Suubi+Adherence-Round 2: A study protocol to examine the longitudinal HIV treatment adherence among youth living with HIV transitioning into young adulthood in Southern Uganda

Abstract

Background Youth living with HIV (YLHIV) in Sub-Saharan African (SSA) are less likely to adhere to antiretroviral therapy (ART) and other health-related regimens. As a consequence, YLHIV are not only at risk for health problems and mental health comorbidities, but are also at risk for cognitive deficits, including in areas of memory and executive functioning. The Suubi+Adherence study followed 702 adolescents (10-16 years of age) receiving bolstered standard of care and a family economic empowerment intervention comprising an incentivized youth financial savings account (YSA) augmented with financial literacy training (FLT) and peer mentorship. The study findings pointed to superior short-term viral suppression and positive adolescent health and mental health functioning among participants receiving the intervention. The original group of adolescents who received Suubi+Adherence are now transitioning into young adulthood. This paper presents a protocol for the follow-up phase titled Suubi+Adherence Round 2. Methods The original cohort in Suubi+Adherence will be tracked for an additional five years (2020-2025). Specifically, the long term follow-up will allow to: 1) ascertain the extent to which the short term outcomes identified in the first 6 years of the intervention are maintained as the same group transitions through young adulthood; and 2) address new scientific questions regarding ART adherence; HIV care engagement; protective health behaviors; and the potential of FEE to mitigate the development of HIV-associated neurocognitive disorders in YLHIV. Additionally, the team examines the potential mechanisms through which the observed long-term outcomes happen. Moreover, the Suubi+Adherence-Round 2 adds a qualitative component and extends the cost effectiveness component. Discussion Guided by asset and human development theories, Suubi+Adherence-R2 will build on the recently concluded Suubi+Adherence study to conduct one of the largest and longest running studies of YLHIV in SSA as they transition into young adulthood. The study will address new scientific questions regarding long-term ART adherence, HIV care engagement, protective health behaviors, and the potential of FEE to mitigate the development of HIV-associated neurocognitive disorders in YLHIV. The findings may inform efforts to improve HIV care among Uganda’s YLHIV, with potential replicability in other low-resource countries. Trial registration ClinicalTrials.gov, ID: NCT01790373

Measuring patient engagement with HIV care in sub‐Saharan Africa: a scoping study

“…Understanding the behaviour of people on ART [ 15 , 21 , 25 , 63 , 65 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 , 106 , 107 , 108 , 109 , 110 , 111 , 112 , 113 , 114 , 115 , 116 , 117 , 118 ]…”

‘It is a complex process, but it’s very important to return these results to participants’. Stakeholders’ perspectives on the ethical considerations for returning individual pharmacogenomics research results to people living with HIV

“…However, several factors should be considered when defining actionable results, especially among people suffering a chronic illness like HIV/AIDS in low-resource settings. For example, for several decades, many PLHIV have been accessing antiretroviral treatment cheaply or freely from the Government of Uganda (Commission UACJKUA, 2015; Spacek et al, 2006; Ssewamala et al, 2023). The introduction of pharmacogenomic research aimed at optimizing HIV treatment may present information about approved and efficacious antiretroviral drugs with minimal adverse drug reactions tailored to an individual’s genetic makeup.…”

Suubi + Adherence4Youth: a study protocol to optimize the Suubi Intervention for Adherence to HIV treatment for youth living with HIV in Uganda

“…Survey assessments will occur at baseline, 6-, 12-, 24-, and 36-months, and all assessments will take place in ICHAD’s private research field offices in Masaka; at satellite sites (MildMay, RTY- Uganda); or at the participants’ homes (if they request it and there is sufficient privacy to ensure confidentiality, or at clinics (in a private room) with each lasting about 60 min [ 105 ]. Flexibility in interview location has been critical to Suubi + Adherence and other ICHAD studies success to date, with approximately 40% conducted in research offices in Masaka, and 50% in satellite sites [ 105 ]. Assessments are administered orally however for questions measuring sensitive behaviors, computer assisted self-interviews will be administered [ 106 ].…”