Feasibility and acceptability of an integrated economic empowerment and substance use risk reduction intervention for youth living with HIV in Uganda: a pilot cluster randomized study.

In 30 seconds

This pilot cluster randomised trial assessed the feasibility, acceptability and short-term outcomes of a life-skills alcohol and drug use risk-reduction intervention, with or without financial literacy training and matched savings, among 95 youth living with HIV aged 18–24 years at six clinics in southwestern Uganda. Six-month retention was 94.7%. Compared with risk reduction alone, the combined intervention was associated with larger declines in self-reported past-six-month drug use (-20.1 vs -5.8 percentage points) and alcohol use (-17.9 vs -6.5 percentage points). Participants and qualitative findings indicated high acceptability, although savings uptake faced structural barriers.

Key findings

• Six-month retention was 94.7% among the 95 enrolled participants.
• Self-reported drug use declined more with the combined intervention than with risk reduction alone (-20.1 vs -5.8 percentage points).
• Self-reported alcohol use declined more with the combined intervention (-17.9 vs -6.5 percentage points).
• Urine-confirmed drug use decreased in both arms (-30.4 vs -26.7 percentage points); urine-confirmed alcohol use declined only with the combined intervention (-33.1 percentage points).

Why it matters

Youth living with HIV in sub-Saharan Africa face substantial alcohol and drug use, while evidence-based interventions are limited. This pilot suggests that pairing risk-reduction skills with economic empowerment is feasible and acceptable, and may be associated with greater reductions in self-reported use. The findings provide a rationale for testing the approach more rigorously, while not establishing its effectiveness.

What to keep in mind

This was a pilot study with short-term follow-up; the reported outcome changes do not establish intervention effectiveness. Savings uptake also faced structural barriers.