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,Ariadna Capasso,Christopher Damulira,Sicong Sun,Torsten B Neilands,Fred M Ssewamala,Ozge Sensoy Bahar,Julia Shu-Huah Wang,Christopher M Doran

doi:10.1371/journal.pone.0226809

Abstract

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. 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). 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. 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.

Highlights

Healthy adolescence is a critical step in transitioning to a healthy adulthood [1]
These findings contribute to the evidence supporting the incorporation of Family economic empowerment (FEE) interventions within national social protection frameworks
The intervention increased self-rated health among participants in both treatment arms as compared to those receiving usual care (Bridges: 0.26 SD, 95% confidence interval (CI) 0.08, 0.43; BridgesPLUS: 0.25 SD, 95% CI 0.06, 0.43)

Summary

Introduction

Healthy adolescence is a critical step in transitioning to a healthy adulthood [1] This developmental period can, be thwarted by poverty and lack of access to healthcare, education and social support. Over 12 million children under age 18 are reported to have lost at least one parent to HIV/AIDS [5]. Within SSA, Uganda is heavily affected; of the 1.9 orphaned children, those orphaned by AIDS make up 35% (660,000) [6]. Children who have lost a parent to HIV/AIDS, known as AIDS orphans, face multiple stressors affecting their health and development. 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

Results

Conclusion