# Bridges2Scale: Testing implementation strategies for an intervention among young people affected by AIDS

> **NIH NIH R01** · WASHINGTON UNIVERSITY · 2024 · $633,612

## Abstract

PROJECT ABSTRACT
Sub-Saharan Africa (SSA), a region dominated by low-resource communities and relatively poor families, is
experiencing rising HIV prevalence among adolescents and youth (AY). Household economic hardships heighten
the risk for AY’s engaging in health-compromising behaviors and their poor engagement with care. This
increases their risk for contracting and transmitting HIV and non-adherence to ART treatment. Economic
empowerment (EE) interventions have demonstrated substantial promise in reducing HIV-related risk-taking
behaviors, and improving ART treatment adherence and mental health outcomes. Based on 10+ years of
research utilizing savings-led EE interventions focused on HIV prevention, care and support for AY affected by
HIV [AYaAIDS] (including AY living with HIV [AYLHIV]; and AY orphaned by AIDS [AYoAIDS] in SSA, our group
has demonstrated the effectiveness of a multi-component EE intervention, Bridges, in four NIH-funded
randomized control trials (RCT) in Uganda
(R01
HD070727, R01HD074949, R34MH081763, R01MH113486),
and one foundation-funded study in Kenya. Bridges involves: 1) financial literacy training (FLT) and mentorship;
2) family income-generating activities (IGA); and 3) incentivized savings via a matched Youth Development
Account (YDA). Bridges has demonstrated robust effects on HIV-related risk-taking behaviors, ART adherence,
mental health, psychosocial outcomes, educational achievement, family economics, and family cohesion. Yet,
scaling EE interventions has been a challenge, signaling the need to identify and test scale-up strategies and
examine determinants of implementation and sustainment. In Bridges2Scale, we will compare two multifaceted
strategies (standard vs enhanced) for scaling Bridges in a two-arm Hybrid III effectiveness-implementation
cluster RCT. The standard implementation strategy has been applied in our prior RCTs and involves educational
meetings that prepare staff to deliver Bridges with minimal disruption to site workflow. This will be compared to
an enhanced strategy that will be developed using Implementation Mapping. We will use the public school system
to recruit 1440 AYaAIDS (ages 13-17 years) from 48 schools in the Greater Masaka region of Uganda, a region
with 11.7% HIV prevalence. Schools will be the unit of randomization (n=24 schools per arm; n=720 students
per arm). Four specific aims guide our study: Aim 1. Compare the implementation effectiveness of the standard
implementation strategy vs. an enhanced implementation strategy; Aim 2. Determine the clinical effectiveness
of Bridges implemented via a standard vs. enhanced implementation strategy; Aim 3. Explore implementation
processes, mechanisms, and determinants; and Aim 4. Compare the cost and cost-effectiveness of the two
implementation strategies. The study will address a critical challenge: how to best support the implementation,
scale-up, and sustainment of EE interventions, which have been proven to be highly efficacious in...

## Key facts

- **NIH application ID:** 10912581
- **Project number:** 5R01HD112323-02
- **Recipient organization:** WASHINGTON UNIVERSITY
- **Principal Investigator:** Noeline Nakasujja
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $633,612
- **Award type:** 5
- **Project period:** 2023-08-23 → 2028-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10912581

## Citation

> US National Institutes of Health, RePORTER application 10912581, Bridges2Scale: Testing implementation strategies for an intervention among young people affected by AIDS (5R01HD112323-02). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10912581. Licensed CC0.

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