Does Economic Strengthening Improve Viral Suppression Among Adolescents Living with HIV? Results From a Cluster Randomized Trial in Uganda

Abstract

To assess the effect of a savings-led economic empowerment intervention on viral suppression among adolescents living with HIV. Using data from Suubi + Adherence, a longitudinal, cluster randomized trial in southern Uganda (2012–2017), we examine the effect of the intervention on HIV RNA viral load, dichotomized between undetectable (< 40 copies/ml) and detectable (≥ 40 copies/ml). Cluster-adjusted comparisons of means and proportions were used to descriptively analyze changes in viral load between study arms while multi-level modelling was used to estimate treatment efficacy after adjusting for fixed and random effects. At 24-months post intervention initiation, the proportion of virally suppressed participants in the intervention cohort increased tenfold (ΔT2–T0 = + 10.0, p = 0.001) relative to the control group (ΔT2–T0 = + 1.1, p = 0.733). In adjusted mixed models, simple main effects tests identified significantly lower odds of intervention adolescents having a detectable viral load at both 12- and 24-months. Interventions addressing economic insecurity have the potential to bolster health outcomes, such as HIV viral suppression, by improving ART adherence among vulnerable adolescents living in low-resource environments. Further research and policy dialogue on the intersections of financial security and HIV treatment are warranted.

Interventions to Improve Antiretroviral Therapy Adherence Among Adolescents and Youth in Low- and Middle-Income Countries: A Systematic Review 2015–2019

“…The study comparing participant savings accounts to standard care also showed no statistically significant difference in viral If a study included children and/or adults, we report the total number of adolescents and youth included, the age group specified, and results specific to this age group suppression between arms. The proportion of participants with a VL < 40 copies/µl at 24 months did not significantly differ by arm − 65.9% in the intervention arm and 63.4% in the control arm [52]. The observational study of intensive adherence counseling also observed low rates of VL suppression post-counseling.…”

“…The second study evaluated an economic intervention in which a savings account was established which could be used for small business development or education, i.e. school fees or lunches to address financial-related barriers to ART adherence [52]. In the third study, three consecutive monthly individual intensive adherence counseling sessions were provided to participants.…”

“…The study evaluating a participant savings account used a 2-arm RCT comparing the intervention to standard care. The primary outcome was VL < 40 copies/ µl 24 months after study enrollment [52]. Eligible patients were ages 10 to 16 years of age, in care at an HIV care facility, and prescribed ART.…”

Effect of a differentiated service delivery model on virological failure in adolescents with HIV in Zimbabwe (Zvandiri): a cluster-randomised controlled trial

“…There was some evidence of an intervention effect on the primary outcome at midline (adjusted PR 0 [26][27].…”

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

“…As a result, HIV positive patients tend to sacrifice healthcare, including adherence to treatment, and other basic needs, including food and school fees for children due to financial constraints [15][16][17][18]. Despite the limited literature on economic empowerment (EE) and adolescent adherence, existing research suggests that EE has the potential to significantly improve adherence outcomes, particularly viral suppression [15,16,[19][20][21][22][23].…”