The National Institute of Child Health and Development has awarded $3.4 million to three Brown School faculty to test the long-term impact of an intervention that has shown early success in improving adherence to medication through economic support for families with HIV-positive youth.
Fred Ssewamala, William E. Gordon Distinguished Professor at the Brown School, and Research Assistant Professors Proscovia Nabunya and Ozge Sensoy Bahar will lead the extended Suubi+Adherence study, which extends their original 2012-18 research in southwest Uganda. Suubi means ‘hope’ in Luganda, one of the main languages in southwest Uganda.
In the original study, participants received incentivized financial savings, financial literacy training and income-generation workshops. Early results were promising, with data showing that participants who received the intervention consistently reported improved adherence to antiretroviral medications.
Moreover, the suppression of HIV among youth receiving the intervention increased significantly compared to the control group, and the cost per participant was not prohibitive. The results were published in several peer-reviewed journals, including PLOS One and AIDS and Behavior.
“We found that the first five years of the Suubi+Adherence study produced several desired outcomes,” said Ssewamala. “But the question remains as to how long the reported outcomes will be sustained through young adulthood. There is a need for a longer-term follow-up to establish the impact across the years as participants go through social transitions – a very vulnerable stage for adherence – and the associated costs and cost-effectiveness.” He said the continued funding will extend one of the largest and longest-running studies of young people living with HIV in sub-Saharan Africa.
In addition to tracking the original cohort of study participants for five more years, the new funding will allow the team to dig deeper into the potential mechanisms of change, including long-term effects on economic stability, sexual risk-taking behavior, adherence self-efficacy, cognitive functioning, mental health, and social support.
“We believe that providing a financial support system for these youth has the potential to lead to long-term systemic, positive life choices,” said Nabunya. “To my knowledge, the long-term effects on this population have never been measured, which is why this continued funding is so essential.”
In-depth interviews with participants and the continued measurement of cost-effectiveness will enable the team to assess the long-term value of the intervention compared to other options.
“Lessons learned from interviews and cost measurement will give us richer tools and data to share with policymakers and stakeholders to ensure sustainability of this important intervention,” added Sensoy Bahar.