Peer-reviewed article
Suubi4Her: a study protocol to examine the impact and cost associated with a combination intervention to prevent HIV risk behavior and improve mental health functioning among adolescent girls in Uganda
Fred M. Ssewamala, Laura Gauer Bermudez, Torsten B. Neilands, Claude A. Mellins, Mary M. McKay et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001Suubi4Her is a study protocol for a cluster randomized-controlled trial in Uganda evaluating a combination intervention to reduce HIV risk and improve mental health among adolescent girls aged 15-17. The intervention combines savings-led economic empowerment through youth development accounts with family strengthening delivered via Multiple Family Groups. The study will compare three arms (economic empowerment only, economic empowerment plus family strengthening, and usual care) across 42 secondary schools, tracking HIV risk behavior, mental health, and related outcomes over three years, with cost-effectiveness analysis to inform potential scale-up.
Key points
- The intervention integrates asset-based economic empowerment, family strengthening, and health education to address HIV risk factors among adolescent girls
- The study employs a three-arm cluster randomized-controlled trial design with 1,260 girls across 42 secondary schools in Central Uganda
- Primary outcomes include change in HIV risk behavior and mental health functioning; secondary outcomes include HIV/STI incidence, pregnancy, educational attainment, savings behavior, gender attitudes, and self-esteem
- Assessments occur at baseline, 12, 24, and 36 months to track intervention effects over time
- Cost-effectiveness analysis will compare the relative costs and outcomes of each intervention arm to inform potential scale-up
Limitations
This is a study protocol describing planned research rather than completed findings, so no outcomes or effectiveness data are available. The document does not provide preliminary results, actual implementation challenges, or evidence of whether the intervention components work in practice.
Abstract
BACKGROUND: Asset-based economic empowerment interventions, which take an integrated approach to building human, social, and economic capital, have shown promise in their ability to reduce HIV risk for young people, including adolescent girls, in sub-Saharan Africa. Similarly, community and family strengthening interventions have proven beneficial in addressing mental health and behavioral challenges of adolescents transitioning to adulthood. Yet, few programs aimed at addressing sexual risk have applied combination interventions to address economic stability and mental health within the traditional framework of health education and HIV counseling/testing. This paper describes a study protocol for a 5-year, NIMH-funded, cluster randomized-controlled trial to evaluate a combination intervention aimed at reducing HIV risk among adolescent girls in Uganda. The intervention, titled Suubi4Her, combines savings-led economic empowerment through youth development accounts (YDA) with an innovative family strengthening component delivered via Multiple Family Groups (MFG). METHODS: Suubi4Her will be evaluated via a three-arm cluster randomized-controlled trial design (YDA only, YDA + MFG, Usual Care) in 42 secondary schools in the Central region of Uganda, targeting a total of 1260 girls (ages 15-17 at enrollment). Assessments will occur at baseline, 12, 24, and 36 months. This study addresses two primary outcomes: 1) change in HIV risk behavior and 2) change in mental health functioning. Secondary exploratory outcomes include HIV and STI incidence, pregnancy, educational attainment, financial savings behavior, gender attitudes, and self-esteem. For potential scale-up, cost effectiveness analysis will be employed to compare the relative costs and outcomes associated with each study arm. CONCLUSIONS: Suubi4Her will be one of the first prospective studies to examine the impact and cost of a combination intervention integrating economic and social components to reduce known HIV risk factors and improve mental health functioning among adolescent girls, while concurrently exploring mental health as a mediator in HIV risk reduction. The findings will illuminate the pathways that connect economic needs, mental health, family support, and HIV risk. If successful, the results will promote holistic HIV prevention strategies to reduce risk among adolescent girls in Uganda and potentially the broader sub-Saharan Africa region. TRIAL REGISTRATION: Clinical Trials NCT03307226 (Registered: 10/11/17).