Suubi4Her: a study protocol to examine the impact and cost associated with a combination intervention to prevent HIV risk behavior and improve mental health functioning among adolescent girls in Uganda

Abstract

BackgroundAsset-based economic empowerment interventions, which take an integrated approach to building human, social, and economic capital, have shown promise in their ability to reduce HIV risk for young people, including adolescent girls, in sub-Saharan Africa. Similarly, community and family strengthening interventions have proven beneficial in addressing mental health and behavioral challenges of adolescents transitioning to adulthood. Yet, few programs aimed at addressing sexual risk have applied combination interventions to address economic stability and mental health within the traditional framework of health education and HIV counseling/testing. This paper describes a study protocol for a 5-year, NIMH-funded, cluster randomized-controlled trial to evaluate a combination intervention aimed at reducing HIV risk among adolescent girls in Uganda. The intervention, titled Suubi4Her, combines savings-led economic empowerment through youth development accounts (YDA) with an innovative family strengthening component delivered via Multiple Family Groups (MFG).MethodsSuubi4Her will be evaluated via a three-arm cluster randomized-controlled trial design (YDA only, YDA + MFG, Usual Care) in 42 secondary schools in the Central region of Uganda, targeting a total of 1260 girls (ages 15–17 at enrollment). Assessments will occur at baseline, 12, 24, and 36 months. This study addresses two primary outcomes: 1) change in HIV risk behavior and 2) change in mental health functioning. Secondary exploratory outcomes include HIV and STI incidence, pregnancy, educational attainment, financial savings behavior, gender attitudes, and self-esteem. For potential scale-up, cost effectiveness analysis will be employed to compare the relative costs and outcomes associated with each study arm.ConclusionsSuubi4Her will be one of the first prospective studies to examine the impact and cost of a combination intervention integrating economic and social components to reduce known HIV risk factors and improve mental health functioning among adolescent girls, while concurrently exploring mental health as a mediator in HIV risk reduction. The findings will illuminate the pathways that connect economic needs, mental health, family support, and HIV risk. If successful, the results will promote holistic HIV prevention strategies to reduce risk among adolescent girls in Uganda and potentially the broader sub-Saharan Africa region.Trial registrationClinical Trials NCT03307226 (Registered: 10/11/17).

Prevalence and Correlates of Depressive Symptoms Among High School Adolescent Girls in Southern Uganda

“…As such, other supportive strategies to enable adolescents deal with stressful situations as they transition through adolescence, including developing trusting relationships, respectful and open child-caregiver communication, may be important. Indeed, one of the intervention components of the study focuses on strengthening family relationships to address mental health challenges and sexual risk-taking behaviors among adolescent girls [75]. We hope that analysis of post intervention data will reveal signi cant improvements, not only in family functioning, but also in the overall mental health functioning of study participants.…”

Efficacy of HIV interventions among factory workers in low- and middle-income countries: a systematic review

“…The combination effect of educational intervention and community intervention is better than a single intervention [53,54]. Highly effective interventions, such as those that have an educational component, are imperative to undertake, but the cost of these designs -especially in LMIC -often limit their implementation even though they demonstrate high uptake of HCT and lower risky behaviors [54,55]. Costeffectiveness analysis provides information to help us balance the cost and e cacy when we implement educational intervention [54], so more research is needed to analyze the cost-effectiveness of an educational intervention.…”

Prevalence and Correlates of Depressive Symptoms Among High School Adolescent Girls in Southern Uganda

“…The schools included in the study were matched on the following characteristics: socioeconomic status of the students attending these schools, school size (total number of students enrolled), location (urban vs. rural), and overall performance based on the Uganda Certificate of Education (UCE) examinations, administered by the Uganda Government's Ministry of Education and Sports. Detailed information on participants recruitment and selection process, as well as the intervention is described in the study protocol and in our other publications [75,76].…”