Background: Antiretroviral therapy (ART) adherence and treatment outcomes remain poor among adolescents living with HIV (ALHIV). We assessed the impact of an economic empowerment intervention on viral suppression and mental health among ALHIV.

Methods: Thirty-nine clinics (clusters) from seven districts in Uganda were randomized (1:1) to deliver the standard of care (control) or the “Suubi" intervention to ALHIV. Eligible participants had to be aged 10 - 16, living with HIV, taking ART, living with a family, and registered to receive care from one of the study clinics. The intervention package comprising a savings account (where ALHIV saved money that was matched 1:1 by the study each month), financial literacy training, and micro-enterprise workshops was delivered over 24 months. Adolescents were followed up annually for seven years. The primary outcome was the proportion of ALHIV with a viral load below 1000 copies/ml, while the secondary outcomes included depression, hopelessness, and self-concept. We ran complete-case, intention-to-treat, and mixed-effects models to determine the main effects of group, time, and group-time interaction. The trial is registered at ClinicalTrials.gov, number NCT01790373.

Findings: Between January 2014 and December 2015, 702 ALHIV were enrolled, of whom 358 were randomized to the intervention group. At enrollment, the mean age was 12 years, 56% were female, and 73.79% had a viral load below 1000 copies/ml. At the end of the seventh year, 572 (82%) of the adolescents had outcome data. At the end-line, 91.97% of ALHIV in the intervention and 90.96% in the control groups had suppressed viral loads. All outcomes improved over time, although the intervention did not affect the outcomes for the whole sample. Among ALHIV with few assets, the intervention significantly improved self-concept (χ²(1) = 5.21, p<0.023) and reduced hopelessness (χ² (1) = 4.18, p=0.041).

Conclusions: Our intervention improved mental health outcomes, especially among ALHIV owning few assets among ALHIV. Given the poor HIV treatment outcomes in ALHIV, economic strengthening interventions should be considered in programs for ALHIV. More research is required to test interventions aimed at improving viral suppression.