The efficacy and cost‐effectiveness of a family‐based economic empowerment intervention (Suubi + Adherence) on suppression of HIV viral loads among adolescents living with HIV: results from a Cluster Randomized Controlled Trial in southern Uganda

Abstract

Introduction Evidence from low‐resource settings indicates that economic insecurity is a major barrier to HIV treatment adherence. Economic empowerment (EE) interventions have the potential to improve adherence outcomes among adolescents living with HIV (ALWHIV) by mitigating the effects of poverty. This study aims to assess the efficacy and cost‐effectiveness of a savings‐led family‐based EE intervention, Suubi + Adherence, aimed at improving antiretroviral therapy (ART) adherence outcomes ALWHIV in Uganda. Methods Adolescents (mean age 12 years at enrolment; 56% female) receiving ART for HIV at 39 health centres were randomized to Suubi + Adherence intervention (n = 358) or bolstered standard of care (BSOC; n = 344). A difference‐in‐differences analysis was employed to assess the change in the proportion of virally suppressed adolescents (HIV RNA viral load <40 copies/mL) over 24 months. The cost‐effectiveness analysis examined how much the intervention cost to virally suppress one additional adolescent relative to BSOC from the healthcare provider perspective. Results At 24 months, the intervention was associated with an 8.85‐percentage point [95% confidence interval (CI) 0.80 to 16.90 percentage points] increase in the proportion of virally suppressed adolescents between the study arms (p = 0.032). Per‐participant costs were US$177 and US$263 for the BSOC and intervention groups respectively. The incremental cost of virally suppressing one additional adolescent was estimated at US$970 [95% CI, US$508 to 10,725] over two years. Conclusions Our results support the integration of family‐based EE interventions into adherence‐support strategies as part of routine HIV care in low‐resource settings to address the underlying economic drivers of poor ART adherence among ALWHIV. Moreover, per‐participant costs to achieve viral suppression do not seem prohibitive compared to other community‐based adherence interventions targeted at ALWHIV in low‐resource settings. Further research on combination interventions at the nexus of economic security and HIV treatment and care is needed to inform the development of feasible and scalable HIV policies and programmes.

Depression-Mediating Pathways From Household Adversity to Antiretroviral Therapy Nonadherence Among Children and Adolescents Living With HIV in Zambia: A Structural Equation Modeling Approach

“…Randomized and observational studies have demonstrated the potential for cash transfers to meaningfully rupture pathways from food insecurity and other material asset deprivations to HIV-related outcomes, including improved HIV self-management. [38][39][40] In evaluating the psychometric properties of the validated depressive symptom scale used in our study, we found that 1 symptom ("Little interest or pleasure in activities") was insubstantially correlated with other indicators of depression, resulting in its exclusion from the final EFA model. Among depressive symptoms, this one was endorsed most frequently (66%) by CALWH or their caregiver proxies.…”

“…Randomized and observational studies have demonstrated the potential for cash transfers to meaningfully rupture pathways from food insecurity and other material asset deprivations to HIV-related outcomes, including improved HIV self-management. 38–40…”

Strategies to Promote Empowerment Status of Breast Cancer Women

“…Numerous studies have also shown the role of family-based empowerment in reducing the adverse effects of diseases and increasing the patients' quality of life, some of which are the studies by Tozan et al [ 59 ], Etemadifar et al [ 60 ], Davarpanah et al [ 48 ], and Hosseini et al [ 30 ]. It is worth mentioning that the family-centered empowerment model has been emphasized more in other chronic diseases [ 61 , 62 ] but could also be used in empowering breast cancer patients.…”

The effect of family support on self‐reported adherence to ART among adolescents perinatally infected with HIV in Uganda: A mediation analysis

“…Participants were recruited from health clinics located in Rakai, Masaka, Lwengo, Lyantonde, Bukomasimbi, and Kalungu Districts—a region with high prevalence for HIV, compared to the national average (Uganda AIDS Commission, 2021). Details on participant recruitment and the intervention are provided in the study protocol (Ssewamala et al, 2019) and elsewhere (Ssewamala et al, 2020; Tozan et al, 2021).…”