Suubi+Adherence-R2 (2020-2025)

SUUBI+Adherence-R2: Examining the longitudinal HIV treatment adherence among youth living with HIV (YLHIV) transitioning into young adulthood

Principal Investigator: Fred Ssewamala, PhD, Ozge Sensoy Bahar, PhD, Proscovia Nabunya, PhD

Project Team Members: Rachel Brathwaite, PhD; Derek Brown, PhD; Shenyang Guo, PhD; Claude Mellins, PhD (Columbia University); Barbara Mukasa, MBChB (Mildmay); Torsten Neilands, PhD (University of California – San Francisco); John Santelli, PhD (Columbia University); April Denise Thames, PhD (University of California Los Angeles)

Field Coordinators: Phionah Namatovu, MPH

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

Suubi+Adherence-R2 (R01HD074949) is a five-year study (2020-2025) funded by the Eunice Kennedy Shriver National Institutes of Child Health & Human Development (NICHD). In addition to tracking the original cohort of study participants in Suubi+Adherence for an additional five years, this continued funding will allow the team to dig deeper into the potential mechanisms of change including whether the intervention has any long-term effects on economic stability, sexual risk-taking behavior, adherence self-efficacy; cognitive functioning; mental health functioning; and young adult transitions and social support. Providing a financial support system for these youth has the potential to lead to long-term systemic, positive life choices. This continuation study adds a qualitative component and extends a cost-effectiveness component that will enable the team to assess the long-term financial cost of the intervention relative to other means of achieving the same desirable outcome of suppressed viral loads.

Suubi+Adherence (2012-2018)

Suubi+Adherence: Evaluating a Youth-Focused Economic Empowerment Approach to HIV Treatment Adherence

Principal Investigator: Fred M. Ssewamala, PhD

Project Team Members: Claude Mellins, PhD; Mary McKay, PhD; Irwin Garfinkel, PhD; Torsten Neilands, PhD; Godfrey Kigozi, PhD; Gertrude Nakigozi, PhD

Field Coordinators: Apollo Kivumbi, MPH; Miriam Mukasa

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

Suubi+Adherence is a five-year longitudinal study funded by the Eunice Kennedy Shriver National Institutes of Child Health & Human Development (NICHD). It examines the impact and cost associated with an economic empowerment intervention to increase adherence to HIV treatment for HIV positive adolescents in Uganda. The study is the first in Uganda to use a financial stability model to positively affect treatment adherence for youth. The study intervention, financial empowerment, combines a matched savings account, financial education, health education, and income-generating activities. This is meant to promote saving money for study participants and their families so there is sufficient income to meet the needs associated with managing HIV as a chronic illness, to provide support for adherence to antiretroviral therapy, to develop microenterprises to generate family income, and/or to further their studies in secondary education.

SUUBI+Adherence Publications

Girma AZ, Brathwaite R, Karamagi Y, Nakabuye F, Nakasujja N, Byansi W, Nabunya P, Sensoy Bahar O, Ssewamala FM. The impact of COVID-19 changes and disruptions on generalized anxiety disorder among young adults living with HIV (YLHIV) in Uganda. J Health Psychol. 2024 Feb 6:13591053241228205. doi: 10.1177/13591053241228205. Sage

Kizito S, Namuwonge F, Nabayinda J, Nalwanga D, Najjuuko C, Nabunya P, Atwebembere R, Namuyaba OI, Mukasa M, Ssewamala FM. A cluster-randomized controlled trial of an economic strengthening intervention to enhance antiretroviral therapy adherence among Adolescents Living with HIV. AIDS Behav. 2024 Jan 17. https://doi.org/10.1007/s10461-024-04268-4. Springer

Kizito S, Namuwonge F, Nabayinda J, Nabunya P, Nattabi J, Sensoy Bahar O, Kiyingi J, Magorokosho N, Ssewamala FM. Using Hierarchical Regression to Examine the Predictors of Sexual Risk-taking Attitudes among Adolescents Living with HIV in Uganda. J Adolesc Health. 2023 Apr 17. doi: 10.1016/j.jadohealth.2023.02.034. Science Direct

Kizito S, Nabayinda J, Neilands TB, Kiyingi J, Namuwonge F, Damulira C, Nabunya P, Nattabi J, Ssewamala FM. A Structural Equation Model of the Impact of a Family-Based Economic Intervention on ART Adherence Among Adolescents Living with HIV in Uganda. J Adolesc Health. 2023 May;72(5S):S41-S50. doi: 10.1016/j.jadohealth.2022.12.012. Science Direct

Nabunya P, Kizito S, Ssewamala FM. The Effect of Family Responsibility on Self-Reported Adherence to ART among adolescents Perinatally Infected with HIV in Uganda: A Mediation Analysis. Journal of Adolescence, 2023 Feb 22; 1–10. https://doi.org/10.1002/jad.12157. Wiley

Dvalishvili D, Ssewamala FM, Nabunya P, Sensoy Bahar O, Kizito S, Namuwonge F, Namatovu P. Impact of Family-Based Economic Empowerment Intervention, Suubi+Adherence (2012-2018) on Multidimensional Poverty for Adolescents living with HIV (ALWHIV) in Uganda. Int. J. Environ. Res. Public Health 2022, 19(21), 14326. International Journal of Environmental Research and Public Health

Kizito S, Namuwonge F, Brathwaite R, Neilands TB, Nabunya P, Sensoy Bahar O, Damulira C, Mwebembezi A, Mellins C, McKay MM, Ssewamala FM. Monitoring Adherence to Antiretroviral Therapy among Adolescents in Southern Uganda: Comparing Wisepill to Self-Report in predicting viral suppression. Journal of International AIDS Society. 2022 Sept 02. Wiley

Kizito S, Nabayinda J, Kiyingi J, Neilands TB, Namuwonge F, Namatovu P, Nabunya P, Sensoy Bahar O, Ssentumbwe V, Magorokosho N, Ssewamala FM. The Impact of an Economic Strengthening Intervention on Academic Achievement Among Adolescents Living with HIV: Findings from the Suubi+Adherence Cluster Randomized Clinical Trial in Uganda (2012-2018). AIDS and Behavior. 2022 Sep 01. Springer

Brathwaite R, Ssewamala FM, Mutumba M, Neilands TB, Byansi W, Namuwonge F, Damulira C, Nabunya P, Nakigozi G, Makumbi F, Mellins CA, McKay MM, Team SAF. The Long-term (5-year) Impact of a Family Economic Empowerment Intervention on Adolescents Living with HIV in Uganda: Analysis of Longitudinal Data from a Cluster Randomized Controlled Trial from the Suubi+Adherence Study (2012-2018). AIDS Behav. 2022 Apr 16. doi: 10.1007/s10461-022-03637-1. Springer

Tozan, Y., Capasso, A., Sun, S., Neilands, T. B., Damulira, C., Namuwonge, F., Nakigozi, G., Mwebembezi, A., Mukasa, B., Bahar, O.S., Nabunya, P., Mellins, C.A., McKay, M.M & Ssewamala, F. M. (2021). The efficacy and cost-effectiveness of a family-based economic empowerment intervention (Suubi + Adherence) on suppression of HIV viral loads among adolescents living with HIV: results from a Cluster Randomized Controlled Trial in southern Uganda Journal of the International AIDS Society, 24(6), e25752. J International AIDS Society

Byansi, W., Brathwaite, R., Calvert, M., Nabunya, P., Sensoy Bahar, O., Damulira, C., Namuwonge, F., McKay, M. M., Mellins, C. A., & Ssewamala, F. M. (2021). Relationship between mental health and HIV transmission knowledge and prevention attitudes among adolescents living with HIV: Lessons from Suubi+Adherence cluster randomized study in Southern Uganda. AIDS and Behavior. Springer

Byansi, W., Nabunya, P., Muwanga, J., Mwebembezi, A., Damulira, C., Mukasa, B., Zmachinski, L., Nattabi, J., Brathwaite, R., Namuwonge, F., Bahar, OS., Torsten B. Neilands, TB., Mellins, CA., & Ssewamala, FM. (2021). The relationship between life satisfaction, personal health, quality of life, and medication adherence among adolescents living with HIV in southwestern Uganda. J Public Health (Berl.). Public Health

Brathwaite,R., Ssewamala, F.M., Neilands, T.B., Okumu, M., Mutumba, M., Damulira, C., Nabunya, P., Kizito, S., Sensoy Bahar, O., Mellins, C.A., & McKay. M.M. (2021). Predicting the individualized risk of poor adherence to ART medication among adolescents living with HIV in Uganda: the Suubi+Adherence study Pubmed

Cavazos-Rehg, P., Byansi, W., Doroshenko, C., Neilands, T. B., Anako, N., Bahar, O. S., Kasson, E., Nabunya, P., Mellins, C.A., & Ssewamala, F. M. (2021). Evaluating potential mediators for the impact of a family-based economic intervention (Suubi+ Adherence) on the mental health of adolescents living with HIV in Uganda. Social Science & Medicine, 280, 113946 Social Science & Medicine

Shato, T., Nabunya, P., Byansi, W., Nwaozuru, U., Okumu, M., Mutumba, M., Brathwaite, R., Damulira, C., Namuwonge, F., Sensoy Bahar, O., Neilands, T. B., & Ssewamala, F. M. (2021). Family economic empowerment, social support and sexual risk behaviors among adolescents living with HIV in Uganda: The Suubi+Adherence Study. Journal of Adolescent Health. ScienceDirect

Ssewamala, F. M., Sensoy Bahar, O., Nabunya, P., Thames, A. D., Neilands, T. B., Damulira, C., Mukasa, B., Brathwaite, R., Mellins, C., Santelli, J., Brown, D., Guo, S., Namatovu, P., Kiyingi, J., Namuwonge, F., & McKay, M. M. (2021). Suubi+Adherence-Round 2: A study protocol to examine the longitudinal HIV treatment adherence among youth living with HIV transitioning into young adulthood in Southern Uganda. BMC Public Health. Springer

Cavazos-Rehg, P., Byansi, W., Xu, C., Nabunya, P., Sensoy Bahar, O., …Ssewamala, F. M. (2020). The impact of a family-based economic intervention on the mental health of HIV-infected adolescents in Uganda: Results from Suubi+Adherence. Journal of Adolescent Health. Science Direct

Cavazos-Rehg, P., Xu, C., Borodovsky, J., Kasson, E., Byansi, W., Nabunya, P., Bahar, O.S., & Ssewamala, F.M. (2020). The impact of discomfort with HIV status and hopelessness on depressive symptoms among adolescents living with HIV in Uganda. AIDS Care. PubMed

Cavazos-Rehg, P., Xu, C., Kasson, E., Byansi, W., Sensoy Bahar, O., & Ssewamala, F. M. (2020). Social and economic equity and family cohesion as potential protective factors from depression among adolescents living with HIV in Uganda. AIDS and Behavior. PubMed

Nabunya, P., Byansi, W., Sensoy Bahar, O., McKay, M. M., Ssewamala, F. M., & Damulira, C. (2020). Factors associated with HIV disclosure and HIV-related stigma among adolescents living with HIV in Southwestern Uganda. Frontiers in Psychiatry. PubMed

Nabunya, P., Byansi, W., Muwanga, J., Damulira, C., Brathwaite, R., Sensoy Bahar, O., Namuwonge, F., & Ssewamala, F. M. (2020). Gender, HIV Knowledge and Prevention Attitudes Among Adolescents Living with HIV Participating in an Economic Empowerment Intervention in Uganda. AIDS Care. Taylor & Francis Online

Nabunya, P., Sensoy Bahar, O., Chen, B., Dvalishvili, D., Damulira, C., & Ssewamala F. M. (2020) The role of family factors in antiretroviral therapy (ART) adherence self-efficacy among HIV-infected adolescents in southern Uganda. BMC Public Health 20, 340 PubMed

Ssewamala, F. M., Dvalishvili, D., Mellins, C., Geng, E., Makumbi, F., & Neilands, T. (2020). The long-term effects of a family based economic empowerment intervention (Suubi+Adherence) on suppression of HIV viral loads among adolescents living with HIV in southern Uganda: Findings from 5-year cluster randomized trial. PLoS One 15(2): p. e0228370. PubMed

Damulira, C., Mukasa, M., Byansi, W., Nabunya, P., Kivumbi, A., Namatovu, P., Namuwonge, F., Dvalishvili, D., Sensoy Bahar, O., & Ssewamala, F. M. (2019). Examining the relationship of social support and family cohesion on ART adherence among HIV-positive adolescents in southern Uganda: Baseline findings. Vulnerable Child Youth Studies, 14(2), 181-190. PubMed

Mukasa, M., Sensoy, Bahar O., Ssewamala, F. M., Kirkbride, G., Kivumbi, A., Namuwonge, F., & Damulira, C. (2019). Examining the organizational factors that affect health workers’ attendance: Findings from southwestern Uganda. International Journal of Health Planning and Management, 34(2). PubMed

Ssewamala, F. M., Byansi, W., Sensoy Bahar, O., Nabunya, P., Neilands T.B., Mellins, Claude., McKay, M., Namuwonge, F., Mukasa, M., Makumbi, F.E., & Nakigozi, G. (2019). Suubi+Adherence Study Protocol: A family economic empowerment intervention addressing HIV treatment adherence for perinatally infected adolescents. Contemporary Clinical Trials Communications, 100459. PubMed

Gauer-Bermudez, L. G., Ssewamala, F. M., Neilands, T. B., Lu, L., Jennings, L., Nakigozi, G., Mellins, C., McKay, M., & Mukasa, M. (2018). Does economic strengthening improve viral suppression among adolescents living with HIV? Results from a cluster randomized trial in Uganda. AIDS and Behavior, 22(11), 3763-3772. PubMed

Michalopoulos, L. M., Meinhart, M., Barton, S. M., Kuhn, J., Mukasa, M. N., Namuwonge, F., … Ssewamala, F. M. (2018). Adaptation and validation of the shame questionnaire among Ugandan youth living with HIV. Child Indicators Research. Springer

Gauer-Bermudez, L., Jennings, L., Ssewamala, F. M., Nabunya, P., Mellins, C. & McKay, M. (2016) Equity in adherence to antiretroviral therapy among economically-vulnerable adolescents living with HIV in Uganda. AIDS Care. NIHMS772360 PubMed