Acceptability of Group-Based HIV Stigma Reduction Interventions for Adolescents Living with HIV and Their Caregivers in Uganda

Background. Acceptability of interventions –defined as the extent to which people delivering or receiving a healthcare intervention consider it to be appropriate, based on anticipated or experienced cognitive and emotional responses to the intervention is critical for intervention success. This study qualitatively explored acceptability and experiences of adolescents and caregivers participating in two group-based stigma reduction interventions in Uganda.

Methods. We conducted semi-structured in-depth interviews with 34 adolescents and their caregivers (dyads) upon completion of group-based cognitive behavioral therapy and a family strengthening intervention tested as part of a cluster randomized clinical trial (2020-2022). The larger trial recruited adolescent-caregiver dyads (N=178) from nine health care clinics in the greater Masaka region of Uganda. Adolescents were eligible to participate if they were: 1) living with HIV and disclosed to; 2) between 10-14 years; 3) enrolled on ART at one of the participating health clinics; and 4) living within a family, including extended family units. Adults aged 18+ who identified as the primary caregiver of the recruited adolescent were recruited. In-depth interviews explored participants’ motivation to participate, thoughts about the different aspects of the interventions, facilitators and barriers to session attendance, as well as perceived impact of the interventions on the different aspects of their lives. Data were analyzed using thematic analysis.

Results. Four main themes emerged from data analysis: 1) Anticipated outcomes, financial incentives, and ensured confidentiality as key motivators for participation; 2) Fear of stigma and uncertainty as initial concerns for participation; 3) Communication, incentives and facilitator support as key facilitators for attendance; 4) Miscommunication, sickness and family emergencies as barriers to participation; 5) Group-based learning, facilitator support, and content relevance among positive experiences related to program organization; and 6) Evidence of awareness, building resilience, and connectedness as perceived impact of the interventions sessions.

Conclusion and Implications. Study findings showed high intervention acceptability, as well as positive outcomes among adolescent and their caregivers. For adolescents, these benefits reduced loneliness, fostered a sense of belonging, and promoted resilience. Caregivers also valued the shared group experience, which strengthened family support networks and improved communication within households. These findings highlight the potential of group-based approaches to address the social and emotional needs of both adolescents and their caregivers. Policymakers and practitioners should prioritize group-based interventions that integrate resilience-building and family-centered approaches.