JMIR Publications

ABSTRACT

Background:

Adolescent alcohol and drug use (ADU) is a significant public health challenge. Uganda, one of the poorest countries in sub-Saharan Africa (SSA), has the second highest rate of per capita alcohol consumption in SSA, and over one third of adolescents in Uganda have used alcohol in their lifetime and over 50% engage in heavy episodic drinking. These estimates reach even greater magnitudes in the country’s fishing villages – a key HIV vulnerable population- where ADU is normative. However, few studies have assessed ADU among adolescents and youth living with HIV (AYLHIV) despite their increased risk for ADU and its impact on engagement in HIV care. Moreover, there is a paucity of data on risk and resilience factors for ADU as only a minority of studies evaluating ADU interventions in SSA have reported positive outcomes. The majority have been implemented in school settings, which may exclude adolescents in fishing communities that have high rates of school dropout, and none has targeted risk factors such as poverty and mental health, which are rampant among AYLHIV and their families, undermine AYLHIV’s coping skills and resources, and have been associated with increased risk for ADU among adolescents.

Objective:

Given the lack of evidence-based culturally tailored interventions to prevent ADU in AYLHIV in Uganda, we propose a study among sample of 200 AYLHIV (ages 18 - 24) seen at six HIV clinics located in the fishing communities of southwestern Uganda to: 1) examine the prevalence and consequences of ADU among AYLHIV and identify the multilevel risk and resilience factors associated with ADU among AYLHIV; and 2) explore the feasibility and short-term effects of an economic empowerment intervention on ADU among AYLHIV.

Methods:

We propose a mixed-methods study comprising 4 components: (1) focus group discussions (FGDs) with AYLHIV (n=20) and in-depth qualitative interviews (QI) with health providers (n=10) from two randomly selected clinics; (2) a cross-sectional survey (CS) with 200 AYLHIV; (3) a randomized control trial (RCT) with a sub-group of AYLHIV (n=100); and (4) two post-intervention FGD with AYLHIV (n=10 per study group).

Results:

Recruitment of participants for the first qualitative phase has commenced. As of April 30, 2023 eight (n=8) health providers from 5 clinics have been recruited, provided written consent to participate, and participated in in-depth qualitative interviews. One focus group discussion was conducted with 10 AYLHIV from one clinic. We expect to complete data collection for the qualitative phase in early May and commence transcription, translation and analysis of qualitative data immediately thereafter. The cross-sectional survey will begin shortly after the qualitative phase. Data collection will occur over the next year and dissemination of the main study findings is targeted for 2024. Data collection will occur over the next year and dissemination of the main study findings is targeted for 2024.

Conclusions:

Our findings will advance our understanding of ADU among AYLHIV and inform the design of future interventions to address ADU among AYLHIV. Clinical Trial: The study was registered on ClinicalTrials.gov (NCT05597865), on October 28, 2022. https://clinicaltrials.gov/ct2/show/NCT05597865