Bridges to the Future

Bridges to the Future R2 (2022 – 2026)

Bridges Round 2: Examining the longitudinal impacts of an economic empowerment intervention on HIV risk prevention and care continuum outcomes among orphaned youth transitioning to young adulthood.

Principal Investigators: Fred M. Ssewamala, PhD, Ozge Sensoy Bahar, PhD, Proscovia Nabunya, PhD

Project Team Members: Patricia Cavazos-Rehg, PhD, Noeline Nakasujja, PhD (Makerere University), Torsten Neilands, PhD (University of California San Francisco)

Implementing Partners: Barbara Mukasa, MBChB (Mildmay Uganda), Abel Mwebembezi, PhD (Youth the Reach Uganda)

Study Coordinators: Phionah Namatovu, MPH; Winnie Kirabo; Josephine Nabayinda, MSc.

Funded by the National Institute of Mental Health (NIMH), Bridges Round 2 study (hereafter, Bridges-R2), builds on the original Bridges to the Future Study (2011-2018), to examine the longitudinal impacts of an economic empowerment intervention on HIV risk prevention and care continuum outcomes among orphaned youth transitioning to young adulthood. Findings from the first round of the study filled important gaps on the effects of an economic empowerment intervention on short term stability. However, the extent to which these observed short-term behaviors are sustained over time is unknown. Yet, given the unique vulnerabilities during the transition into young adulthood, it is critical to examine the long-term effectiveness of economic empowerment across the life course of youth orphaned by HIV. The study will follow the Bridges cohort (N=1383 orphaned youth) for an additional 4-year period, with three data points, to address the following specific aims:

Aim 1. Examine the long-term impact of Bridges on: HIV prevalence (measured via participant’s HIV status); and explore in secondary analyses the long-term impact of Bridges on key developmental and behavioral outcomes (e.g., mental health, alcohol, and drug misuse);

Aim 2. Elucidate the long-term effects of Bridges on potential mechanisms of change, including: a) economic stability, viral suppression (for ALHIV); PrEP use (for HIV negative adolescents), medical male circumcision (for boys); and b) young adult transitions;

Aim 3: Qualitatively investigate participants’ experiences with Bridges that may have influenced engagement with the program, sexual risk-taking decisions, financial behaviors; experiences with developmental transitions; and perceptions on program sustainability;

Aim 4: To assess the long-term costs and benefits of Bridges using formal economic evaluation.

Findings from this study may enable us to 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, health and treatment outcomes.

Bridges to the Future (2011-2018)

Principal Investigator: Fred Ssewamala, PhD

Project Team Members: Irwin Garfinkel, PhD, Jane Waldfogel, PhD, Jeanne Brooks-Gunn, PhD, Torsten Neilands, PhD

Field Coordinators: Miriam Mukasa, Christopher Damulira

Research Collaborators: Abel Mwebembezi (Reach the Youth-Uganda), Fr. Kato Bakulu (Masaka Diocese)

Bridges to the Future: A Family-Based Economic Empowerment Intervention for Children Orphaned by AIDS in Uganda, is a five-year longitudinal study (2011-2016) funded by the Eunice Kennedy Shriver National Institutes of Child Health & Human Development (NICHD). It evaluates the impact and cost-effectiveness of an innovative family-based economic empowerment intervention for orphans made vulnerable by AIDS. The study intervention includes a matched savings account registered in the child’s name, income-generating activity training, and mentorship. The intervention aims to encourage saving money for secondary education, promote microenterprise development to generate family income and provide support programs to protect children from future risks. Currently the study is in a no-cost extension.

Bridges to the Future Publications

Brathwaite, R., Ssewamala, F. M., Neilands, T. B., Nabunya, P., Byansi, W., & Damulira, C. (2021). Development and external validation of a risk calculator to predict internalising symptoms among Ugandan youths affected by HIV. Psychiatry Research, 114028. Science Direct

Wang, J. S. H., Malaeb, B., Ssewamala, F. M., Neilands, T. B., & Brooks-Gunn, J. (2021). A Multifaceted Intervention with Savings Incentives to Reduce Multidimensional Child Poverty: Evidence from the Bridges Study (2012–2018) in Rural Uganda. Social Indicators Research, 1-44. Springer

Ssewamala, F. M., Wang, J. S-H., Brathwaite, R., Sun, S., Jennings Mayo-Wilson, L., Neilands, T. B., & Brooks-Gunn, J. (2021). Impact of a family economic intervention (Bridges) on health functioning of adolescents orphaned by HIV/AIDS: A 5-year (2012-2017) cluster randomized controlled trial in Uganda. American Journal of Public Health, 111(3), 504–513. AJPH

Sun, S., Nabunya, P., Byansi, W., Sensoy Bahar, O., Damulira, C., Neilands, T., Guo, S., Namuwonge, F., & Ssewamala, F. M. (2020). Access and Utilization of Financial Services among Poor HIV-Impacted Children and Families in Uganda. Children and Youth Services Review, 109. Science Direct

Karimli, L., Ssewamala, F. M., Neilands, T.B., Wells, C.R., & Bermudez, L.G. (2019). Poverty, economic strengthening, and mental health among AIDS orphaned children in Uganda: Mediation model in a randomized clinical trial. Social Science & Medicine, 228:17-24. Science Direct

Kivumbi, A., Byansi, W., Ssewamala, F. M., Nabunya, P., Damulira, C., & Namatovu, P. (2019). Utilizing a family-based economic strengthening intervention to improve mental health wellbeing among female adolescent orphans in Uganda. Child and Adolescent Psychiatry and Mental Health, 13, 14. Biomed Central

Nabunya, P., Namatovu, P., Damulira, C., Kivumbi, A., Byansi, W., Mukasa, M., Nattabi J. & Ssewamala, F.M. (2019). Assessing the impact of an economic empowerment interventions on educational outcomes of orphaned children and adolescents: Findings from a randomized experiment in Uganda. Asia Pacific Journal of Social Work Development, 29(1), 59-69. Taylor & Francis Online

Nabunya, P., Padgett, D., Ssewamala, F. M., Courtney, M.E., & Neilands, T (2019). Examining the nonkin support networks of orphaned adolescents participating in a family-based economic-strengthening intervention in Uganda. Journal of Community Psychology; 47(3):579-593. Wiley

Tozan, Y., Sun, S., Capasso, A., Shu-Huah Wang, J., Neilands, T. B., Sensoy Bahar, O., S., Damulira, C., & Ssewamala, F. M. (2019). Evaluation of a savings-led family-based economic empowerment intervention for AIDS-affected adolescents in Uganda: A four-year follow-up on efficacy and cost-effectiveness. PloS One, 14PubMed

Ssewamala, F. M., Gauer-Bermudez, L. G., & Santelli, J. (2018). The power of financial inclusion: Reporting on the efficacy of economic strengthening interventions in sub-Saharan Africa. Journal of Adolescent Health, 62(S1), 3-S5. Journal of Adolescent Health

Ssewamala, F. M., Wang, J. S-H., Neilands, T.B., Gauer Bermudez, L., Garfinkel, I., Waldfogel, J., Brooks-Gunn, J., & Kirkbride, G. (2018). Cost-Effectiveness of a savings matched economic empowerment intervention for AIDS-affected adolescents in Uganda: Implications for scale-up in low resource communities. Journal of Adolescent Health, 62(S1), 29-36. PMCID: PMC5744872. Science Direct

Wang, J. S-H., Ssewamala, F. M., Neilands, T.B., Gauer Bermudez, L., Garfinkel, I., Waldfogel, J., Brooks-Gunn, J & You, J. (2018). Effects of financial incentives on savings outcomes and material-wellbeing: Evidence from a randomized controlled trial in Uganda. Journal of Policy Analysis and Management, 37(3), 602-629. Wiley

Nabunya, P., Ssewamala, F. M., Mukasa, M. N. Byansi, & Nattabi, J. (2015). Peer mentorship program and HIV/AIDS knowledge, beliefs and prevention attitudes among AIDS- orphaned adolescents: An evidence based practice. Vulnerable Children & Youth Studies, 10(4), 345-356. Taylor & Francis Online

Ssewamala, F. M., Nabunya, P., Ilic, V., Mukasa, M. N., & Damulira, C. (2015). Relationship between family economic resources, psychosocial well-being, and educational preferences of AIDS-orphaned children in southern Uganda: Baseline findings. Global Social Welfare, 2(2), 75-86. Springer

Nabunya, P. & Ssewamala, F. M. (2014). The effects of parental loss on the psychosocial wellbeing of AIDS-orphaned children living in AIDS-impacted communities: Does gender matter? Children and Youth Services Review, 43, 131- 137. Science Direct

Ssewamala, F. M., Nabunya, P., Mukasa, M., Ilic, V., & Nattabi, J. (2014). Integrating a mentorship component in programming for care and support of AIDS- orphaned and vulnerable children: Lessons from the Suubi and Bridges Programs in sub-Saharan Africa. Global Social Welfare, 1(1), 9-24. Springer