Abstract
BackgroundAsset-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).MethodsSuubi4Her 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.ConclusionsSuubi4Her 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 registrationClinical Trials NCT03307226 (Registered: 10/11/17).
Highlights
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
Sub-Saharan Africa (SSA) remains the world’s most affected region in the HIV epidemic, home to 71% of people living with HIV worldwide [1] and girls accounting for 7 out of 10 new infections among adolescents [2]
Being out-of-school is one of the key characteristics found to increase young women’s vulnerability to HIV as it is associated with numerous risk factors, including age-disparate and transactional sex, early marriage, inconsistent condom use, and limited power in relationships – most significantly the ability to negotiate safe sex [5,6,7,8,9,10,11]. Alongside these risks exist mental health challenges associated with economically motivated sex, which have been shown to have a bi-directional relationship with depression, low self- esteem, and anxiety for young women [12, 13]
Summary
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. Being out-of-school is one of the key characteristics found to increase young women’s vulnerability to HIV as it is associated with numerous risk factors, including age-disparate and transactional sex, early marriage, inconsistent condom use, and limited power in relationships – most significantly the ability to negotiate safe sex [5,6,7,8,9,10,11] Alongside these risks exist mental health challenges associated with economically motivated sex (both age-disparate and transactional), which have been shown to have a bi-directional relationship with depression, low self- esteem, and anxiety for young women [12, 13].
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