Abstract: The Long-Term Impact of Family-Based Economic Strengthening on Viral Suppression and Mental Health Outcomes Among Adolescents Living with HIV in Low-Income Settings: Lessons from a Cluster-Randomized Controlled Trial (2012 to 2022) in Uganda (Society for Social Work and Research 28th Annual Conference - Recentering & Democratizing Knowledge: The Next 30 Years of Social Work Science)

Schedule:

Friday, January 12, 2024

Mint, ML 4 (Marriott Marquis Washington DC)

* noted as presenting author

Samuel Kizito, MD, MS, Research fellow, Washington University in St. Louis, St Louis, MO

Josephine Nabayinda, Msc, Doctoral student, Washington University in Saint Louis, Saint Louis, MO

Flavia Namuwonge, MBA, Doctoral Student, Washington University in St. Louis, MO

Proscovia Nabunya, MSW, PhD, Assistant Professor, Washington University in Saint Louis, St. Louis, MO

Ozge Sensoy Bahar, PhD, Research Assistant Professor, Washington University in Saint Louis, St. Louis, MO

Joshua Kiyingi, MSTAT, Doctoral Student, Washington University in St. Louis, St. Louis, MO

Jennifer Nattabi, MSW, Doctoral Student, Washington University in Saint Louis, St. Louis, MO

Fred Ssewamala, PhD, Professor, Washington University in Saint Louis, Saint Louis, MO

Background and Purpose

Antiretroviral therapy (ART) adherence and viral suppression remain low among adolescents living with HIV (ALHIV). We examined the impact of a family-based economic empowerment intervention on clinical and mental health outcomes among ALHIV.

Methods

Thirty-nine clinics (clusters) from seven districts in Uganda were randomized (1:1) to deliver the standard of care (control) or a family economic empowerment (EE) intervention called “Suubi+Adherence" for ALHIV. Eligible participants had to be aged 10 - 16, living with HIV and aware of their status, taking ART, living with a family, and registered to receive care from one of the 39 study clinics. The family EE intervention package comprising a matched bank savings account (where ALHIV saved money was matched 1:1 over a 24-month intervention period), financial literacy training, and micro-enterprise development workshops. Adolescents were followed up between 2012 to 2022. The primary outcome was the proportion of ALHIV with a viral load below 50 copies/ml, while the secondary outcomes included depression, hopelessness, and self-concept. We ran complete-case, intention-to-treat mixed-effects models to determine the main effects of group, time, and group-time interaction.

Findings

Between January 2013 and December 2015, 702 ALHIV were enrolled, of whom 358 from 20 health clinics were randomized at the clinic level to the intervention group, and 344 from 19 health clinics were randomized to the control condition. At enrollment, the mean age was 12 years, 56% were female, and ~ 60% (60.4%) had a viral load below 50 copies/ml. By 2022, 572 (82%) of the adolescents had observable outcome data. The intervention improved viral suppression, with the group, with group joint main effects (χ²(6) = 12.67, p=0.049). There was significant group-by-time interaction effect for viral suppression, (χ²(5) = 12.54, p=0.028). The economic intervention significantly improved self-concept (χ²(1) = 21.23, p<0.001) and reduced hopelessness (χ² (1) = 4.18, p=0.041) among a sub-sample of ALHIV with few economic assets. Time main effects were significant for all outcomes, meaning that all outcomes improved over time.

Conclusions and Implications

Economic interventions have the potential to improve viral suppression and mental health outcomes among ALHIV, a population with poor HIV treatment outcomes, especially in Sub-Saharan Africa.