. International Center for Child Health and Development, Brown School, Washington University in St. Louis, MO, , USA. Electronic address: nabunyap@wustl.edu.

Abstract summary 

We examined the impact of a family-based economic empowerment intervention on viral suppression and mental health among ALHIV.Between 2013 and 2014, 702 participants aged 10-16, living with HIV, and taking antiretroviral therapy, were recruited from 39 clinics in Uganda. Twenty clinics (n = 358 participants) were randomized to the intervention and 19 clinics (n = 344 participants) were randomized to the control conditions. The intervention comprised a matched savings account, financial literacy training, and microenterprise workshops. The primary outcome was viral suppression, while the secondary outcomes included depression, hopelessness, and self-concept. We ran mixed-effects models to determine the intervention effects.At enrollment, participants' mean age was 12 years. The intervention improved viral suppression, evidenced by significant intervention-by-time interaction effects [χ(5) = 12·81, p = 0·025], further qualified by increased viral suppression in the intervention group at year two, OR = 1.89 (95% CI: 1.14-3.15), year three, OR = 2.31 (95% CI: 1.05-5.04), and year four, OR = 2.34 (95% CI: 1.03-5.33). Regarding mental health, we did not find significant intervention main effects or intervention-by-time interaction effects for depressive symptoms, hopelessness, or self-concept for the entire sample. However, for participants owning fewer assets, we found significant intervention-by-time interaction effects for hopelessness [χ(5) = 12·33, p = 0·031], and self-concept [χ(5) = 27·26, p < 0·001], suggesting beneficial intervention effect for this demographic.Family EE interventions have the potential to improve viral suppression and mental health outcomes among ALHIV. These findings offer insights in designing programs and policies to improve outcomes among ALHIV.

Authors & Co-authors:  Kizito Samuel S Ssewamala Fred M FM Nabayinda Josephine J Namuwonge Flavia F Neilands Torsten B TB Nabunya Proscovia P Bahar Ozge Sensoy OS Ssentumbwe Vicent V Nattabi Jennifer J

Study Outcome 

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Citations : 
Authors :  9
Identifiers
Doi : 10.1016/j.socscimed.2024.117546
SSN : 1873-5347
Study Population
Male,Female
Mesh Terms
Other Terms
Adolescents;Economic empowerment;HIV/AIDS;Mental health;Sub-Saharan Africa;Virological suppression
Study Design
Randomized Control Trial
Study Approach
Mixed Methods
Country of Study
Uganda
Publication Country
England