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Does Economic Strengthening Improve Viral Suppression Among Adolescents Living with HIV? Results From a Cluster Randomized Trial in Uganda

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Abstract

To assess the effect of a savings-led economic empowerment intervention on viral suppression among adolescents living with HIV. Using data from Suubi + Adherence, a longitudinal, cluster randomized trial in southern Uganda (2012–2017), we examine the effect of the intervention on HIV RNA viral load, dichotomized between undetectable (< 40 copies/ml) and detectable (≥ 40 copies/ml). Cluster-adjusted comparisons of means and proportions were used to descriptively analyze changes in viral load between study arms while multi-level modelling was used to estimate treatment efficacy after adjusting for fixed and random effects. At 24-months post intervention initiation, the proportion of virally suppressed participants in the intervention cohort increased tenfold (ΔT2−T0 = + 10.0, p = 0.001) relative to the control group (ΔT2−T0 = + 1.1, p = 0.733). In adjusted mixed models, simple main effects tests identified significantly lower odds of intervention adolescents having a detectable viral load at both 12- and 24-months. Interventions addressing economic insecurity have the potential to bolster health outcomes, such as HIV viral suppression, by improving ART adherence among vulnerable adolescents living in low-resource environments. Further research and policy dialogue on the intersections of financial security and HIV treatment are warranted.

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Acknowledgements

We are grateful to Godfrey Kigozi at Rakai Health Sciences Program in Uganda; Fred Makumbi at Makerere University School of Public Health; Abel Mwebembezi at Reach the Youth—Uganda; and Christopher Damulira and Apollo Kivumbi at the International Center for Child Health and Development (Ichad) for their respective contributions to the study design, implementation, and data management. We are also grateful to Jessica Pac for her statistical support on this paper. We wish to thank all of the participants and their families who have given their time for this trial.

Funding

This work was supported by the National Institute of Child and Human Development (NICHD) under Grant number 1R01HD074949-01 (FS, PI). The fifth author’s work on this manuscript was supported by the NIMH (K01MH107310) and the Johns Hopkins University Center for AIDS Research (P30AI094189).

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Authors and Affiliations

  1. Columbia University School of Social Work, 1255 Amsterdam Ave., New York, NY, 10027, USA

    Laura Gauer Bermudez

  2. George Warren Brown School of Social Work, Washington University in St. Louis, 1 Brookings Drive, St. Louis, MO, 63130, USA

    Fred M. Ssewamala & Mary McKay

  3. School of Medicine, University of California San Francisco, 550 16th Street, San Francisco, CA, 94158, USA

    Torsten B. Neilands

  4. Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY, 10032, USA

    Lily Lu

  5. Department of International Health, Social and Behavioral Interventions Program, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E5038, Baltimore, MD, 21205, USA

    Larissa Jennings

  6. Rakai Health Sciences Program, Old Bukoba Road, 279, Kalisizo, Uganda

    Gertrude Nakigozi

  7. HIV Center for Clinical & Behavioral Studies, New York State Psychiatric Institute and Columbia University, 1051 Riverside Dr, New York, NY, 10032, USA

    Claude A. Mellins

  8. International Center for Child Health and Development Field Office, Plot 23 Circular Rd, Masaka, Uganda

    Miriam Mukasa

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  1. Laura Gauer Bermudez
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  2. Fred M. Ssewamala
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  7. Claude A. Mellins
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Correspondence to Laura Gauer Bermudez.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Bermudez, L.G., Ssewamala, F.M., Neilands, T.B. et al. Does Economic Strengthening Improve Viral Suppression Among Adolescents Living with HIV? Results From a Cluster Randomized Trial in Uganda. AIDS Behav 22, 3763–3772 (2018). https://doi.org/10.1007/s10461-018-2173-7

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