Abstract
BackgroundYouth living with HIV (YLHIV) in Sub-Saharan African (SSA) are less likely to adhere to antiretroviral therapy (ART) and other health-related regimens. As a consequence, YLHIV are not only at risk for health problems and mental health comorbidities, but are also at risk for cognitive deficits, including in areas of memory and executive functioning. The Suubi+Adherence study followed 702 adolescents (10-16 years of age) receiving bolstered standard of care and a family economic empowerment intervention comprising an incentivized youth financial savings account (YSA) augmented with financial literacy training (FLT) and peer mentorship. The study findings pointed to superior short-term viral suppression and positive adolescent health and mental health functioning among participants receiving the intervention. The original group of adolescents who received Suubi+Adherence are now transitioning into young adulthood. This paper presents a protocol for the follow-up phase titled Suubi+Adherence Round 2.MethodsThe original cohort in Suubi+Adherence will be tracked for an additional five years (2020-2025). Specifically, the long term follow-up will allow to: 1) ascertain the extent to which the short term outcomes identified in the first 6 years of the intervention are maintained as the same group transitions through young adulthood; and 2) address new scientific questions regarding ART adherence; HIV care engagement; protective health behaviors; and the potential of FEE to mitigate the development of HIV-associated neurocognitive disorders in YLHIV. Additionally, the team examines the potential mechanisms through which the observed long-term outcomes happen. Moreover, the Suubi+Adherence-Round 2 adds a qualitative component and extends the cost effectiveness component.DiscussionGuided by asset and human development theories, Suubi+Adherence-R2 will build on the recently concluded Suubi+Adherence study to conduct one of the largest and longest running studies of YLHIV in SSA as they transition into young adulthood. The study will address new scientific questions regarding long-term ART adherence, HIV care engagement, protective health behaviors, and the potential of FEE to mitigate the development of HIV-associated neurocognitive disorders in YLHIV. The findings may inform efforts to improve HIV care among Uganda’s YLHIV, with potential replicability in other low-resource countries.Trial registrationClinicalTrials.gov, ID: NCT01790373
Highlights
Sub Saharan Africa (SSA) has the highest HIV prevalence rate in the world [1]
The study will address new scientific questions regarding long-term antiretroviral therapy (ART) adherence, HIV care engagement, protective health behaviors, and the potential of family economic empowerment (FEE) to mitigate the development of HIV-associated neurocognitive disorders in youth living with HIV (YLHIV)
The scientific premise for this study derives from previous research that signals that YLHIV face more challenges related to treatment adherence as well as critical developmental, psychosocial, neurological, and economic problems than the general population [221,222,223,224,225,226]
Summary
Overview of the Suubi+Adherence Study (original study) The goal of the Suubi+Adherence study was to examine the impact and cost of an innovative EE intervention to increase adherence to HIV treatment for HIV-infected youth (see Suubi+Adherence study protocol [3] for more details). In addition to VL, to assess sexual risk-taking behaviors, a secondary outcome, we will test for Gonorrhea, Trichomonas, and Chlamydia In conducting these tests, collection, counseling, notification, referral for treatment, follow up and monitoring procedures for these biological test—all used in current studies by Ssewamala and colleagues – will be completed at Waves 6 – 10. The first set will be at Wave 6 (Immediately following reconsenting) to explore: 1) participants’ previous experiences with the FEE intervention and its specific components for the treatment group, and their experiences with BSOC for the control group; 2) key multi-level factors (individual, economic, family, contextual, and programmatic) that may have impacted their participation; and 3) key multi-level factors that may have affected their decision-making and behaviors around ART adherence as well as overall mental health since the completion of the Suubi+Adherence study. Rural/urban/semi-urban; exposure to outside HIV/STI-related programs; economic/household income; asset accumulation
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