Peer-reviewed article
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
Yesim Tozan, Ariadna Capasso, Sicong Sun, Torsten B. Neilands, Christopher Damulira et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study tested whether a family-based economic empowerment programme called Suubi + Adherence could help adolescents living with HIV in Uganda take their HIV medications consistently and suppress the virus. The programme provided savings support and economic training to families alongside standard HIV care. After 24 months, the intervention increased viral suppression by nearly 9 percentage points compared to standard care, at a cost of approximately US$970 to virally suppress one additional adolescent.
Key points
- At 24 months, Suubi + Adherence increased viral suppression (HIV RNA <40 copies/mL) by 8.85 percentage points compared to bolstered standard of care (p = 0.032)
- The intervention cost US$263 per participant compared to US$177 for standard care
- The incremental cost to virally suppress one additional adolescent was US$970 over two years
- The study included 702 adolescents (mean age 12 years at enrolment, 56% female) across 39 health centres in southern Uganda
- Economic insecurity was identified as a major barrier to HIV treatment adherence that the intervention aimed to address
Limitations
The study does not report longer-term outcomes beyond 24 months or examine whether viral suppression is maintained after the intervention ends. The analysis is from a healthcare provider perspective and does not include societal or household-level costs.
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.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- Suubi + Adherence: a family-based economic empowerment intervention combining savings support, financial education, and economic strengthening with adherence support
- Population
- Adolescents living with HIV (mean age 12 years at enrolment, 56% female) receiving ART at 39 health centres in southern Uganda (n=358 intervention, n=344 comparison)
Key finding
8.85 percentage point increase in viral suppression (HIV RNA <40 copies/mL) at 24 months in intervention vs control (95% CI 0.80 to 16.90, p = 0.032)
Tozan et al. · Prof. Fred M. Ssewamala (OpenAlex works) · 1 Jun 2021