Suubi4Her-Round 2 (2024-2029)

Suubi4Her-Round 2: Examining the long-term impact of a combination intervention on HIV prevention, care and mental health for adolescents and young women in Uganda.

Principal Investigators: Fred M. Ssewamala, PhD; April Thames, PhD (University of California Los Angeles); Noeline Nakasujja, PhD (Makerere University)

Project Team Members: Proscovia Nabunya, PhD; Ozge Sensoy Bahar, PhD; Rachel Brathwaite, PhD; Derek Brown, PhD; Anita Kabarambi, MBChB, Torsten Neilands , PhD (University of California, San Francisco)

Implementing Partners: Abel Mwebembezi, PhD (Reach the Youth, Uganda)

Study Coordinators: Olive Imelda Namuyaba

Funded by the National Institute of Mental Health (NIMH), Suubi4Her Round 2 study (hereafter, Suubi4Her-R2), builds on the Original Suubi4Her study (2017-2022) to examine the longitudinal impact of an evidence-based combination intervention combining economic empowerment (EE) and family strengthening (FS) on HIV risk behaviors, cognitive, and mental health outcomes among adolescent girls transitioning into young adulthood in poverty-impacted and HIV-burdened rural communities in Uganda. The study provides a unique opportunity to examine the longer-term effects of an evidence-based combination intervention on HIV prevention,  care and support continuum trajectories, during transition into young adulthood, a high-risk, yet understudied developmental stage in sub-Saharan Africa (SSA). The study will follow the Suubi4Her cohort for an additional five-year period, with four data points to address the following specific aims:

Aim 1: To examine the long-term impact of the Suubi4Her intervention on young women’s HIV risk behaviors.

Aim 2: To elucidate the long-term effect of the Suubi4Her intervention on cognitive and mental health, and to explore specific cognitive underlying factors that mediate the link between the intervention and reduced HIV risk.

Aim 3: To examine the long-term cost-effectiveness of the Suubi4Her intervention.

Findings from this large longitudinal dataset may contribute to the scientific knowledge on the potential value of investing modest economic resources in poor and vulnerable girls during early adolescence and how these resources may offer long-term protection against known HIV, cognitive and mental health risks, with potential replicability in other low-resource countries.

Suubi4Her (2017-2023)

Principal Investigator: Fred M. Ssewamala, PhD

Project Team Members: Mary McKay, PhD; Claude Mellins, PhD (Columbia University); Irwin Garfinkel, PhD (Columbia University); Proscovia Nabunya, PhD; Torsten Neilands, PhD (University of California – San Francisco); Ozge Sensoy Bahar, PhD 

Field Coordinator: Flavia Namuwonge 

Research Collaborators: Abel Mwebembezi (Reach the Youth-Uganda), Fr. Kato Bakulu (Masaka Diocese), Gertrude Nakigozi (Rakai Health Sciences Program)

Suubi4Her is longitudinal study (2017-2023) funded by the National Institute of Mental Health (NIMH). It examines the impact and cost associated with Suubi (hope) for Girls (hereafter, Suubi4Her), which is an innovative combination intervention that aims to prevent HIV risk behavior in communities heavily affected by poverty and HIV/AIDS in Southern Uganda. This is done through economic empowerment and promotion of behavioral health. This study combines two evidence-based approaches:

1. a youth monetary savings program that supports adolescent girls in secondary school education and family small-business/microenterprises development

2. a 16 session manualized MFG intervention that strengthens family relationships to address mental health challenges which frequently accompany adolescent girls’ transition to adulthood.

mHealth Component

This study seeks to examine access and utilization of mobile phones (technology) and acceptability of mhealth interventions among adolescent girls. Specifically, the study assesses behavioral health and psychosocial functioning, cell phone access, as well as beliefs and attitudes about tobacco, alcohol, substance use, sexual decision-making, and HIV-risk factors.

Qualitative Component

With this additional support, the team will qualitatively examine participants’ experiences with the intervention and explore multi-level factors that may have impacted participants’ observable behaviors and decision-making in regards to savings, mental health, and sexual risk-taking. The team will also interview the multiple family group facilitators and school head teachers in treatment schools to examine factors that may influence system-level sustainability.

Diversity Supplement

This administrative supplement will assess the impact of antiretroviral therapy (ART) and attitudes on HIV testing behavior and adherence among the study participants. The study findings will enrich extant literature about the attitudes and perceptions of adolescent girls (an HIV vulnerable population) towards ART and provide insight which will be useful in informing the development of interventions, diagnosis, treatment and management of HIV, including adherence to ART.