Addressing Psychosocial Well-Being through a Mobile Health Intervention: Preliminary Effects on HIV Stigma and Shame, Loneliness, and Quality of Life Among Adolescents Living with HIV In Uganda

Background: Adolescents living with HIV (ALHIV) in sub-Saharan Africa face substantial psychosocial challenges beyond biomedical HIV management, including stigma, shame, loneliness, and reduced quality of life (QoL). These challenges can affect overall well-being and engagement in care, underscoring the need for interventions that address psychosocial needs alongside HIV treatment. Social work interventions that incorporate accessible and scalable approaches are particularly important in low-resource settings. Digital health interventions offer a promising strategy to deliver psychosocial support to vulnerable youth. This study examined the preliminary effects of the Suubi-Mhealth intervention on HIV-related stigma and shame, loneliness, and QoL among ALHIV in Uganda.

Methods: A pilot cluster-randomized controlled trial was conducted among 200 adolescents aged 14–17 years recruited from 10 health clinics in southern Uganda. Participants were randomized to either the treatment or a waitlist control group (100 per arm). The intervention delivered cognitive behavioral therapy–based psychoeducational content through a mobile application over two months. Assessments were conducted at baseline, 1 month, and 2 months. Outcomes included HIV stigma, HIV shame, loneliness, and QoL. Linear mixed-effects models with random intercepts accounting for clustering at the participant and clinic levels was conducted to assess difference between groups over time.

Results: The group-by-time interaction was statistically significant for QoL (χ² = 6.11, p = 0.047) and borderline significant for HIV shame (χ² = 5.96, p = 0.051), indicating greater improvements over time in the intervention group. For HIV stigma, the interaction was not statistically significant (χ² = 3.91, p = 0.142), although declines were observed in both groups. Loneliness showed no significant time (χ² = 1.29, p = 0.526) or interaction effects (χ² = 3.23, p = 0.199). While pairwise comparisons at individual time points were not statistically significant, predicted means consistently favored the intervention group, particularly for shame and QoL.

Conclusion: The Suubi-Mhealth intervention demonstrated promising preliminary effects on HIV-related shame and quality of life among ALHIV, with more modest or non-significant effects for stigma and loneliness. Findings highlight the complexity of addressing multiple psychosocial outcomes within a short intervention period. For social work practice, results underscore the potential of digital, scalable interventions to support psychosocial well-being among adolescents living with HIV in low-resource settings. Future research should examine longer-term impacts, refine intervention components, and explore strategies to strengthen effects across multiple domains of psychosocial functioning.