Peer-reviewed article
Evaluation of a savings-led family-based economic empowerment intervention for AIDS-affected adolescents in Uganda: A four-year follow-up on efficacy and cost-effectiveness
Yesim Tozan, Sicong Sun, Ariadna Capasso, Julia Shu‐Huah Wang, Torsten B. Neilands et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study evaluated a savings-based economic empowerment intervention called Bridges for AIDS-orphaned adolescents in Uganda over four years. Two versions of the intervention—with different levels of matched savings incentives—were compared to usual care. Both interventions improved self-rated health and HIV knowledge, while the higher-incentive version also improved self-concept, self-efficacy, and reduced hopelessness, at a reasonable cost of $224–$298 per unit of improvement.
Key points
- BridgesPLUS (2:1 matched incentive) improved self-rated health, HIV knowledge, self-concept, self-efficacy, and lowered hopelessness at 48 months
- Bridges (1:1 matched incentive) improved self-rated health and HIV knowledge at 48 months
- Effects were sustained at two years post-intervention for both treatment arms
- Incremental cost-effectiveness ratios ranged from $224 to $298 per 0.2 standard deviation change in outcomes
- Higher matching incentives produced significantly greater and lasting effects on more outcomes at similar incremental cost
Limitations
The document does not report on all primary outcomes mentioned (e.g., sexual health outcomes are not presented in the findings). Long-term sustainability beyond two years post-intervention and applicability to other populations or contexts are not discussed.
Abstract
BACKGROUND: Children who have lost a parent to HIV/AIDS, known as AIDS orphans, face multiple stressors affecting their health and development. Family economic empowerment (FEE) interventions have the potential to improve these outcomes and mitigate the risks they face. We present efficacy and cost-effectiveness analyses of the Bridges study, a savings-led FEE intervention among AIDS-orphaned adolescents in Uganda at four-year follow-up. METHODS: Intent-to-treat analyses using multilevel models compared the effects of two savings-led treatment arms: Bridges (1:1 matched incentive) and BridgesPLUS (2:1 matched incentive) to a usual care control group on the following outcomes: self-rated health, sexual health, and mental health functioning. Total per-participant costs for each arm were calculated using the treatment-on-the-treated sample. Intervention effects and per-participant costs were used to calculate incremental cost-effectiveness ratios (ICERs). FINDINGS: Among 1,383 participants, 55% were female, 20% were double orphans. Mean age was 12 years at baseline. At 48-months, BridgesPLUS significantly improved self-rated health, (0.25, 95% CI 0.06, 0.43), HIV knowledge (0.21, 95% CI 0.01, 0.41), self-concept (0.26, 95% CI 0.09, 0.44), and self-efficacy (0.26, 95% CI 0.09, 0.43) and lowered hopelessness (-0.28, 95% CI -0.43, -0.12); whereas Bridges improved self-rated health (0.26, 95% CI 0.08, 0.43) and HIV knowledge (0.22, 95% CI 0.05, 0.39). ICERs ranged from $224 for hopelessness to $298 for HIV knowledge per 0.2 standard deviation change. CONCLUSIONS: Most intervention effects were sustained in both treatment arms at two years post-intervention. Higher matching incentives yielded a significant and lasting effect on a greater number of outcomes among adolescents compared to lower matching incentives at a similar incremental cost per unit effect. These findings contribute to the evidence supporting the incorporation of FEE interventions within national social protection frameworks.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- Savings-led family economic empowerment intervention with matched savings incentives delivered at household level
- Population
- 1,383 AIDS-orphaned adolescents in Uganda; 55% female, 20% double orphans, mean age 12 years at baseline
Key finding
BridgesPLUS improved self-rated health (0.25, 95% CI 0.06–0.43), HIV knowledge (0.21, 95% CI 0.01–0.41), self-concept (0.26, 95% CI 0.09–0.44), and self-efficacy (0.26, 95% CI 0.09–0.43)
Tozan et al. · Prof. Fred M. Ssewamala (OpenAlex works) · 31 Dec 2019