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BMC Public Health. 2018 Jun 5;18(1):693. doi: 10.1186/s12889-018-5604-5.

Suubi4Her: a study protocol to examine the impact and cost associated with a combination intervention to prevent HIV risk behavior and improve mental health functioning among adolescent girls in Uganda.

Author information

1
Brown School, Washington University in St. Louis, 1 Brookings Drive, St. Louis, MO, 63130, USA. fms1@wustl.edu.
2
Columbia University School of Social Work, 1255 Amsterdam Ave., New York, NY, 10027, USA. lgb2123@columbia.edu.
3
School of Medicine, University of California San Francisco, 550 16th Street, San Francisco, CA, 94158, USA.
4
HIV Center for Clinical & Behavioral Studies, New York State Psychiatric Institute and Columbia University, 1051 Riverside Dr, New York, NY, 10032, USA.
5
Brown School, Washington University in St. Louis, 1 Brookings Drive, St. Louis, MO, 63130, USA.
6
Columbia University School of Social Work, 1255 Amsterdam Ave., New York, NY, 10027, USA.
7
Rakai Health Sciences Program, Old Bukoba Road, 279, Kalisizo, Uganda.
8
International Center for Child Health and Development Field Office, Plot 23 Circular Rd, Masaka, Uganda.
9
Department of Population and Family Health, Columbia University Mailman School of Public Health, 60 Haven Ave B-4 Suite 432, New York, NY, 10032, USA.

Abstract

BACKGROUND:

Asset-based economic empowerment interventions, which take an integrated approach to building human, social, and economic capital, have shown promise in their ability to reduce HIV risk for young people, including adolescent girls, in sub-Saharan Africa. Similarly, community and family strengthening interventions have proven beneficial in addressing mental health and behavioral challenges of adolescents transitioning to adulthood. Yet, few programs aimed at addressing sexual risk have applied combination interventions to address economic stability and mental health within the traditional framework of health education and HIV counseling/testing. This paper describes a study protocol for a 5-year, NIMH-funded, cluster randomized-controlled trial to evaluate a combination intervention aimed at reducing HIV risk among adolescent girls in Uganda. The intervention, titled Suubi4Her, combines savings-led economic empowerment through youth development accounts (YDA) with an innovative family strengthening component delivered via Multiple Family Groups (MFG).

METHODS:

Suubi4Her will be evaluated via a three-arm cluster randomized-controlled trial design (YDA only, YDA + MFG, Usual Care) in 42 secondary schools in the Central region of Uganda, targeting a total of 1260 girls (ages 15-17 at enrollment). Assessments will occur at baseline, 12, 24, and 36 months. This study addresses two primary outcomes: 1) change in HIV risk behavior and 2) change in mental health functioning. Secondary exploratory outcomes include HIV and STI incidence, pregnancy, educational attainment, financial savings behavior, gender attitudes, and self-esteem. For potential scale-up, cost effectiveness analysis will be employed to compare the relative costs and outcomes associated with each study arm.

CONCLUSIONS:

Suubi4Her will be one of the first prospective studies to examine the impact and cost of a combination intervention integrating economic and social components to reduce known HIV risk factors and improve mental health functioning among adolescent girls, while concurrently exploring mental health as a mediator in HIV risk reduction. The findings will illuminate the pathways that connect economic needs, mental health, family support, and HIV risk. If successful, the results will promote holistic HIV prevention strategies to reduce risk among adolescent girls in Uganda and potentially the broader sub-Saharan Africa region.

TRIAL REGISTRATION:

Clinical Trials NCT03307226 (Registered: 10/11/17).

KEYWORDS:

Adolescent girls; Assets; Combination interventions; Economic empowerment; Family strengthening; HIV

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