Suubi4Her: A Combination Intervention Addressing HIV Risk Behaviors Among Older Adolescent Girls Transitioning Into Adulthood in Uganda
Condition: HIV/AIDS
MeSH terms: Acquired Immunodeficiency Syndrome; HIV Infections
Study type: Interventional

Summary: 
      This study examines the impact and cost associated with Suubi4Her, an innovative combination
      intervention that aims to prevent HIV risk behaviors among 15-17 year-old girls living in
      communities heavily affected by poverty and HIV/AIDS in Uganda. Participants will be randomly
      assigned at the school level into one of three study conditions: 1) Savings (Youth
      Development Accounts - YDA) - with a 1:1 incentive match rate - for education and
      microenterprise development; 2) Savings (YDA) + Multiple Family Groups intervention; 3)
      Control condition receiving standard health and sex education provided in schools. The
      intervention will last for 24 months. Assessments will be conducted at baseline, 12, 24 and
      36 months. Assessments will include biologically confirmed STIs, proportion of HIV infections
      during the study period, and for HIV+ participants markers for ART adherence. The study aims
      to examine the impact of the Suubi4Her intervention on behavioral health functioning, and
      protecting adolescent girls against known HIV risk factors. The study will also examine the
      cost-effectiveness of each intervention condition.
    

Detailed description: 
      Aligned with the NIH priority of addressing disparities in new HIV infections and the UNAIDS
      call for implementing combination HIV prevention approaches, the proposed study will examine
      the impact and cost associated with Suubi4Her, an innovative combination intervention that
      aims to prevent HIV risk behaviors among 14-17 year-old girls living in communities heavily
      affected by poverty and HIV/AIDS in Uganda. In sub-Saharan Africa (SSA), family financial
      stress can compromise the support available to adolescents, with girls living in poverty
      exhibiting higher rates of risky sexual behavior increasing their vulnerability in acquiring
      HIV and other STIs. At the same time, internalizing mental health disorders such as
      depression and low self-esteem disproportionately affect girls and may be contributing to HIV
      risk behavior. Against that backdrop, support over and above health and sex education is
      needed to help adolescent girls in SSA successfully transition into young adulthood. The
      proposed study is informed by two previously tested interventions - asset-based matched
      savings accounts (YDA) and family strengthening through Multiple Family Groups (MFG) which
      have successfully been implemented with younger primary school-going adolescents. Suubi4Her
      will test the theory that youth cognitive and behavioral change is influenced by economic
      stability while examining if enhanced intra-familial support and communication are needed to
      maintain positive behavioral health functioning and reinforce engagement in protective health
      behaviors. Nested within 47 secondary schools across four districts of Uganda heavily
      impacted by HIV/AIDS, 1260 older girls (ages 14-17 at enrollment) will be randomly assigned
      (at school level) to one of three study conditions: 1) Savings (Youth Development Accounts -
      YDA)- with a 1:1 incentive match rate - for education and microenterprise development; 2)
      Savings (YDA) + MFG intervention; 3) Control condition receiving standard health and sex
      education provided in schools. The intervention will be provided for 24 months. Assessments
      at baseline,12, 24, and 36-months will include biomedical data to measure our primary
      sexual-risk outcome:1) proportion of girls' biologically confirmed STIs (Gonorrhea,
      Trichomonas and Chlamydia); and secondary outcomes: 2) the proportion of new HIV infections
      during the study period, and 3) for HIV+ girls, viral load and CD4 as markers of ART
      adherence. The study aims are to: 1) Examine whether the Suubi4Her intervention is effective
      in protecting adolescent girls against known HIV risk factors (including
      economically-motivated sex and intimate partner violence). 2) Elucidate the effects of the
      Suubi4Her intervention on behavioral health functioning (i.e., depression, self-efficacy and
      hopelessness) and examine the effects of these variables as potential mechanisms of change,
      mediating the relationship between each intervention and HIV risk reduction. 3) Evaluate the
      cost-effectiveness of each intervention condition. The study will also use the Child
      Depression Index and Beck Hopelessness Scale to examine the efficacy of interventions in
      improving mental health in this vulnerable population.
    

Intervention name(s): Youth Development Accounts (YDA); YDA + Multiple Family Groups (MFG)
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Youth Development Accounts (YDA) with 1:1 incentive match rate to be used for education and microenterprise development Financial workshops on asset-building, saving and investing in Income Generating Activities (IGAs) Behavioral: Youth Development Accounts (YDA); Youth Development Accounts (YDA) with 1:1 incentive match rate to be used for education and microenterprise development 12 Financial Management workshops on asset-building, saving and investing in Income Generating Activities (IGAs) 18 Multiple Family Groups sessions focused on strengthening family relationships and mental health
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Care Provider)
Primary purpose: Prevention
Keywords: Suubi; Adolescent Girls; Poverty; Economic Empowement Interventions; Adherence to HIV antiretroviral therapy; HIV/AIDS-impacted girls; Uganda; Cost-effectiveness