IMPACT OF ECONOMIC EMPOWERMENT ON ART ADHERENCE IN HIV-POSITIVE ADOLESCENTS IN UGANDA

Presented During:

Wednesday, Feb 16, 2022: 2:00 PM - 3:30 PM MST

Abstract Submission Number:

725 

Abstract Type:

General Abstract  

Authors:

samuel kizito1, Proscovia Nabunya1, Flavia Namuwonge2, Josephine Nabayinda1, Joshua Kiyingi1, Jennifer Nattabi1, Fred Ssewamala1

Institutions:

1Washington University in St Louis, St Louis, MO, United States, 2International Center for Child Health and Development, Masaka, Uganda

Presenting Author:

Dr Samuel Kizito  
Washington University in St Louis

Background:

Optimal Antiretroviral Therapy (ART) adherence is associated with better treatment outcomes. However, ART adherence among adolescents living with HIV (ALWHIV) is low. Poverty remains a significant threat to ART adherence. There is scanty literature about the role of economic empowerment on ART adherence among ALWHIV. Also, ART adherence may be influenced through alternative mechanisms. We examined the mediation pathways for the association between an economic empowerment intervention and ART adherence among ALWHIV in Uganda.

Methods:

In this longitudinal cluster-randomized controlled trial (2012 - 2018), we recruited 702 ALWHIV aged 12-16 in Uganda between January 2014 and December 2015. Thirty-nine clinics were randomized into the control (n=344) or intervention arm (n=358). The intervention comprised a long-term child development account (CDA), four micro-enterprise workshops, and 12 mentorship and educational sessions. We used Wilson's three-item self-report measure to determine ART adherence at baseline, 12-, 24-, 36- and 48-months post-intervention. We then used structural equation modeling (SEM) to test the mediation effect of mental health functioning, HIV stigma, family cohesion, food security, and stigma. We ran three separate models for adherence at 24-, 36-, and 48 months. Study is registered at ClinicalTrials.gov (#NCT01790373).

Results:

At 24-months, the intervention directly improved ART adherence β=0.75 (95% CI: 0.03 – 2.52). Also, the intervention improved food security β=0.29 (95% CI: 0.05 - -0.53). While improved mental function, β= 0.001 (95% CI: 0.0004 – 0.002), and family cohesion β=0.09 (95% CI: 0.02 – 0.15) improved adherence.

At 48 months, the intervention resulted in reduced stigma, β=-0.76 (95% CI: -1.38 - -0.13). While, stigma and low mental function reduced adherence, β=-0.12 (95% CI: -0.23 - -0.12) and β=-0.25 (95% CI: -0.42 - -0.08) respectively.

Conclusions:

These results support the theory that economic empowerment improves patient key outcomes and demonstrate that financial savings and financial literacy are crucial in improving ART adherence. Therefore, there is a need to incorporate economic empowerment components in HIV care programs in low-income settings.

Clinical:

(Q) HIV, SARS-CoV-2, or Both in Infants, Children, and Adolescents

Search Terms:

Economic
Empowerment
HIV
Treatment adherence
Africa

Supporting Image: SEM_CROI.png
 

Does this abstract include any aspects of research on SARS-CoV-2 or COVID-19?

No

Is this abstract a case report, meta-analysis, or systematic review?

No