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We examined the impact of a family-based economic strengthening intervention on school dropout and repeating a class among ALWHIV in Uganda. In this cluster-randomized trial (2012–2018) conducted in 39 clinics, we recruited adolescents aged 10–16 years living with HIV. We included data from 613 adolescents. We plotted a Kaplan Meier survival curve and fitted Cox proportional hazards models to test the effect of the economic strengthening intervention on school dropout. The incidence of school dropout was 13.0% and 9.6% in the control and intervention groups, respectively. Also, economic empowerment reduced the risk of school dropout, aHR = 0.68 (95% CI 0.52–0.88), p-value 0.004. In other words, participants in the intervention group had 32% reduced hazards of dropping out of school. Also, increasing age aHR = 1.54 (95% CI 1.42–1.66), p-value < 0.001 and double orphanhood aHR = 0.67 (95% CI 0.47–0.96) p-value 0.030 increased the risks for dropping out of school. The intervention was not efficacious in reducing the rates of repeating a class. The intervention offered the ALWHIV an opportunity to live a productive adult life. More research is required on these kinds of interventions intended to keep ALWHIV and those impacted by HIV in school.

INTRODUCTION: This exploratory study sought to examine the extent to which family-level factors are associated with disruptive behavioral disorder (DBD) symptoms, including oppositional defiant disorder (ODD) and conduct disorder (CD) among school children in Uganda, a low-resource country in SSA. The examination of key influences within the SSA context is important to guide needed investments in mental health care and family-level support. Importantly, identifying families at higher risk can inform the development of contextualized family interventions that reinforce positive parenting practices. METHOD: We analyzed baseline data (N = 2110) from the NIH-funded Strengthening Mental health And Research Training in Africa (SMART Africa) scale-up study in Southwestern Uganda. Children aged 8–13 and their caregivers were recruited from 30 public primary schools. DBDs were examined using the DBD rating scale, Iowa Conners, and Impairment scales. Logistic regression analysis using cluster adjusted robust standard errors to adjust for within-school clustering was conducted to assess the association between DBD symptoms and family-level factors, including parenting practices, marital status, and family size. RESULTS: Results indicate that poor parental supervision (OR = 1.17; CI: 1.13, 1.21; P

In Uganda, one in five children presents mental health challenges, including disruptive behavior disorders (DBDs). DBDs can persist through adulthood and result in negative outcomes. Effective interventions for DBDs have been developed and tested in high-poverty communities in developed countries. Yet, most African countries, such as Uganda, lack such interventions. This paper describes the adaptation process of an evidence-based intervention of U.S. origin to optimize fit to context with intervention fidelity, as part of a randomized trial conducted with youth that exhibit behavioral challenges and their caregivers in 30 schools in Uganda. The process involved: initial meetings with headteachers and teachers to introduce the study and the main concepts of the intervention; initial manual review focusing on 4Rs and 2Ss content by the Uganda team; engagement of community stakeholders for additional feedback on content and cultural relevance; final revision of the manual; and collection of children's drawings for the illustration of the manual. This paper describes both similarities and differences between the original and adapted intervention content and methods of delivery. The findings also highlight the importance of involving community stakeholders in the adaptation process.En Uganda, uno de cada cinco niños presenta problemas de salud mental, incluidos los trastornos del comportamiento disruptivo (TCD). Los TCD pueden continuar hasta la adultez y tener consecuencias negativas. Se han desarrollado intervenciones eficaces para los TCD, las cuales se han evaluado en comunidades con altos índices de pobreza en países desarrollados. Sin embargo, la mayoría de los países africanos, como Uganda, carecen de dichas intervenciones. Este artículo describe el proceso de adaptación de una intervención factual de origen estadounidense para optimizar su adaptación al contexto con la fidelidad de la intervención como parte de un ensayo aleatorizado realizado con jóvenes que presentan problemas conductuales y sus cuidadores en 30 escuelas de Uganda. El proceso consistió en reuniones iniciales con directores y maestros para presentar el estudio y los conceptos principales de la intervención; una revisión inicial del manual centrada en el contenido de la intervención “4Rs and 2 Ss” por parte del equipo de Uganda; la participación de partes interesadas de la comunidad para obtener comentarios adicionales sobre el contenido y la relevancia cultural; la revisión final del manual; y la recopilación de dibujos de los niños para la ilustración del manual. Este artículo describe tanto las similitudes como las diferencias entre el contenido de la intervención original y la adaptada y los métodos de implementación. Los resultados también destacan la importancia de hacer participar a las partes interesadas en el proceso de adaptación.在乌干达，每五个儿童中就有一个孩子存在这样或那样的心理健康问题，其中包括破坏性行为障碍(DBDs )。 DBDs 可以持续到成年期，带来诸多不良后果。在发达国家的高度贫困社区，针对DBDs的有效干预措施已经得到开发和测试。但是在乌干达这样的大多数非洲国家，相关的干预措施仍属罕见。该论文描述了一项源自美国的循证干预措施在乌干达的国情下如何尽可能优化并保持原有效度的调适过程。作为一项随机测试的部分内容，本文调查研究了乌干达的30所学校中表现出行为问题的青少年及其他们的照顾者。研究过程涉及以下方面：初期组织校长和老师参加集会，介绍本研究的内容和干预措施的主要概念；在起始阶段组织乌干达团队对4Rs和2Ss相关内容进行了整体学习；邀请社区利益相关者积极参与并针对干预措施的内容和文化相关性提供更多的反馈；指导手册的最终修订版；收集儿童的绘画作品，以供编辑手册时使用。本文描述了原有干预措施和调整后的干预方案在内容方面以及实施方法上的异同。研究结果还强调了让社区利益相关者参与调适修改过程的重要性。.

Several studies in sub-Saharan Africa have linked social support to better ART (antiretroviral therapy) adherence among adults living with HIV. Less is known about the role of social support and family cohesion in ART adherence among children below 18 years. This paper focuses on HIV-infected adolescents as they transition through the vulnerable developmental stage of adolescence to examine the association between family cohesion and social support, and ART adherence in southern Uganda. We utilized baseline data from Suubi+Adherence study, a five-year randomized longitudinal clinical trial with the overall goal of examining the impact and cost associated with an innovative asset-based social intervention to increase adherence to HIV treatment for HIV-infected adolescents in Uganda. This study employed self-reports to measure social support, family cohesion and ART adherence to treatment from 702 participants in 39 clinics situated in southern Uganda. Regression results indicated that after adjusting for sociodemographic characteristics that family cohesion and social support from caregivers/family were associated with self-reported adherence to ART among HIV-infected adolescents. Social support from classmates, teachers, and friends were not associated with ART adherence. Study results suggest that strengthening family relationships and promoting social support within families caring for adolescents living with HIV can be crucial in addressing ART adherence challenges among adolescents in sub-Saharan Africa.

The African region remains the world's most affected region in the HIV epidemic. A related consequence of HIV/AIDS in sub-Saharan Africa (SSA), including in Uganda, is the high prevalence of children and adolescents who have lost one or both parents to this virus or who have been perinatally infected. Guided by the Practical, Robust Implementation and Sustainability (PRISM) framework, this paper describes the strategies by which we have engaged community and government partners in research using three NIH-funded randomized clinical trials testing an evidence-based combination intervention aimed at improving health and mental health outcomes among children and adolescents impacted by HIV/AIDS in Uganda. We specifically lay out four strategies that have been used to facilitate stakeholder engagement, namely consultative meetings, stakeholder accountability meetings, training of key players (task-shifting), and policymaker engagement. We emphasize that community collaborations and partnerships are especially critical when implementing combination interventions that require a high level of communication and coordination among multiple implementation partners. We underline that building and sustaining long-term relationships and communication with the stakeholders can allow the researchers to successfully design rigorous studies that are responsive to local needs and can make a difference especially in low-resource settings. Finally, we highlight that the process of engagement and collaboration can be guided by conceptual frameworks.