Examining the Long-Term Effect of a Family-Based Economic Strengthening Intervention on Depression Among HIV Positive Adolescents in Southern Uganda

Background and Purpose: Previous studies have documented positive effects of economic strengthening interventions on the mental health functioning of children orphaned by HIV/AIDS in sub-Saharan Africa. However, no evidence exist on the effect of these interventions on the mental health functioning of adolescents living with HIV. Yet, mental health wellbeing is critical for HIV care and adherence to treatment protocols among adolescents living with HIV. This study therefore, examines the effect of a family-based economic strengthening intervention that utilizes child development accounts (CDAs), on depression among HIV positive adolescents in southwestern Uganda

Methods: This study utilized data from NICHD-funded study called Suubi+Adherence (2012-2018), implemented in the southwestern region of Uganda. A total of 702 HIV positive adolescents (n=306 boys and n=396 girls), average age = 12 years at study enrollment, participated in the study. Participants were randomly assigned, at the clinic/health level, to either the control condition (n=344) receiving usual care services for HIV positive children, or the treatment condition (n=358) receiving usual care services above, plus three intervention components: 1) economic strengthening in the form of a CDA, 2) workshops on financial management and microenterprise development, and 3) a mentorship program. Mental health functioning was measured by the Child Depression Inventory (CDI). Multilevel regression analyses were conducted to test the effect of the intervention on the CDI, and the moderating effect of participants’ age, school enrollment and Plasma HIV RNA levels <40 copies/ml, during the intervention (12 and 24-months) and post intervention (36-months and 48-months follow-up).

Results: At 24 months follow-up, participants in the treatment condition reported significant positive self-rated mental health functioning (b=-0.35, 95%CI = -0.54, -0.21, p<.01) compared to the control condition. Moreover, age, (b=-0.23, 95%CI = -0.30, -0.17, p<.001) school enrollment status (b= -1.05, 95%CI = -1.42, -0.59, p<.001) and Plasma HIV RNA levels <40 copies/ml (b=-0.42, 95%CI = -0.80, -0.04, p<.05) were found as strong moderators for participant’s mental health functioning overtime

Conclusions and Implications: Findings suggest that family-based economic strengthening has the potential to improve HIV positive adolescents’ mental health functioning. Therefore, incorporating economic strengthening components into future programming that target HIV positive adolescents, may be instrumental not only in alleviating economic hardships, but also improving adolescents’ abilities in making both