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Randomized Controlled Trial
. 2018 Nov;22(11):3763-3772.
doi: 10.1007/s10461-018-2173-7.

Does Economic Strengthening Improve Viral Suppression Among Adolescents Living with HIV? Results From a Cluster Randomized Trial in Uganda

Laura Gauer Bermudez  1 , Fred M Ssewamala  2 , Torsten B Neilands  3 , Lily Lu  4 , Larissa Jennings  5 , Gertrude Nakigozi  6 , Claude A Mellins  7 , Mary McKay  2 , Miriam Mukasa  8
Affiliations
Randomized Controlled Trial

Does Economic Strengthening Improve Viral Suppression Among Adolescents Living with HIV? Results From a Cluster Randomized Trial in Uganda

Laura Gauer Bermudez et al. AIDS Behav. 2018 Nov.

Abstract

To assess the effect of a savings-led economic empowerment intervention on viral suppression among adolescents living with HIV. Using data from Suubi + Adherence, a longitudinal, cluster randomized trial in southern Uganda (2012-2017), we examine the effect of the intervention on HIV RNA viral load, dichotomized between undetectable (< 40 copies/ml) and detectable (≥ 40 copies/ml). Cluster-adjusted comparisons of means and proportions were used to descriptively analyze changes in viral load between study arms while multi-level modelling was used to estimate treatment efficacy after adjusting for fixed and random effects. At 24-months post intervention initiation, the proportion of virally suppressed participants in the intervention cohort increased tenfold (ΔT2-T0 = + 10.0, p = 0.001) relative to the control group (ΔT2-T0 = + 1.1, p = 0.733). In adjusted mixed models, simple main effects tests identified significantly lower odds of intervention adolescents having a detectable viral load at both 12- and 24-months. Interventions addressing economic insecurity have the potential to bolster health outcomes, such as HIV viral suppression, by improving ART adherence among vulnerable adolescents living in low-resource environments. Further research and policy dialogue on the intersections of financial security and HIV treatment are warranted.

Keywords: ART; Adolescents; Assets; Economic empowerment; HIV; SUUBI; Savings-led intervention.

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Figures

Fig. 1
Fig. 1
Consort diagram adherence study
Fig. 2
Fig. 2
Percentage of virally suppressed adolescents by study arm
See this image and copyright information in PMC

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