Feasibility and acceptability of an integrated economic empowerment and substance use risk reduction intervention for youth living with HIV in Uganda: a pilot cluster randomized study

Youth living with HIV (YLHIV) in sub-Saharan Africa experience high rates of alcohol and drug use (ADU), yet evidence-based interventions remain limited. We conducted a pilot cluster randomized trial to assess the feasibility, acceptability, and short-term outcomes of a life-skills-based Alcohol and Drug Use Risk Reduction intervention (ADURR), delivered alone or combined with economic empowerment (EE) through financial literacy training and matched savings accounts. Ninety-five YLHIV aged 18 to 24 years were enrolled from six clinics in southwestern Uganda and followed at baseline, 3 months, and 6 months using surveys and urine toxicology. Participants had a mean age of 21.9 years, and 65.3% were female. Retention at 6 months was 94.7%. Compared with ADURR-only, the ADURR+EE intervention was associated with larger declines in self-reported past-6-month drug use (-20.1 vs -5.8 percentage points), alcohol use (-17.9 vs -6.5 percentage points). Urine-confirmed drug use decreased in both arms (-30.4 vs -26.7 percentage points), while urine-confirmed alcohol use declined only in ADURR+EE (-33.1 percentage points). Psychosocial changes were modest; hopelessness decreased in ADURR+EE (-6.4%) but increased in ADURR-only (+13.0%). Qualitative findings indicated high acceptability, though savings uptake faced structural barriers. Findings support progression to a fully powered trial.