Suubi+Adherence4Youth: Optimizing the Suubi Intervention for Adherence to HIV Treatment in Uganda (MOST STUDY)

Principal Investigators: Fred M. Ssewamala, Lead (Lead PI); John Sauceda (MPI)

Agency: NIMH

Project Team Members:  

The research team includes Brown School faculty members  Ozge Sensoy Bahar, Proscovia Nabunya, Shenyang Guo , Rachel Brathwaite, Derek Brown of Washington University in St. Louis; and external faculty members Torsten Neilands of UCSF and Marya Gwadz of New York University

In-country research team includes Noeline Nakasujja at Makerere University.

Implementing Partner: Abel Mwebembezi, at Reach the Youth Uganda,

Additional Study Partners: Barbara Mukasa, Executive Director at Mildmay Uganda.

Study Coordinators: Flavia Namuwonge, Allan Mugarura

Study Aims: 

Aim 1. Conduct a factorial experiment (optimization trial) to test the main effects of each of the four Suubi intervention components and combinations of components (interactions) on viral suppression (primary outcome).

Aim 2. Test mediators and explore moderators that explain and modify the relationship between each of the four Suubi intervention component and viral suppression.

Aim 3. Compare the cost and cost-effectiveness of each of the four Suubi intervention components and every combination of components.

Study Interventions: The Suubi+Adherence4Youth study (2022-2027), is a Multi-Phase Optimization Strategy (MOST) of the four Suubi components: 1) Financial Literacy Training; 2) Incentivized Matched Youth Savings Accounts with income-generating activities; 3) A manualized intervention for antiretroviral (ART) adherence and stigma reduction; and 4) Engagement with HIV treatment-experienced role models who share lived experiences with HIV.  This study will assess and optimize the multi-component Suubi intervention using the MOST Strategy, an engineering-inspired intervention framework.

 Study Design: The study will use a 24 factorial design resulting in 16 unique conditions representing all possible combinations of the 4 Suubi components. Forty-eight health clinics will be randomized to 16 conditions each recruiting 12 ALHIV. Assessments will be conducted at baseline, 12, 24 and 36 months. A total of 576 ALHIV will be recruited for the study.