A Cluster-Randomized Controlled Trial of an Economic Strengthening Intervention to Enhance Antiretroviral Therapy Adherence among Adolescents Living with HIV.

Abstract:

We examined the impact of an economic empowerment intervention on ART adherence among ALHIV. We used data from 455 ALHIV, randomized into intervention, n = 111, and control n = 344. ALHIV were aged 12–16 and recruited from 39 clinics in Uganda between January 2013 and December 2015. The intervention comprised a long-term child development account (CDA), micro-enterprise workshops, and educational sessions. Adherence was measured using unannounced pill counts. We used mixed-effects logistic regression analysis to examine the effect of the intervention on ART adherence. The mean age was 12.6 years. Despite observing non-significant group main effects, we found significant group-by-time interaction effects χ2(5) = 45.41, p < 0.001. Pairwise comparisons showed that compared to the control group, participants who received the intervention had significantly higher adherence at visit four, OR = 1.52 (95% CI: 1.07–2.18), p = 0.020; visit five, OR = 1.59 (95% CI: 1.06–2.38), p = 0.026; and visit six, OR = 1.94 (95% CI: 1.24–3.04), p = 0.004. Efforts to support ALHIV to live longer and healthier lives should incorporate components addressing poverty. However, declining adherence raises concerns over ALHIV’s long-term well-being. The trial was registered at ClinicalTrials.gov, registration number NCT01790373, with a primary outcome of adherence to HIV treatment.

Authors: Samuel Kizito, Flavia Namuwonge, Josephine Nabayinda, Damalie Nalwanga, Claire Najjuuko, Proscovia Nabunya, Raymond Atwebembere, Olive Imelda Namuyaba, Miriam Mukasa, Fred M. Ssewamala

Journal: AIDS and Behavior

Link to publication: https://doi.org/10.1007/s10461-024-04268-4