A Multifaceted Intervention with Savings Incentives to Reduce Multidimensional Child Poverty: Evidence from the Bridges Study (2012-2018) in Rural Uganda

Bridges-Round 2: A study protocol to examine the longitudinal HIV risk prevention and care continuum outcomes among orphaned youth transitioning to young adulthood

BACKGROUND

Youth orphaned by HIV in sub-Saharan Africa experience immense hardships including social disadvantage, adverse childhood events and limited economic prospects. These adversities disrupt the normative developmental milestones and can gravely compromise their health and emotional wellbeing. The Bridges to the Future study (2012-2018) prospectively followed 1,383 adolescents, between 10-16 years, to evaluate the efficacy and cost-effectiveness of a family-based economic empowerment intervention comprising of child development accounts, financial literacy training, family income generating activities and peer mentorship. Study findings show efficacy of this contextually-driven intervention significantly improving mental health, school retention and performance and sexual health. However, critical questions, such as those related to the longitudinal impact of economic empowerment on HIV prevention and engagement in care remain. This paper presents a protocol for the follow-up phase titled, Bridges Round 2.

METHODS

The Original Bridges study participants will be tracked for an additional four years (2022-2026) to examine the longitudinal developmental and behavioral health outcomes and potential mechanisms of the effect of protective health behaviors of the Bridges cohort. The study will include a new qualitative component to examine participants' experiences with the intervention, the use of biomedical data to provide the most precise results of the highly relevant, but currently unknown sexual health outcomes among study participants, as well as a cost-benefit analysis to inform policy and scale-up.

DISCUSSION

Study findings may 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, poor mental health functioning and improve treatment among the HIV treatment care continuum.

Self-efficacy, academic performance and school transition among orphaned adolescents in southern Uganda

INTRODUCTION

Self-efficacy is critical to adolescents' development. This study examined the relationship between self-efficacy, academic performance and transition to post primary education among orphaned adolescents in southern Uganda.

METHODS

Longitudinal data from a cluster randomized clinical trial for orphaned adolescents was analyzed. Adolescents (N = 1410) between 10 and 16 years at study initiation, in their last three years of primary schooling were eligible to participate in the study. Data collected at baseline, 12, 24, 36 and 48-months follow-up were analyzed. Ordinary least square and logistic regression analyses were conducted to assess the relationship between adolescents' self-efficacy, academic performance -as measured by Primary Leaving Examinations (PLE) scores, and transition to post primary education.

RESULTS

Results indicate that adolescents' self-efficacy was associated with better PLE grades (lower scores indicate better performance [b = -0.05, 95 % CI = -0.09, -0.01, p≤0.01]) and a higher likelihood of transition to post primary education (OR = 1.02, 95 % CI = -0.09, 1.00, 1.03, p≤0.01).

CONCLUSION

Findings point to the importance of integrating components focused on promoting self-efficacy among adolescents -especially those made vulnerable by poverty and HIV/AIDS in low resource settings.

Impact of Family-Based Economic Empowerment Intervention, Suubi+Adherence (2012-2018) on Multidimensional Poverty for Adolescents Living with HIV (ALWHIV) in Uganda

Children growing up in poverty are disproportionately affected by diseases, including HIV. In this study, we use data from Suubi+Adherence, a longitudinal randomized control trial (2012-2018) with 702 adolescents living with HIV (ALWHIV), to examine the effectiveness of a family-based multifaceted economic empowerment (EE) intervention in addressing economic instability and multidimensional poverty among ALWHIV in Southern Uganda. We constructed a Multidimensional Poverty Index of individual and household indicators, including health, assets, housing and family dynamics. We computed the proportion of multidimensionally poor children (H), estimated poverty intensity (A) and adjusted headcount ratio (M₀). Using repeated measures at five-time points (baseline, years 1, 2, 3 and 4-post baseline) across two study arms: treatment (receiving the EE intervention) vs. control arm (not receiving EE), we find that both the incidence and proportion of multidimensional poverty decreased in the treatment arm vs. the control arm. Given that there is a direct link between economic instability and poor health outcomes, these findings are informative. They point to the potential for family EE interventions to decrease multidimensional poverty among vulnerable children, including ALWHIV, impacting their overall wellbeing and ability to meet their treatment needs and improve HIV care continuum outcomes.