Trial finds improving household finances linked to effective HIV treatment
More adolescents with HIV virally suppressed after taking part in savings scheme for families in rural Uganda
A trial in southern Uganda that supported families to save money for education, health and income-generating activities increased viral suppression rates among adolescents with HIV by 9%.
The findings from the Suubi + Adherence scheme suggest that making family-based saving schemes part of HIV care would be an effective – and cost-effective way – to address some of the financial issues that can make it difficult for adolescents to stay on antiretroviral treatment (ART). For example, families may not be able to afford the cost of travelling to a clinic, or have enough food to take medication.
The randomised control trial involved around 700 adolescents (ages 10-16) receiving ART from 39 health centres in the greater Masaka region. This is a rural part of southern Uganda where 12% of people have HIV.
Around half (56%) of the participants were female and their average age was 12. All adolescents were living with families, but 26% had lost both parents and 39% had lost one parent. Most (87%) were at school. Around 60% had an undetectable viral load (defined as having less than 40 copies of HIV in one millilitre of blood) when joining the study.
All participants received a ‘bolstered standard of HIV care’ (BSOC) at their health centre. This consisted of medical care, plus ART adherence support from trained lay counsellors and peer navigators. Ugandan Ministry of Health communication materials for families were also provided.
Around half the participants were also enrolled on the Suubi + Adherence scheme. Those enrolled had six extra counselling sessions on ART adherence and mentorship from peers. They also took part in four workshops on asset building, family income-generating activities, and financial saving and planning.
Participants also received a savings account containing an initial sum of money. Their families were then encouraged to put more money into the accounts. Any deposits were matched at a ratio of 1:1 over a period of two years. Matched funds were only permitted to pay for education, healthcare or income-generating activities.
At the end of the trial, the number of virally suppressed adolescents only increased slightly in the BSOC group. But in the Suubi + Adherence group, the proportion of virally suppressed adolescents had risen by 8.85%.
The scheme increased the cost of providing adherence support for each adolescent by about 50% (US$177 versus US$263 per adolescent) over two years. The incremental cost of virally suppressing each extra adolescent was US$970 over two years. But expanding the scheme to support more adolescents would likely reduce costs.
Although schemes such as Suubi + Adherence might cost more in the short-term, they give adolescents with HIV valuable skills and resources, and are likely to improve their health. This not only improves adolescents’ quality of life, but also means they will be less likely to rely on government support and more likely to contribute to the economy. Improving someone's ART adherence also makes it more likely they will be able to stay on first-line ART, which is less expensive than second-line treatments.
These benefits suggest that policymakers and donors would be justified in investing in economic empowerment adherence support for adolescents with HIV in Masaka and similar rural settings. This would also be in line with the Ugandan Government’s Vision 2040, which commits to the economic empowerment of vulnerable people.