Background

Adolescents orphaned by HIV/AIDS in sub-Saharan Africa face significant challenges in acquiring accurate HIV prevention knowledge and developing protective health attitudes. The Bridges to the Future study, a five-year (2011–2016) cluster-randomized controlled trial, evaluated the effectiveness of a family-based economic empowerment intervention in improving various outcomes including HIV knowledge among AIDS-orphaned youth in Uganda.

Methods

A total of 1,410 participants (aged 10–16 years) were recruited from 48 public primary schools in four HIV-affected districts. Schools were randomized into control and treatment arms, with the intervention providing financial literacy training, a Child Development Account, and mentorship. HIV knowledge was assessed using a composite score based on five Likert-scale items measuring awareness of HIV transmission, prevention, and risk perception. A mixed-effects regression model examined changes in HIV knowledge scores over time between control and treatment groups, accounting for school- and participant-level clustering.

Results

HIV knowledge scores significantly increased over time (χ²(4) = 208.60, p < 0.001). The intervention group showed significantly greater improvements in HIV knowledge compared to the control group (χ²(1) = 6.72, p = 0.0095). More importantly, interaction effects between time and study group indicated a sustained impact of the intervention (χ²(4) = 19.38, p = 0.0007), with higher adjusted predictions for HIV knowledge at all follow-up time points.

Conclusion

Findings suggest that economic empowerment interventions incorporating financial literacy, savings incentives, and mentorship may significantly enhance HIV knowledge among vulnerable adolescents. These results highlight the importance of integrating economic support with health education to improve adolescent health outcomes in resource-limited settings. Future research should explore how financial stability and caregiver support contribute to sustained behavioral change in HIV prevention.