The long-term impact of family economic empowerment on viral suppression and mental health outcomes among adolescents living with HIV in low-income settings: A cluster-randomized controlled trial in Southern Uganda

Objectives: We examined the impact of a family-based economic empowerment intervention on viral suppression and mental health among ALHIV.

Study design: Between 2013 and 2014, 702 participants aged 10-16, living with HIV, and taking antiretroviral therapy, were recruited from 39 clinics in Uganda. Twenty clinics (n = 358 participants) were randomized to the intervention and 19 clinics (n = 344 participants) were randomized to the control conditions. The intervention comprised a matched savings account, financial literacy training, and microenterprise workshops. The primary outcome was viral suppression, while the secondary outcomes included depression, hopelessness, and self-concept. We ran mixed-effects models to determine the intervention effects.

Results: At enrollment, participants' mean age was 12 years. The intervention improved viral suppression, evidenced by significant intervention-by-time interaction effects [χ²(5) = 12·81, p = 0·025], further qualified by increased viral suppression in the intervention group at year two, OR = 1.89 (95% CI: 1.14-3.15), year three, OR = 2.31 (95% CI: 1.05-5.04), and year four, OR = 2.34 (95% CI: 1.03-5.33). Regarding mental health, we did not find significant intervention main effects or intervention-by-time interaction effects for depressive symptoms, hopelessness, or self-concept for the entire sample. However, for participants owning fewer assets, we found significant intervention-by-time interaction effects for hopelessness [χ²(5) = 12·33, p = 0·031], and self-concept [χ²(5) = 27·26, p < 0·001], suggesting beneficial intervention effect for this demographic.

Conclusions: Family EE interventions have the potential to improve viral suppression and mental health outcomes among ALHIV. These findings offer insights in designing programs and policies to improve outcomes among ALHIV.