Suubi4Stigma:  Addressing HIV-associated stigma among adolescents

Principal Investigator: Proscovia Nabunya, PhD; Fred M. Ssewamala, PhD

Project Team Members: James Mugisha, PhD(Makerere University); Ozge Sensoy Bahar, PhD; Jean-Francois Trani, PhD

Field Coordinators: Raymond Atwebembere, MBChB; Herbert Migadde

Research Collaborators: Abel Mwebembezi (Reach the Youth-Uganda)

Study Design:
This three-arm pilot randomized clinical trial will be conducted across 9 health clinics in the greater Masaka region of Uganda. Clinics will be randomized to one of three study arms (n=3 clinics; 30 child-caregiver dyads each arm): 1) Usual care to receive the currently implemented usual care addressing HIV/AIDS-associated stigma (educational materials from the Uganda Ministry of Health); 2) G-CBT intervention + Usual care; and 3) MFG intervention + Usual care.

Intervention Sessions and Duration:
G-CBT sessions will be facilitated by trained para-counselors and will include no more than 10 participants (children only) per group. The 10 sessions will be delivered twice per week outside of school hours and will last approximately 1 hour each. G-CBT sessions will focus on the exploration of HIV’s role and impact of stigma in adolescent’s life; use of cognitive restructuring to identify and address the negative stigma-associated beliefs, loss of self-worth, self-blame; and skill-building around stress management and emotion-focused coping strategies to address negative feelings (e.g. assertiveness, relaxation skills and problem solving skills).

MFG sessions will be delivered by trained community health workers and parent peers, with 10 families (child and caregiver/family member) per group. Session content will focus on HIV and stigma, and the core components of MFG, also known as 4Rs and 2S’s (rules, responsibility, relationships, respectful communication, stress and social support). MFG sessions (10 sessions in total) will last approximately 1 hour and will be delivered twice a week, outside of school hours.

Both treatment and usual care arms will be delivered over a 3-month period. Participants will be followed over a 6-month period, with data collected at baseline, 3 months, and 6 months post-intervention initiation.

Suubi4Stigma Study Publications

Nabunya P, Kizito S, Naseh M, Atwebembere R, Ssentumbwe V. Preliminary Impact of Group-Based Interventions on Stigma and Mental Health of Caregivers of Adolescents Living with HIV in Uganda. AIDS Beh. 2024 Apr 29. Springer

Nabunya P, Ssewamala FM, Kizito S, Mugisha J, Brathwaite R, Neilands TB, Migadde H, Namuwonge F, Ssentumbwe V, Najjuuko C, Sensoy Bahar O, Mwebembezi A, McKay MM. Preliminary Impact of Group-Based Interventions on Stigma, Mental Health, and Treatment Adherence Among Adolescents Living with Human Immunodeficiency Virus in Uganda. J Pediatr. 2024 Feb 23;269:113983. doi: 10.1016/j.jpeds.2024.113983. Science Direct

Nabunya P, Migadde H, Namuwonge F, Mugisha J, Kirabo W, Ssentumbwe V, Najjuuko C, Atwebembere R, Sensoy Bahar O, Mwebembezi A, McKay MM, Ssewamala FM. Feasibility and Acceptability of Group-Based Stigma Reduction Interventions for Adolescents Living with HIV and their Caregivers: The Suubi4Stigma Randomized Clinical Trial (2020-2022). AIDS Behav. 2024 Feb 03. Springer

Kizito S, Nabunya P, Ssewamala FM. Enhancing Adherence to Antiretroviral Therapy among Adolescents Living with HIV through Group-Based Therapeutic Approaches in Uganda. Findings from a Pilot Cluster-Randomized Controlled Trial. Journal of Pediatric Psychology. 2023 Nov 3. Oxford University Press

Nabunya P, Byansi W, Sensoy Bahar O, Namuwonge F, Atwebembere R. Emotional and Behavior Difficulties and the Mental Health of Caregivers of Adolescents Living with HIV. J Child Fam Stud. 2023 June 10. Springer

Nabunya P, Namuwonge F, Sensoy Bahar O, Ssentumbwe V, Migadde H, Mugisha J, Ssewamala FM. Stigma by Association, Parenting Stress and the Mental Health of Caregivers of Adolescents Living with HIV in Uganda. J Adolesc Health. 2023 May;72(5S):S18-S23. doi: 10.1016/j.jadohealth.2022.08.017. Science Direct

Nabunya P, Namuwonge F. HIV-Related Shame, Stigma and the Mental Health Functioning of Adolescents Living with HIV: Findings from a Pilot Study in Uganda. Child Psychiatry Hum Dev. 2022 Jun 7. Epub ahead of print. PMID: 35668284. Springer

Nabunya, P., Ssewamala, F. M., Bahar, O. S., Michalopoulos, L., Mugisha, J., Neilands, T. B., Trani, J. F., & McKay, M. M. (2022). Suubi4Stigma study protocol: a pilot cluster randomized controlled trial to address HIV-associated stigma among adolescents living with HIV in Uganda. Pilot and feasibility studies8(1), 95. BMC