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

Laura Gauer Bermudez, Fred M. Ssewamala, Torsten B. Neilands, Lily Lu, Larissa Jennings Mayo-Wilson, Gertrude Nakigozi, Claude A. Mellins, Mary McKay, Miriam Mukasa

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)1-10
Number of pages10
JournalAIDS and Behavior
DOIs
StateAccepted/In press - May 30 2018

Keywords

  • Adolescents
  • ART
  • Assets
  • Economic empowerment
  • HIV
  • Savings-led intervention
  • SUUBI

ASJC Scopus subject areas

  • Social Psychology
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

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  • Cite this

    Bermudez, L. G., Ssewamala, F. M., Neilands, T. B., Lu, L., Mayo-Wilson, L. J., Nakigozi, G., Mellins, C. A., McKay, M., & Mukasa, M. (Accepted/In press). Does Economic Strengthening Improve Viral Suppression Among Adolescents Living with HIV? Results From a Cluster Randomized Trial in Uganda. AIDS and Behavior, 1-10. https://doi.org/10.1007/s10461-018-2173-7