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Cited by 36Poverty, Education, and Child WelfareHIV/AIDS Impact and ResponsesHIV/AIDS Research and Interventions

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Evaluation of a savings-led family-based economic empowerment intervention for AIDS-affected adolescents in Uganda: A four-year follow-up on efficacy and cost-effectiveness

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Tozan, Yesim, Sun, Sicong, Capasso, Ariadna, Shu-Huah Wang, Julia, Neilands, Torsten B., Bahar, Ozge Sensoy, Damulira, Christopher, Ssewamala, Fred M.·2019·PLOS ONE
DOI 10.1371/journal.pone.0226809PMC PMC6938344
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Abstract

BACKGROUND: Children who have lost a parent to HIV/AIDS, known as AIDS orphans, face multiple stressors affecting their health and development. Family economic empowerment (FEE) interventions have the potential to improve these outcomes and mitigate the risks they face. We present efficacy and cost-effectiveness analyses of the Bridges study, a savings-led FEE intervention among AIDS-orphaned adolescents in Uganda at four-year follow-up. METHODS: Intent-to-treat analyses using multilevel models compared the effects of two savings-led treatment arms: Bridges (1:1 matched incentive) and BridgesPLUS (2:1 matched incentive) to a usual care control group on the following outcomes: self-rated health, sexual health, and mental health functioning. Total per-participant costs for each arm were calculated using the treatment-on-the-treated sample. Intervention effects and per-participant costs were used to calculate incremental cost-effectiveness ratios (ICERs). FINDINGS: Among 1,383 participants, 55% were female, 20% were double orphans. Mean age was 12 years at baseline. At 48-months, BridgesPLUS significantly improved self-rated health, (0.25, 95% CI 0.06, 0.43), HIV knowledge (0.21, 95% CI 0.01, 0.41), self-concept (0.26, 95% CI 0.09, 0.44), and self-efficacy (0.26, 95% CI 0.09, 0.43) and lowered hopelessness (-0.28, 95% CI -0.43, -0.12); whereas Bridges improved self-rated health (0.26, 95% CI 0.08, 0.43) and HIV knowledge (0.22, 95% CI 0.05, 0.39). ICERs ranged from $224 for hopelessness to $298 for HIV knowledge per 0.2 standard deviation change. CONCLUSIONS: Most intervention effects were sustained in both treatment arms at two years post-intervention. Higher matching incentives yielded a significant and lasting effect on a greater number of outcomes among adolescents compared to lower matching incentives at a similar incremental cost per unit effect. These findings contribute to the evidence supporting the incorporation of FEE interventions within national social protection frameworks.

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  • In Uganda, a trial of two financial incentives encouraging young orphans to save more money reported statistically significant reductions in depression at 2-year follow up, with the most generous financial scheme being more cost-effective.

    “In Uganda, a trial of two financial incentives encouraging young orphans to save more money reported statistically significant reductions in depression at 2-year follow up, with the most generous financial scheme being more cost-effective. 440”

    From The Lancet Psychiatry Commission on youth mental health (2024) · cites this paper as [440]

    The Discussion (page unavailable) says that at 24 months the higher savings incentive did not produce different treatment effects or cost-effectiveness ratios; at 48 months, the lower-incentive arm was more cost-effective for outcomes significant in both arms. The paper does not establish the claimed statistically significant reduction in depression at 24 months, and its Results report no significant depression effect at 48 months. (LLM, conf=0.88)

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  • At 4-year follow up, these improvements in depression were no longer statistically significant, although other benefits, such as reduced hopelessness, persisted.

    “At 4-year follow up, these improvements in depression were no longer statistically significant, although other benefits, such as reduced hopelessness, persisted. 440”

    From The Lancet Psychiatry Commission on youth mental health (2024) · cites this paper as [440]

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Metadata

Authors
Tozan, Y., Sun, S., Capasso, A., Shu-Huah Wang, J., Neilands, T. B., Bahar, O. S., Damulira, C., & Ssewamala, F. M.
Affiliations
  • New York University (US)
  • Washington University in St. Louis (US)
  • University of California, San Francisco (US)
Corresponding author
Ssewamala, Fred M.
ORCID
Venue
PLOS ONE
Publisher
Public Library of Science (PLoS)
Published
2019-12-31
Volume
14
Issue
12
Pages
e0226809
ISSN
1932-6203 (ISSN-L)
DOI
10.1371/journal.pone.0226809
PMC
PMC6938344
OpenAlex
W2998257217
Cited by
36
References
2
Citations by year
2026: 2 · 2025: 7 · 2024: 6 · 2023: 5 · 2022: 8 · 2021: 7 · 2020: 1
FWCI
7.00
Type
journal article
Language
en
Open access
Licence
Locations
  • PLoS ONE (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • RePEc: Research Papers in Economics (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • KU ScholarWorks (University of Kansas) (submittedVersion, cc-by)
Funders
National Institute of Child Health and Development at the National Institutes of Health (R01-HD070727-01)
Topics
  • Social Sciences › Development › Poverty, Education, and Child Welfare
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › HIV/AIDS Impact and Responses
  • Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
Keywords
family economic empowerment, AIDS orphans, cost-effectiveness, self-rated health, HIV/AIDS knowledge, mental health, hopelessness, self-efficacy, social protection, long-term follow-up, Uganda, double orphans, sexual health, self-concept, intervention sustainability
MeSH terms
Psychosocial Support Systems, Acquired Immunodeficiency Syndrome, Adolescent, Aid to Families with Dependent Children, Child, Cost-Benefit Analysis, Female, Follow-Up Studies, Humans, Male, Mental Health, Motivation, Socioeconomic Factors, Uganda, United States, Self Efficacy, Child, Orphaned

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