家庭经济赋权对低收入环境中感染艾滋病毒青少年病毒抑制和心理健康结果的长期影响：乌干达南部的一项整群随机对照试验

The long-term impact of family economic empowerment on viral suppression and mental health outcomes among adolescents living with HIV in low-income settings: A cluster-randomized controlled trial in Southern Uganda.

作者信息

Kizito Samuel, Ssewamala Fred M, Nabayinda Josephine, Namuwonge Flavia, Neilands Torsten B, Nabunya Proscovia, Bahar Ozge Sensoy, Ssentumbwe Vicent, Nattabi Jennifer

机构信息

International Center for Child Health and Development, Brown School, Washington University in St. Louis, MO, 63130, USA.

Division of Prevention Science, University of California, San Francisco, CA, 94143, USA.

出版信息

Soc Sci Med. 2025 Jan;364:117546. doi: 10.1016/j.socscimed.2024.117546. Epub 2024 Nov 26.

DOI:10.1016/j.socscimed.2024.117546

PMID:39608336

Abstract

OBJECTIVES

We examined the impact of a family-based economic empowerment intervention on viral suppression and mental health among ALHIV.

STUDY DESIGN

Between 2013 and 2014, 702 participants aged 10-16, living with HIV, and taking antiretroviral therapy, were recruited from 39 clinics in Uganda. Twenty clinics (n = 358 participants) were randomized to the intervention and 19 clinics (n = 344 participants) were randomized to the control conditions. The intervention comprised a matched savings account, financial literacy training, and microenterprise workshops. The primary outcome was viral suppression, while the secondary outcomes included depression, hopelessness, and self-concept. We ran mixed-effects models to determine the intervention effects.

RESULTS

At enrollment, participants' mean age was 12 years. The intervention improved viral suppression, evidenced by significant intervention-by-time interaction effects [χ(5) = 12·81, p = 0·025], further qualified by increased viral suppression in the intervention group at year two, OR = 1.89 (95% CI: 1.14-3.15), year three, OR = 2.31 (95% CI: 1.05-5.04), and year four, OR = 2.34 (95% CI: 1.03-5.33). Regarding mental health, we did not find significant intervention main effects or intervention-by-time interaction effects for depressive symptoms, hopelessness, or self-concept for the entire sample. However, for participants owning fewer assets, we found significant intervention-by-time interaction effects for hopelessness [χ(5) = 12·33, p = 0·031], and self-concept [χ(5) = 27·26, p < 0·001], suggesting beneficial intervention effect for this demographic.

CONCLUSIONS

Family EE interventions have the potential to improve viral suppression and mental health outcomes among ALHIV. These findings offer insights in designing programs and policies to improve outcomes among ALHIV.

摘要

目标

我们研究了一项基于家庭的经济赋权干预措施对青少年艾滋病病毒感染者病毒抑制情况及心理健康的影响。

研究设计

2013年至2014年期间，从乌干达的39家诊所招募了702名年龄在10 - 16岁、感染了艾滋病病毒且正在接受抗逆转录病毒治疗的参与者。20家诊所（n = 358名参与者）被随机分配到干预组，19家诊所（n = 344名参与者）被随机分配到对照组。干预措施包括一个配对储蓄账户、金融知识培训和微型企业工作坊。主要结局是病毒抑制，次要结局包括抑郁、绝望和自我概念。我们运行混合效应模型来确定干预效果。

结果

入组时，参与者的平均年龄为12岁。干预改善了病毒抑制情况，显著的干预与时间交互效应[χ(5) = 12·81，p = 0·025]证明了这一点，在第二年干预组病毒抑制增加进一步证实了这一点，比值比（OR）= 1.89（95%置信区间：1.14 - 3.15），第三年OR = 2.31（95%置信区间：1.05 - 5.04），第四年OR = 2.34（95%置信区间：1.03 - 5.33）。关于心理健康，对于整个样本，我们没有发现干预的主要效应或干预与时间的交互效应在抑郁症状、绝望或自我概念方面有显著差异。然而，对于资产较少的参与者，我们发现绝望[χ(5) = 12·33，p = 0·031]和自我概念[χ(5) = 27·26，p < 0·001]存在显著的干预与时间交互效应，表明该干预措施对这一人群有有益效果。