Bridges to the Future: Economic Empowerment for AIDS-Orphaned Children in Uganda

October 10, 2018 updated by: Fred Ssewamala, PhD, Columbia University
Bridges to the Future: Economic Empowerment for AIDS-Orphaned Children in Uganda, represents the first study that measures medium-term efficacy and cost-effectiveness of a family economic empowerment intervention for AIDS-orphaned children. The usual care provided to AIDS orphans in sub-Saharan Africa consists mainly of informal counseling as well as limited material support (e.g., specifically school lunches, textbooks for the required subjects, and note-books). Given the challenges facing these children and their caregivers, further supports are needed in order to help them successfully make the transition from primary school to secondary school and into adolescence. In the context of resource-poor countries, interventions that improve families' economic capabilities are likely to be particularly consequential. Both theory and prior research indicate that economic instability (including poverty) constitutes one of the primary risk factors for AIDS-orphaned children's risk-taking behaviors (including sexual risk-taking), poor mental health functioning, and poor educational outcomes. Thus, the lack of economic security constitutes an important risk factor for AIDS-orphaned children. Yet, to-date, few interventions aimed at care and support of AIDS-orphaned children have incorporated components to address family-level poverty/economic instability of the children and their caregiving families. Within this context, there is a need for innovative interventions that promote sustainable (more than short-term) economic and behavior change among AIDS-orphaned children and create the supports necessary to sustain these changes.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

The overall goal of the proposed research is to evaluate the efficacy and cost-effectiveness of an innovative family-based economic empowerment intervention for AIDS-orphaned children. This will be accomplished via a three-group cluster randomized control trial (RCT). The three groups are: Bridges, Bridges PLUS, and usual care for AIDS-orphaned children. There will be five assessment points: baseline (pretest), 12, 24, 36, and 48-months post-intervention initiation.

The intervention, "Bridges to the Future" (Bridges) will be guided by asset-theory and both Bridges and Bridges PLUS will include the following intervention components tested in the two earlier pilot studies, SEED-Uganda and SUUBI-Uganda: 1) workshops focused on asset building, future planning, and protection from risks; 2) mentors to reinforce learning and build optimism; 3) a Child Development Account (CDA) that can be used for secondary education by the AIDS-orphaned child; and 4) a family income generating/micro-enterprise promotion component for children enrolled in Bridges and Bridges PLUS, and their families.

Study Type

Interventional

Enrollment (Actual)

1410

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Uganda
    • Rakai And Masaka Districts
      • Masaka, Rakai And Masaka Districts, Uganda
        • International Center for Child Health and Asset Development

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

11 years to 17 years (Child)

Accepts Healthy Volunteers

Yes

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • An HIV/AIDS-orphaned child (a child who has lost one or both parents to HIV/AIDS)
  • Enrolled in grade 5 or 6 of primary school
  • Living within a family

Exclusion Criteria:

  • Any child who does not self-identify as an HIV/AIDS-orphan
  • Any child who is not enrolled in grade 5 or 6 of primary school
  • Any child who is not living within a family at the time of enrollment

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Supportive Care
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Other: Usual Care
Other: Usual Care
Participants in the usual care condition will receive usual care for AIDS-orphaned children in the study area. This includes: counseling, school lunches, and scholastic materials (textbooks and notebooks). Counseling will be provided by priests in the community (as is currently done).
Other Names:
  • Usual Services
Experimental: Bridges
Behavioral: Bridges
Each child participant in the Bridges Arm will receive the usual care in addition to a Child Development Account (CDA) to be used for secondary education by the AIDS-orphaned child. The CDA will be a matched savings account held in the child's name in a financial institution registered by the Central Bank (Bank of Uganda). The account will be matched with money from the program at a match rate of 1:1. Additionally, participants will receive: 1) twelve 1-2 hour workshops focused on asset building, future planning, and protection from risks; 2) mentorship sessions to reinforce learning and build optimism; and 3) a family income-generating /micro-enterprise promotion component for children enrolled in Bridges and their families.
Other Names:
  • Child Development Account
Other: Usual Care
Participants in the usual care condition will receive usual care for AIDS-orphaned children in the study area. This includes: counseling, school lunches, and scholastic materials (textbooks and notebooks). Counseling will be provided by priests in the community (as is currently done).
Other Names:
  • Usual Services
Experimental: Bridges PLUS
Other: Usual Care
Participants in the usual care condition will receive usual care for AIDS-orphaned children in the study area. This includes: counseling, school lunches, and scholastic materials (textbooks and notebooks). Counseling will be provided by priests in the community (as is currently done).
Other Names:
  • Usual Services
Behavioral: Bridges PLUS
Each child participant in the Bridges PLUS Arm will receive the usual care in addition to a Child Development Account (CDA) to be used for secondary education by the AIDS-orphaned child. The CDA will be a matched savings account held in the child's name in a financial institution registered by the Central Bank (Bank of Uganda). The account will be matched with money from the program at a match rate of 2:1. Additionally, participants will receive: 1) twelve 1-2 hour workshops focused on asset building, future planning, and protection from risks; 2) mentorship sessions to reinforce learning and build optimism; and 3) a family income-generating /micro-enterprise promotion component for children enrolled in Bridges PLUS and their families.
Other Names:
  • Child Development Account

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Savings and Asset Accumulation
Time Frame: 12-month post-intervention follow-up assessment
Increased confidence in saving ability and stronger financial stability. Accumulation of formal and informal savings and wealth/assets (e.g. livestock, type of housing, land); and change in attitudes toward saving.
12-month post-intervention follow-up assessment
Educational Achievement
Time Frame: 12-month post-intervention follow-up assessment
School enrollment and attendance. Educational attainment, plans, and aspirations. Performance on National Primary Leaving Examinations.
12-month post-intervention follow-up assessment
Mental Health Functioning
Time Frame: 12-month post-intervention follow-up assessment
Degree of hopefulness about the future. Ability to identify specific future goals. Level of mental health functioning. Depressive symptoms.
12-month post-intervention follow-up assessment
Sexual Risk-Taking Behavior
Time Frame: 12-month post-intervention follow-up assessment
Ability to negotiate safe sex practices. Decreased intentions to engage in sexual risk behavior. Knowledge about and attitude toward HIV/AIDS and other STDs.
12-month post-intervention follow-up assessment
Savings and Asset Accumulation
Time Frame: 24-month post-intervention follow-up assessment
Increased confidence in saving ability and stronger financial stability. Accumulation of formal and informal savings and wealth/assets (e.g. livestock, type of housing, land); and change in attitudes toward saving.
24-month post-intervention follow-up assessment
Educational Achievement
Time Frame: 24-month post-intervention follow-up assessment
School enrollment and attendance. Educational attainment, plans, and aspirations. Performance on National Primary Leaving Examinations.
24-month post-intervention follow-up assessment
Mental Health Functioning
Time Frame: 24-month post-intervention follow-up assessment
Degree of hopefulness about the future. Ability to identify specific future goals. Level of mental health functioning. Depressive symptoms.
24-month post-intervention follow-up assessment
Sexual Risk-Taking Behavior
Time Frame: 24-month post-intervention follow-up assessment
Ability to negotiate safe sex practices. Decreased intentions to engage in sexual risk behavior. Knowledge about and attitude toward HIV/AIDS and other STDs.
24-month post-intervention follow-up assessment
Savings and Asset Accumulation
Time Frame: 36-month post-intervention follow-up assessment
Increased confidence in saving ability and stronger financial stability. Accumulation of formal and informal savings and wealth/assets (e.g. livestock, type of housing, land); and change in attitudes toward saving.
36-month post-intervention follow-up assessment
Educational Achievement
Time Frame: 36-month post-intervention follow-up assessment
School enrollment and attendance. Educational attainment, plans, and aspirations. Performance on National Primary Leaving Examinations.
36-month post-intervention follow-up assessment
Mental Health Functioning
Time Frame: 36-month post-intervention follow-up assessment
Degree of hopefulness about the future. Ability to identify specific future goals. Level of mental health functioning. Depressive symptoms.
36-month post-intervention follow-up assessment
Sexual Risk-Taking Behavior
Time Frame: 36-month post-intervention follow-up assessment
Ability to negotiate safe sex practices. Decreased intentions to engage in sexual risk behavior. Knowledge about and attitude toward HIV/AIDS and other STDs.
36-month post-intervention follow-up assessment
Savings and Asset Accumulation
Time Frame: 48-month post-intervention follow-up assessment
Increased confidence in saving ability and stronger financial stability. Accumulation of formal and informal savings and wealth/assets (e.g. livestock, type of housing, land); and change in attitudes toward saving.
48-month post-intervention follow-up assessment
Educational Achievement
Time Frame: 48-month post-intervention follow-up assessment
School enrollment and attendance. Educational attainment, plans, and aspirations. Performance on National Primary Leaving Examinations.
48-month post-intervention follow-up assessment
Mental Health Functioning
Time Frame: 48-month post-intervention follow-up assessment
Degree of hopefulness about the future. Ability to identify specific future goals. Level of mental health functioning. Depressive symptoms.
48-month post-intervention follow-up assessment
Sexual Risk-Taking Behavior
Time Frame: 48-month post-intervention follow-up assessment
Ability to negotiate safe sex practices. Decreased intentions to engage in sexual risk behavior. Knowledge about and attitude toward HIV/AIDS and other STDs.
48-month post-intervention follow-up assessment

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Columbia University

Collaborators

Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

February 1, 2012

Primary Completion (Actual)

January 15, 2018

Study Completion (Actual)

January 15, 2018

Study Registration Dates

First Submitted

October 4, 2011

First Submitted That Met QC Criteria

October 4, 2011

First Posted (Estimate)

October 6, 2011

Study Record Updates

Last Update Posted (Actual)

October 12, 2018

Last Update Submitted That Met QC Criteria

October 10, 2018

Last Verified

October 1, 2018

More Information

Terms related to this study

Keywords

Other Study ID Numbers

  • AAA11950
  • 1R01HD070727-01 (U.S. NIH Grant/Contract)

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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