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

Overview

Journal Soc Sci Med

Date 2021 May 21

PMID 34020312

Citations 8

Authors

Patricia Cavazos-Rehg

William Byansi

Christine Doroshenko

Torsten B Neilands

Nnenna Anako

Ozge Sensoy Bahar

Erin Kasson

Proscovia Nabunya

Claude A Mellins

Fred M Ssewamala

Affiliations

Soon will be listed here.

Abstract

Introduction: Many adolescents living with HIV in sub-Saharan Africa (SSA) experience poverty and have access to limited resources, which can impact HIV and mental health outcomes. Few studies have analyzed the impact of economic empowerment interventions on the psychosocial wellbeing of adolescents living with HIV in low resource communities, and this study aims to examine the mediating mechanism(s) that may explain the relationship between a family economic empowerment intervention (Suubi + Adherence) and mental health outcomes for adolescents (ages 10-16 at enrollment) living with HIV in Uganda.

Method: We utilized data from Suubi + Adherence, a large-scale six-year (2012-2018) longitudinal randomized controlled trial (N = 702). Generalized structural equation models (GSEMs) were conducted to examine 6 potential mediators (HIV viral suppression, food security, family assets, and employment, HIV stigma, HIV status disclosure comfort level, and family cohesion) to determine those that may have driven the effects of the Suubi + Adherence intervention on adolescents' mental health.

Results: Family assets and employment were the only statistically significant mediators during follow-up (β from -0.03 to -0.06), indicating that the intervention improved family assets and employment which, in turn, was associated with improved mental health. The proportion of the total effect mediated by family assets and employment was from 42.26% to 71.94%.

Conclusions: Given that mental health services provision is inadequate in SSA, effective interventions incorporating components related to family assets, employment, and financial stability are crucial to supporting the mental health needs of adolescents living with HIV in under-resourced countries like Uganda. Future research should work to develop the sustainability of such interventions to improve long-term mental health outcomes among this at-risk group.

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References

Tsai A, Bangsberg D, Frongillo E, Hunt P, Muzoora C, Martin J . Food insecurity, depression and the modifying role of social support among people living with HIV/AIDS in rural Uganda. Soc Sci Med. 2012; 74(12):2012-9. PMC: 3348339. DOI: 10.1016/j.socscimed.2012.02.033. View

Sweetland A, Norcini Pala A, Mootz J, Kao J, Carlson C, Oquendo M . Food insecurity, mental distress and suicidal ideation in rural Africa: Evidence from Nigeria, Uganda and Ghana. Int J Soc Psychiatry. 2018; 65(1):20-27. PMC: 6386592. DOI: 10.1177/0020764018814274. View

Thompson R, Craig A, Mrakotsky C, Bousvaros A, DeMaso D, Szigethy E . Using the Children's Depression Inventory in youth with inflammatory bowel disease: support for a physical illness-related factor. Compr Psychiatry. 2012; 53(8):1194-9. PMC: 4017927. DOI: 10.1016/j.comppsych.2012.04.006. View

Frigati L, Ameyan W, Cotton M, Gregson C, Hoare J, Jao J . Chronic comorbidities in children and adolescents with perinatally acquired HIV infection in sub-Saharan Africa in the era of antiretroviral therapy. Lancet Child Adolesc Health. 2020; 4(9):688-698. DOI: 10.1016/S2352-4642(20)30037-7. View

Kinyanda E, Salisbury T, Muyingo S, Ssembajjwe W, Levin J, Nakasujja N . Major Depressive Disorder Among HIV Infected Youth in Uganda: Incidence, Persistence and Their Predictors. AIDS Behav. 2020; 24(9):2588-2596. DOI: 10.1007/s10461-020-02815-3. View

Mellins C, Malee K . Understanding the mental health of youth living with perinatal HIV infection: lessons learned and current challenges. J Int AIDS Soc. 2013; 16:18593. PMC: 3687078. DOI: 10.7448/IAS.16.1.18593. View

Parker E, Short S . Grandmother Co-Residence and School Enrollment in sub-Saharan Africa. J Fam Issues. 2012; 30(6):813-836. PMC: 3505141. DOI: 10.1177/0192513X09331921. View

Nalugya-Sserunjogi J, Rukundo G, Ovuga E, Kiwuwa S, Musisi S, Nakimuli-Mpungu E . Prevalence and factors associated with depression symptoms among school-going adolescents in Central Uganda. Child Adolesc Psychiatry Ment Health. 2016; 10:39. PMC: 5081935. DOI: 10.1186/s13034-016-0133-4. View

Weiser S, Young S, Cohen C, Kushel M, Tsai A, Tien P . Conceptual framework for understanding the bidirectional links between food insecurity and HIV/AIDS. Am J Clin Nutr. 2011; 94(6):1729S-1739S. PMC: 3226026. DOI: 10.3945/ajcn.111.012070. View

10.

Lwidiko A, Kibusi S, Nyundo A, Mpondo B . Association between HIV status and depressive symptoms among children and adolescents in the Southern Highlands Zone, Tanzania: A case-control study. PLoS One. 2018; 13(2):e0193145. PMC: 5823441. DOI: 10.1371/journal.pone.0193145. View

11.

Bermudez L, Ssewamala F, Neilands T, Lu L, Jennings L, Nakigozi G . Does Economic Strengthening Improve Viral Suppression Among Adolescents Living with HIV? Results From a Cluster Randomized Trial in Uganda. AIDS Behav. 2018; 22(11):3763-3772. PMC: 6204092. DOI: 10.1007/s10461-018-2173-7. View

12.

Singer A, Weiser S, McCoy S . Does Food Insecurity Undermine Adherence to Antiretroviral Therapy? A Systematic Review. AIDS Behav. 2014; 19(8):1510-26. DOI: 10.1007/s10461-014-0873-1. View

13.

Kemigisha E, Zanoni B, Bruce K, Menjivar R, Kadengye D, Atwine D . Prevalence of depressive symptoms and associated factors among adolescents living with HIV/AIDS in South Western Uganda. AIDS Care. 2019; 31(10):1297-1303. PMC: 6614012. DOI: 10.1080/09540121.2019.1566511. View

14.

Ssewamala F, Neilands T, Waldfogel J, Ismayilova L . The impact of a comprehensive microfinance intervention on depression levels of AIDS-orphaned children in Uganda. J Adolesc Health. 2012; 50(4):346-52. PMC: 3314188. DOI: 10.1016/j.jadohealth.2011.08.008. View

15.

Ssewamala F, Byansi W, Bahar O, Nabunya P, Neilands T, Mellins C . Suubi+Adherence study protocol: A family economic empowerment intervention addressing HIV treatment adherence for perinatally infected adolescents. Contemp Clin Trials Commun. 2019; 16:100463. PMC: 6915750. DOI: 10.1016/j.conctc.2019.100463. View

16.

McHenry M, Nyandiko W, Scanlon M, Fischer L, McAteer C, Aluoch J . HIV Stigma: Perspectives from Kenyan Child Caregivers and Adolescents Living with HIV. J Int Assoc Provid AIDS Care. 2016; 16(3):215-225. PMC: 5464367. DOI: 10.1177/2325957416668995. View

17.

Nabunya P, Ssewamala F, Mukasa M, Byansi W, Nattabi J . Peer mentorship program on HIV/AIDS knowledge, beliefs, and prevention attitudes among orphaned adolescents: an evidence based practice. Vulnerable Child Youth Stud. 2016; 10(4):345-356. PMC: 4814228. View

18.

Bhana A, Mellins C, Petersen I, Alicea S, Myeza N, Holst H . The VUKA family program: piloting a family-based psychosocial intervention to promote health and mental health among HIV infected early adolescents in South Africa. AIDS Care. 2013; 26(1):1-11. PMC: 3838445. DOI: 10.1080/09540121.2013.806770. View

19.

Beck A, Weissman A, Lester D, Trexler L . The measurement of pessimism: the hopelessness scale. J Consult Clin Psychol. 1974; 42(6):861-5. DOI: 10.1037/h0037562. View

20.

Hudelson C, Cluver L . Factors associated with adherence to antiretroviral therapy among adolescents living with HIV/AIDS in low- and middle-income countries: a systematic review. AIDS Care. 2015; 27(7):805-16. DOI: 10.1080/09540121.2015.1011073. View