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

IF 4.9 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Social Science & Medicine Pub Date : 2024-11-26 DOI:10.1016/j.socscimed.2024.117546

Samuel Kizito , Fred M. Ssewamala , Josephine Nabayinda , Flavia Namuwonge , Torsten B. Neilands , Proscovia Nabunya , Ozge Sensoy Bahar , Vicent Ssentumbwe , Jennifer Nattabi

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Abstract

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.

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家庭经济赋权对低收入环境中感染艾滋病毒的青少年病毒抑制和心理健康结果的长期影响：乌干达南部的分组随机对照试验

研究设计2013 年至 2014 年间，我们从乌干达的 39 家诊所招募了 702 名年龄在 10-16 岁之间、感染艾滋病毒并正在接受抗逆转录病毒治疗的参与者。20家诊所（n = 358 名参与者）被随机纳入干预方案，19家诊所（n = 344 名参与者）被随机纳入对照方案。干预措施包括一个匹配的储蓄账户、金融知识培训和微型企业研讨会。主要结果是病毒抑制，次要结果包括抑郁、绝望和自我概念。我们使用混合效应模型来确定干预效果。干预改善了病毒抑制效果，干预与时间之间的显著交互效应[χ2(5) = 12-81, p = 0-025]进一步证实了这一点，干预组的病毒抑制效果在第二年有所提高，OR = 1.89 (95% CI: 1.14-3.15)，第三年，OR = 2.31 (95% CI: 1.05-5.04)，第四年，OR = 2.34 (95% CI: 1.03-5.33)。在心理健康方面，我们没有发现整个样本的抑郁症状、绝望情绪或自我概念有显著的干预主效应或干预与时间的交互效应。然而，对于拥有较少资产的参与者，我们发现干预与时间之间在绝望感[χ2(5) = 12-33, p = 0-031]和自我概念[χ2(5) = 27-26, p < 0-001]方面存在显著的交互效应，这表明干预对这一人群产生了有益的影响。这些发现为设计改善 ALHIV 治疗效果的计划和政策提供了启示。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Social Science & Medicine PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-

CiteScore

9.10

自引率

5.60%

发文量

762

审稿时长

38 days

期刊介绍： Social Science & Medicine provides an international and interdisciplinary forum for the dissemination of social science research on health. We publish original research articles (both empirical and theoretical), reviews, position papers and commentaries on health issues, to inform current research, policy and practice in all areas of common interest to social scientists, health practitioners, and policy makers. The journal publishes material relevant to any aspect of health from a wide range of social science disciplines (anthropology, economics, epidemiology, geography, policy, psychology, and sociology), and material relevant to the social sciences from any of the professions concerned with physical and mental health, health care, clinical practice, and health policy and organization. We encourage material which is of general interest to an international readership.