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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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  • Yesim Tozan
  • Sicong Sun
  • Ariadna Capasso
  • Julia Shu-Huah Wang
  • Torsten B Neilands
  • Ozge Sensoy Bahar
  • Christopher Damulira
  • Fred M Ssewamala

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.

Suggested Citation

  • Yesim Tozan & Sicong Sun & Ariadna Capasso & Julia Shu-Huah Wang & Torsten B Neilands & Ozge Sensoy Bahar & Christopher Damulira & Fred M Ssewamala, 2019. "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," PLOS ONE, Public Library of Science, vol. 14(12), pages 1-13, December.
    • Handle: RePEc:plo:pone00:0226809
    DOI: 10.1371/journal.pone.0226809
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    References listed on IDEAS

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    1. Atwine, Benjamin & Cantor-Graae, Elizabeth & Bajunirwe, Francis, 2005. "Psychological distress among AIDS orphans in rural Uganda," Social Science & Medicine, Elsevier, vol. 61(3), pages 555-564, August.
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    3. Patrick J. McEwan, 2012. "Cost-effectiveness analysis of education and health interventions in developing countries," Journal of Development Effectiveness, Taylor & Francis Journals, vol. 4(2), pages 189-213, June.
    4. Dean Karlan & Aishwarya Lakshmi Ratan & Jonathan Zinman, 2014. "Savings by and for the Poor: A Research Review and Agenda," Review of Income and Wealth, International Association for Research in Income and Wealth, vol. 60(1), pages 36-78, March.
    5. Dean Karlan & Aishwarya Lakshmi Ratan & Jonathan Zinman, 2014. "Savings by and for the Poor: A Research Review and Agenda," Review of Income and Wealth, International Association for Research in Income and Wealth, vol. 60(1), pages 36-78, March.
    6. Kilburn, Kelly & Handa, Sudhanshu & Angeles, Gustavo & Mvula, Peter & Tsoka, Maxton, 2017. "Short-term impacts of an unconditional cash transfer program on child schooling: Experimental evidence from Malawi," Economics of Education Review, Elsevier, vol. 59(C), pages 63-80.
    7. Brigitte C. Madrian, 2012. "Matching Contributions and Savings Outcomes: A Behavioral Economics Perspective," NBER Working Papers 18220, National Bureau of Economic Research, Inc.
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    1. Chowa, Gina & Masa, Rainier & Manzanares, Miranda & Bilotta, Neil, 2023. "A scoping review of positive youth development programming for vulnerable and marginalized youth in low- and middle-income countries," Children and Youth Services Review, Elsevier, vol. 154(C).

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