# Bridges-Round 2: Evaluating the Long-term Impact of a Family Economic Empowerment Intervention on HIV Risk Prevention and Care Continuum Outcomes among Orphaned Youth Transitioning to Young Adulthood

> **NIH NIH R01** · WASHINGTON UNIVERSITY · 2024 · $571,053

## Abstract

PROJECT ABSTRACT
Globally, adolescents and young adults (AYA; ages 14-29) represent 30% of HIV incidence cases among
persons of reproductive age, with ~75% occurring in Sub Saharan Africa (SSA). HIV incidence rises rapidly in
SSA, as AYA leave school (often prematurely) and migrate for work and marriage. Older adolescents are more
likely to experiment with health compromising behaviors that increase their vulnerability to HIV and sexually
transmitted infections (STIs). Young people orphaned by AIDS [YPoAIDS]), 80% of which live in SSA represent
a particularly vulnerable and unique population. Most YPoAIDS in SSA experience immense hardships, including
higher rates of HIV risk behavior and odds of HIV infection. These adversities cumulatively disrupt the
developmental milestones for YPoAIDS and can compromise their health and emotional wellbeing. Notably, our
team has had great success with implementing a 6-year, three-armed RCT that tested a family-based economic
intervention, Bridges (R01HD070727), among 1,383 primary school going adolescents in rural Uganda (10-14
years of age at enrollment) who lost one or both parents to AIDS. With over 90% retention rate over a 6-year
period (2012-2018), our findings show efficacy of this contextually-driven intervention significantly improving
sexual health, school retention and performance, and mental health. Yet, two critical policy and programming
questions related to HIV prevention and engagement in care continuum remain unaddressed: 1) longer-term
effectiveness of Bridges across YPoAIDS’s life course is currently unknown but critically important because of
unique vulnerabilities during the transition into young adulthood; and 2) self-reports of sexual health are
unreliable, hence the need to integrate biomarkers to provide the most precise results of these highly relevant
(but currently unknown) sexual health outcomes among our participants. Thus, the specific aims of the Bridges-
Round 2 study are: Aim 1. Examine the long-term impact of Bridges on: HIV prevalence (measured via
participant’s HIV status) (Primary outcome); and b) Explore in secondary analyses the long-term impact of
Bridges on key developmental and behavioral outcomes (e.g., mental health, alcohol and drug misuse); Aim 2.
Elucidate the long-term effects of Bridges on potential mechanisms of change, including: a) economic stability,
viral suppression (for ALHIV); PrEP use (for HIV negative adolescents), medical male circumcision (for boys);
and b) young adult transitions; Aim 3: Qualitatively investigate participants’ experiences with Bridges that may
have influenced engagement with the program, sexual risk-taking decisions, financial behaviors; experiences
with developmental transitions; and perceptions on program sustainability; Aim 4: To assess the long-term costs
and benefits of Bridges using formal economic evaluation. Our long-term goal is to translate knowledge into
sustainable, theoretically-guided prevention and treatment effort...

## Key facts

- **NIH application ID:** 10786083
- **Project number:** 5R01MH128232-03
- **Recipient organization:** WASHINGTON UNIVERSITY
- **Principal Investigator:** Proscovia Nabunya
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $571,053
- **Award type:** 5
- **Project period:** 2022-03-17 → 2026-02-28

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10786083

## Citation

> US National Institutes of Health, RePORTER application 10786083, Bridges-Round 2: Evaluating the Long-term Impact of a Family Economic Empowerment Intervention on HIV Risk Prevention and Care Continuum Outcomes among Orphaned Youth Transitioning to Young Adulthood (5R01MH128232-03). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10786083. Licensed CC0.

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