The National Institute of Mental Health (NIMH) has awarded $2.4 million to three Brown School faculty to examine the longitudinal impacts of an economic empowerment intervention on HIV risk prevention and care continuum outcomes among orphaned youth transitioning to young adulthood.
The new study, known as Bridges Round 2 (2022-2026) will be led by Fred Ssewamala, William E. Gordon Distinguished Professor at the Brown School, and Research Assistant Professors Proscovia Nabunya and Ozge Sensoy Bahar. The study will extend their original Bridges to the Future Study (2012-2018), that was implemented in Uganda among 1383 orphaned youth.
In the original study, participants received a combination intervention, consisting of a matched saving account, workshops on asset building and future planning, mentorship to reinforce learning and building optimism, and microenterprise promotion. Findings have demonstrated short-term success with improving emotional wellbeing, reduced self-reported sexual risk-taking behaviors, improved family cohesion, and positive educational outcomes among intervention participants.
Moreover, cost-effectiveness analysis findings indicate that the higher incentives (2:1 match rate) yielded a significant and lasting effect on a greater number of outcomes among participants compared to the lower matching incentives (1:1 match rate) at a similar incremental cost per unit effect. These findings have been widely published in peer-reviewed journals, including the American Journal of Public Health, Plos One and Social Indicators Research.
“Findings from the first round of the study filled important gaps on the effects of an economic empowerment intervention on short term stability. However, the extent to which these observed short-term behaviors are sustained over time is unknown. Yet, given the unique vulnerabilities during the transition into young adulthood, it is critical to examine the long-term effectiveness of economic empowerment across the life course of youth orphaned by HIV. This new funding provides us an opportunity to identify successful and problematic transitions for young people while determining strategic points of intervention.” Ssewamala said.
The original study participants will be followed for an additional 4-year period, with three data points. The team will utilize biomarkers, including HIV testing and viral load for those living with HIV, to provide the most precise results of the highly relevant, but currently unknown, sexual health outcomes among participants.
“As youth transition into young adulthood, they are faced with limited social support and opportunities for education and employment, which elevates their vulnerability to poverty, poor mental health, and increased risk behaviors exposing them to HIV/AIDS. The Bridges Round 2 provides an opportunity to examine this transition period, identify key predictors of positive transitions among orphaned youth, and isolate the effect of financial instability on their transition milestones and behavioral health.” Nabunya said.
The study will also qualitatively examine participants’ experiences with the original Bridges intervention, in addition to the key multi-level factors that may have affected participants’ decision-making and behaviors.
“Findings from this study may enable us to contribute to the scientific knowledge for low-resource communities on the potential value of providing modest economic resources to vulnerable boys and girls during childhood and early adolescence and how these resources may offer long-term protection against known HIV risks, health and treatment outcomes.” noted Sensoy Bahar.
The research team includes Patricia Cavazos-Rehg at Washington University School of Medicine, and Torsten Neilands (Statistical support) at University of California San Francisco.
The in-country team includes Noeline Nakasujja at Makerere University, and implementing partners, Barbara Mukasa at Mildmay Uganda and Abel Mwebembezi at Reach the Youth Uganda.
Learn more about the study.