It Felt Useful and Gave Me Hope”: Acceptability of a Combination Intervention Among Adolescents Orphaned By HIV In Southern Uganda.

Background: Adolescents orphaned by HIV face intersecting economic, social, and emotional vulnerabilities that threaten their educational continuity, health, and long‑term wellbeing. Combination interventions that integrate economic strengthening with psychosocial support have shown promise in sub‑Saharan Africa yet limited qualitative work has examined how such programs are experienced and understood by adolescents themselves. This study explored the acceptability of the Bridges to the Future intervention for adolescents orphaned by HIV in southern Uganda.

Methods: We conducted semi‑structured, in‑depth interviews with 35 youth who participated in the Bridges to the Future program—a combination intervention consisting of a matched Child Development Account (CDA), financial literacy and management workshops, sessions on income‑generating activities (IGAs), and structured mentorship meetings, to explore their experiences with the intervention, including motivations to participate, facilitators and barriers to attendance, and perceived benefits. Data were analyzed thematically, guided by the seven constructs of the Theoretical Framework of Acceptability (TFA), using Dedoose software.

Results: Adolescents characterized Bridges as meaningful, relevant, and feasible within their daily lives. Motivation to participate centered on the matched savings component and the opportunity to open a bank account—features that made financial accumulation feel attainable. Relational and emotional support from program staff further strengthened engagement. Facilitators of attendance included caregiver permission, school‑based reminders, proximity of sessions, and transport/time‑compensation supports, all of which reduced burden and opportunity costs. Barriers reflected structural constraints such as transportation challenges, household labor responsibilities, and absenteeism during boarding or holiday periods. Despite these challenges, adolescents reported substantial perceived benefits, including strengthened financial capability, improved confidence and future orientation, enhanced caregiver communication, and greater awareness of health‑protective behaviors.

Conclusions: Findings demonstrate high acceptability of the Bridges intervention and highlight the importance of integrated economic and psychosocial supports for adolescents orphaned by HIV. Ensuring that such programs remain contextually responsive, relationally supportive, and structurally accessible is essential for maximizing impact and guiding future adolescent‑focused interventions in resource‑limited settings.