Peer-reviewed article
The long-term effects of a family based economic empowerment intervention (Suubi+Adherence) on suppression of HIV viral loads among adolescents living with HIV in southern Uganda: Findings from 5-year cluster randomized trial
Fred M. Ssewamala, Darejan Dvalishvili, Claude A. Mellins, Elvin Hsing Geng, Fredderick Makumbi et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001A five-year cluster randomized trial in Uganda tested whether a family-based economic empowerment intervention (Suubi+Adherence) could improve HIV viral suppression in adolescents living with HIV aged 10-16 years. The intervention group showed significantly higher rates of undetectable viral loads (25.4% incidence) compared to the control group (17.3% incidence). The study found that the economic empowerment intervention, combined with adherence support, improved treatment success and viral suppression among this vulnerable group.
Key points
- Intervention group achieved undetectable viral loads (< 40 copies/ml) at significantly higher rates: 25.4% vs 17.3% in control group (incidence rate ratio 1.468, p=0.008)
- Family economic empowerment intervention effect remained significant after adjusting for confounders (adjusted HR=1.446, p=0.015)
- Higher number of medications per day also significantly predicted viral suppression (adjusted HR=1.852, p=0.001)
- Study included 288 adolescents with detectable viral loads at baseline from 39 accredited health care clinics across five districts in Uganda
- Retention and viral suppression rates for adolescents living with HIV are 50% lower than for adults in Africa, making targeted interventions essential
Limitations
The study does not provide detailed information about the specific components of the economic empowerment intervention or mechanisms explaining how economic support improved viral suppression. Cost-effectiveness and scalability analyses were identified as needed but not included in this report.
Abstract
BACKGROUND: The rapid scale-up of HIV therapy across Africa has failed to adequately engage adolescents living with HIV (ALWHIV). Retention and viral suppression for this group (ALWHIV) is 50% lower than for adults. Indeed, on the African continent, HIV remains the single leading cause of mortality among adolescents. Strategies tailored to the unqiue developmental and social vulnerabilities of this group are urgently needed to enhance successful treatment. METHODS: We carried out a five-year longitudinal cluster randomized trial (ClinicalTrials.gov ID: NCT01790373) with adolescents living with HIV (ALWHIV) ages 10 to 16 years clustered at health care clinics to test the effect of a family economic empowerment (EE) intervention on viral suppression in five districuts in Uganda. In total, 39 accredited health care clinics from study districts with existing procedures tailored to adolescent adherence were eligible to participate in the trial. We used data from 288 youth with detectable HIV viral loads (VL) at baseline (158 -intervention group from 20 clinics, 130 -non-intervention group from 19 clinics). The primary end point was undetectable plasma HIV RNA levels, defined as < 40 copies/ml. We used Kaplan-Meier (KM) analysis and Cox proportional hazard models to estimate intervention effects. FINDINGS: The Kaplan-Meier (KM) analysis indicated that an incidence of undetectable VL (0.254) was significantly higher in the intervention condition compared to 0.173 (in non-intervention arm) translated into incidence rate ratio of 1.468 (CI: 1.064-2.038), p = 0.008. Cox regression results showed that along with the family-based EE intervention (adj. HR = 1.446, CI: 1.073-1.949, p = 0.015), higher number of medications per day had significant positive effects on the viral suppression (adj.HR = 1.852, CI: 1.275-2.690, p = 0.001). INTERPRETATION: A family economic empowerment intervention improved treatment success for ALWHIV in Uganda. Analyses of cost effectiveness and scalability are needed to advance incorporation of this intervention into routine practice in low and middle-income countries.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- Family-based economic empowerment intervention (Suubi+Adherence) tailored to address unique developmental and social vulnerabilities of adolescents living with HIV
- Population
- Adolescents living with HIV aged 10-16 years with detectable viral loads at baseline in southern Uganda (158 in intervention group, 130 in control group across 39 health care clinics)
Key finding
Incidence of undetectable viral loads was 25.4% in intervention group vs 17.3% in non-intervention group (incidence rate ratio 1.468, 95% CI: 1.064-2.038, p=0.008)
Ssewamala et al. · Prof. Fred M. Ssewamala (OpenAlex works) · 10 Feb 2020