{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T23:20:22Z","timestamp":1780701622154,"version":"3.54.1"},"reference-count":36,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2023,11,1]],"date-time":"2023-11-01T00:00:00Z","timestamp":1698796800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100000025","name":"National Institute of Mental Health","doi-asserted-by":"publisher","award":["R21MH121141"],"award-info":[{"award-number":["R21MH121141"]}],"id":[{"id":"10.13039\/100000025","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,11,16]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>We examine the preliminary impact of group-cognitive behavioral therapy (G-CBT) versus a family-strengthening intervention delivered via multiple family group (MFG) in improving ART adherence among adolescents living with HIV (ALHIV) in Uganda.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We analyzed data from a pilot cluster-randomized trial (2020\u20132022) conducted in 9 clinics in Uganda among 89 participants, who were eligible out of the 147 ALHIV screened. Participants were eligible if they were aged 10\u201314\u2009years, HIV positive, taking ART, and living with a family. Adolescents were randomized, at the clinic level, to receive the usual care (n\u2009=\u200929), MFG (n\u2009=\u200934), or G-CBT (n\u2009=\u200926). The interventions were delivered over 3 months. Overall, the mean percentage attendance for the 10 G-CBT and MFG sessions was 87.7% and 90.2%, respectively. Three ALHIV were lost to follow-up, while 1 child died. Adherence was assessed using pharmacy records collected at baseline and 4 additional pharmacy visits. We used mixed-effects logistic regression analysis to examine the effect of the interventions on ART adherence.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>We found statistically significant main effects for the intervention, \u03c72(2) = 7.76, p\u2009=\u2009.021, time, \u03c72(2) = 39.67, p\u2009&amp;lt;\u2009.001, and intervention\u2013time interaction effect \u03c72(6)= 27.65, p\u2009&amp;lt;\u2009.001. Pairwise comparisons showed increasing adherence in the MFG group compared to usual care at visit 3 (odds ratio [OR]\u2009=\u20094.52 [1.01\u201320.11], p\u2009=\u2009.047) and visit 5 (OR\u2009=\u20093.56 [1.42\u20138.91], p\u2009=\u2009.007). Also, compared to usual care, participants who received G-CBT showed higher adherence at visit 4 (OR\u2009=\u20092.69 [1.32\u20135.50], p\u2009=\u2009.007).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Our study showed preliminary evidence that G-CBT and MFG might have contributed to improved ART adherence among ALHIV. Moreover, G-CBT is a low-cost alternative to expensive individual therapy, especially in low-resource settings. The results warrant the need for more extensive studies to better understand the role of these interventions in the routine care of ALHIV. The trial is registered at ClinicalTrials.Gov (#NCT04528732).<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jpepsy\/jsad081","type":"journal-article","created":{"date-parts":[[2023,11,8]],"date-time":"2023-11-08T01:45:40Z","timestamp":1699407940000},"page":"907-913","source":"Crossref","is-referenced-by-count":7,"title":["Enhancing Adherence to Antiretroviral Therapy Among Adolescents Living With HIV Through Group-Based Therapeutic Approaches in Uganda: Findings From a Pilot Cluster-Randomized Controlled Trial"],"prefix":"10.1093","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2413-0398","authenticated-orcid":false,"given":"Samuel","family":"Kizito","sequence":"first","affiliation":[{"name":"International Center for Child Health and Development, Brown School, Washington University in St. Louis , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9088-5839","authenticated-orcid":false,"given":"Proscovia","family":"Nabunya","sequence":"additional","affiliation":[{"name":"International Center for Child Health and Development, Brown School, Washington University in St. Louis , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4849-5650","authenticated-orcid":false,"given":"Fred M","family":"Ssewamala","sequence":"additional","affiliation":[{"name":"International Center for Child Health and Development, Brown School, Washington University in St. Louis , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,11,3]]},"reference":[{"issue":"4","key":"2023111618002772500_jsad081-B1","doi-asserted-by":"crossref","first-page":"321","DOI":"10.2989\/16085906.2017.1380677","article-title":"A qualitative analysis of the barriers to antiretroviral therapy initiation among children 2 to 18 months of age in Swaziland","volume":"16","author":"Ahmed","year":"2017","journal-title":"African Journal of AIDS Research: AJAR"},{"issue":"7","key":"2023111618002772500_jsad081-B2","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1089\/apc.2020.0031","article-title":"Health care-specific enacted HIV-related stigma's association with antiretroviral therapy adherence and viral suppression among people living with HIV in Florida","volume":"34","author":"Algarin","year":"2020","journal-title":"AIDS Patient Care and STDs"},{"issue":"2","key":"2023111618002772500_jsad081-B3","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1037\/0022-006X.61.2.194","article-title":"Cognitive therapy: Past, present, and future","volume":"61","author":"Beck","year":"1993","journal-title":"Journal of Consulting and Clinical Psychology"},{"key":"2023111618002772500_jsad081-B4","volume-title":"Georgetown family symposia (Volume II (1973\u20131974))","author":"Bowen","year":"1977"},{"issue":"1","key":"2023111618002772500_jsad081-B5","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1007\/s10461-019-02644-z","article-title":"Anticipated HIV-related stigma and HIV treatment adherence: The indirect effect of medication concerns","volume":"24","author":"Camacho","year":"2020","journal-title":"AIDS and Behavior"},{"issue":"8","key":"2023111618002772500_jsad081-B6","doi-asserted-by":"crossref","first-page":"e25921","DOI":"10.1002\/jia2.25921","article-title":"Health-related needs reported by adolescents living with HIV and receiving antiretroviral therapy in sub-Saharan Africa: A systematic literature review","volume":"25","author":"Chem","year":"2022","journal-title":"Journal of the International AIDS Society"},{"issue":"2","key":"2023111618002772500_jsad081-B7","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1080\/17450128.2019.1576960","article-title":"Examining the relationship of social support and family cohesion on ART adherence among HIV-positive adolescents in southern Uganda: Baseline findings","volume":"14","author":"Damulira","year":"2019","journal-title":"Vulnerable Children and Youth Studies"},{"issue":"1","key":"2023111618002772500_jsad081-B8","doi-asserted-by":"crossref","first-page":"1358","DOI":"10.1186\/s12889-020-09380-3","article-title":"A group-based mental health intervention for young people living with HIV in Tanzania: Results of a pilot individually randomized group treatment trial","volume":"20","author":"Dow","year":"2020","journal-title":"BMC Public Health"},{"issue":"6","key":"2023111618002772500_jsad081-B9","doi-asserted-by":"crossref","first-page":"1160","DOI":"10.1007\/s10461-009-9593-3","article-title":"From conceptualizing to measuring HIV stigma: A review of HIV stigma mechanism measures","volume":"13","author":"Earnshaw","year":"2009","journal-title":"AIDS and Behavior"},{"key":"2023111618002772500_jsad081-B10","doi-asserted-by":"crossref","first-page":"80","DOI":"10.11604\/pamj.2017.27.80.8544","article-title":"HIV-infected adolescents have low adherence to antiretroviral therapy: A cross-sectional study in Addis Ababa, Ethiopia","volume":"27","author":"Firdu","year":"2017","journal-title":"The Pan African Medical Journal"},{"issue":"9","key":"2023111618002772500_jsad081-B11","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3310\/hta25090","article-title":"The evidence for cognitive behavioural therapy in any condition, population or context: a meta-review of systematic reviews and panoramic meta-analysis","volume":"25","author":"Fordham","year":"2021","journal-title":"Health Technology Assessment (Winchester, England)"},{"issue":"10","key":"2023111618002772500_jsad081-B12","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1037\/hea0000946","article-title":"Pilot trials in health-related behavioral intervention research: problems, solutions, and recommendations","volume":"39","author":"Freedland","year":"2020","journal-title":"Health Psychology: Official Journal of the Division of Health Psychology, American Psychological Association"},{"issue":"8","key":"2023111618002772500_jsad081-B13","doi-asserted-by":"crossref","first-page":"e0272405","DOI":"10.1371\/journal.pone.0272405","article-title":"Achieving the 95 95 95 targets for all: a pathway to ending AIDS","volume":"17","author":"Frescura","year":"2022","journal-title":"PLoS One"},{"key":"2023111618002772500_jsad081-B14","author":"Kabajaasi","year":"2015"},{"issue":"1","key":"2023111618002772500_jsad081-B15","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1186\/s13643-019-0980-1","article-title":"Challenges and support for quality of life of youths living with HIV\/AIDS in schools and larger community in East Africa: A systematic review","volume":"8","author":"Kimera","year":"2019","journal-title":"Systematic Reviews"},{"issue":"1","key":"2023111618002772500_jsad081-B16","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1186\/s12874-016-0281-5","article-title":"Outcome-sensitive multiple imputation: A simulation study","volume":"17","author":"Kontopantelis","year":"2017","journal-title":"BMC Medical Research Methodology"},{"key":"2023111618002772500_jsad081-B17","doi-asserted-by":"crossref","first-page":"9623159","DOI":"10.1155\/2019\/9623159","article-title":"Perceived stigma and fear of unintended disclosure are barriers in medication adherence in adolescents with perinatal HIV in Botswana: A qualitative study","volume":"2019","author":"Madiba","year":"2019","journal-title":"BioMed Research International"},{"issue":"4","key":"2023111618002772500_jsad081-B18","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1300\/J009v18n04_04","article-title":"Multiple family therapy groups: a responsive intervention model for inner city families","volume":"18","author":"McKay","year":"1995","journal-title":"Social Work with Groups"},{"issue":"1","key":"2023111618002772500_jsad081-B19","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1037\/met0000182","article-title":"Fixed effects models versus mixed effects models for clustered data: reviewing the approaches, disentangling the differences, and making recommendations","volume":"24","author":"McNeish","year":"2019","journal-title":"Psychological Methods"},{"issue":"7","key":"2023111618002772500_jsad081-B20","doi-asserted-by":"crossref","first-page":"e0236801","DOI":"10.1371\/journal.pone.0236801","article-title":"Longitudinal evaluation of adherence, retention, and transition patterns of adolescents living with HIV in Nigeria","volume":"15","author":"Meloni","year":"2020","journal-title":"PloS One"},{"key":"2023111618002772500_jsad081-B21","author":"Ministry of Health","year":"2020"},{"issue":"1","key":"2023111618002772500_jsad081-B22","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1186\/s12889-020-8361-1","article-title":"The role of family factors in antiretroviral therapy (ART) adherence self-efficacy among HIV-infected adolescents in southern Uganda","volume":"20","author":"Nabunya","year":"2020","journal-title":"BMC Public Health"},{"issue":"1","key":"2023111618002772500_jsad081-B23","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1186\/s40814-022-01055-7","article-title":"Suubi4Stigma study protocol: A pilot cluster randomized controlled trial to address HIV-associated stigma among adolescents living with HIV in Uganda","volume":"8","author":"Nabunya","year":"2022","journal-title":"Pilot and Feasibility Studies"},{"issue":"1","key":"2023111618002772500_jsad081-B24","doi-asserted-by":"crossref","first-page":"1048","DOI":"10.1186\/s12889-018-5964-x","article-title":"Low HIV viral suppression rates following the intensive adherence counseling (IAC) program for children and adolescents with viral failure in public health facilities in Uganda","volume":"18","author":"Nasuuna","year":"2018","journal-title":"BMC Public Health"},{"issue":"3","key":"2023111618002772500_jsad081-B25","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1080\/17450128.2012.748949","article-title":"HIV+ and HIV\u2013youth living in group homes in South Africa need more psychosocial support","volume":"8","author":"Nestadt","year":"2013","journal-title":"Vulnerable Children and Youth Studies"},{"issue":"1","key":"2023111618002772500_jsad081-B26","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1186\/s12981-017-0138-y","article-title":"Comparison of six methods to estimate adherence in an ART-na\u00efve cohort in a resource-poor setting: which best predicts virological and resistance outcomes?","volume":"14","author":"Orrell","year":"2017","journal-title":"AIDS Research and Therapy"},{"issue":"10036","key":"2023111618002772500_jsad081-B27","doi-asserted-by":"crossref","first-page":"2423","DOI":"10.1016\/S0140-6736(16)00579-1","article-title":"Our future: a Lancet commission on adolescent health and wellbeing","volume":"387","author":"Patton","year":"2016","journal-title":"Lancet (London, England)"},{"issue":"4","key":"2023111618002772500_jsad081-B28","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1177\/10634266050130040201","article-title":"Support, empowerment, and education: A study of multiple family group psychoeducation","volume":"13","author":"Ruffolo","year":"2005","journal-title":"Journal of Emotional and Behavioral Disorders"},{"issue":"4","key":"2023111618002772500_jsad081-B29","doi-asserted-by":"crossref","first-page":"1928","DOI":"10.1111\/famp.12525","article-title":"From \"4Rs and 2Ss\" to \"Amaka Amasanyufu\" (Happy Families): Adapting a U.S.-based Evidence-Based Intervention to the Uganda Context","volume":"59","author":"Sensoy Bahar","year":"2020","journal-title":"Family Process"},{"issue":"2","key":"2023111618002772500_jsad081-B30","first-page":"93","article-title":"Adherence to HIV Care and Associated Health Functioning among Youth Living with HIV in Sub-Saharan Africa","volume":"22","author":"Tarantino","year":"2020","journal-title":"AIDS Reviews"},{"key":"2023111618002772500_jsad081-B31","author":"UAC, Uganda Aids Commission","year":"2021"},{"key":"2023111618002772500_jsad081-B32","author":"Uganda Ministry of Health","year":"2020"},{"key":"2023111618002772500_jsad081-B33","author":"UNAIDS","year":"2014"},{"key":"2023111618002772500_jsad081-B34","author":"UNAIDS","year":"2022"},{"key":"2023111618002772500_jsad081-B35","author":"UNAIDS","year":"2023"},{"key":"2023111618002772500_jsad081-B36","volume-title":"The theory and practice of group psychotherapy","author":"Yalom","year":"2020"}],"container-title":["Journal of Pediatric Psychology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jpepsy\/article-pdf\/48\/11\/907\/53473726\/jsad081.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jpepsy\/article-pdf\/48\/11\/907\/53473726\/jsad081.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,16]],"date-time":"2023-11-16T18:01:01Z","timestamp":1700157661000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jpepsy\/article\/48\/11\/907\/7342467"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,1]]},"references-count":36,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2023,11,3]]},"published-print":{"date-parts":[[2023,11,16]]}},"URL":"https:\/\/doi.org\/10.1093\/jpepsy\/jsad081","relation":{},"ISSN":["0146-8693","1465-735X"],"issn-type":[{"value":"0146-8693","type":"print"},{"value":"1465-735X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,11,1]]},"published":{"date-parts":[[2023,11,1]]}}}