An economic and relationship-strengthening intervention for HIV-affected couples who drink alcohol in Malawi

针对马拉维受艾滋病毒影响的饮酒夫妇的经济和加强关系的干预措施

• 批准号: 10219939
• 负责人: Amy Anne Conroy
• 金额: $ 22.03万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-15 至 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10219939
• 关键词: Address; Adherence; Adolescent; Affect; Africa South of the Sahara; African; Alcohol consumption; Alcohols; Businesses; Caring; Clinic; Clinical; Communication; Comparison arm; Conflict (Psychology); Consumption; Couples; Data; Data Collection; Economic Factors; Economics; Education; Enrollment; Evidence based intervention; Family; Focus Groups; Friendships; Funding; Future; Future Generations; Goals; HIV; HIV Seropositivity; Health; Health behavior; Heavy Drinking; Heterosexuals; Household; Incentives; Income; Individual; Intervention; Interview; Investments; Malawi; Manuals; Mental Health; Methods; Morbidity - disease rate; Names; Outcome; Peer Pressure; Personal Satisfaction; Pilot Projects; Population; Poverty; Problem Solving; Procedures; Process; Protocols documentation; Randomized; Randomized Controlled Trials; Reporting; Research; Research Methodology; Resources; Savings; Social support; South Africa; Testing; Time; Training; Trees; Uganda; Violence; Woman; Work; acceptability and feasibility; alcohol intervention; antiretroviral therapy; arm; base; brief advice; clinical care; coping; design; drinking; economic need; financial literacy; improved; instrument; male; men; mortality; peer; prevent; primary outcome; recruit; reduced alcohol use; retention rate; satisfaction; scale up; skills; standard of care; therapy adherence; transmission process

Project Summary/Abstract Heavy alcohol use has deleterious effects on antiretroviral therapy (ART) adherence and HIV clinical outcomes, and indirectly affects health by damaging the couple relationships needed for social support, economic survival, and well-being. Our recent mixed-methods study with HIV-affected couples in Malawi found that 50% of alcohol drinkers met criteria for heavy alcohol use. Male peer pressure, desires for friendship, and coping with poverty were common barriers to reducing consumption. Men expressed the need for an economic or peer-based intervention to reduce alcohol use, and women were very concerned with how alcohol drains family financial resources and causes conflict in the couple. Yet, there are currently no interventions that have jointly addressed the economic and relationship context of drinking in sub-Saharan Africa. In other populations, standalone relationship-strengthening and economic-strengthening interventions have been effective at addressing alcohol use, engagement in HIV care, adherence to ART, household economics, and mental health. However, such interventions have not been designed for HIV-positive couples who use alcohol, nor have they been combined into a single intervention with potentially synergistic effects. We propose to develop and pilot test a combined economic and relationship-strengthening intervention to redirect funds spent on alcohol into financial investments (e.g., education, income-generating business) and to improve couple relationships and adherence to ART. We posit that engaging couples to work together on alcohol use and financial goals—equipped with financial, communication, and problem-solving skills—will decrease alcohol use, and improve relationship dynamics and adherence to ART. The specific aims are: (1) to adapt and integrate two proven interventions, Suubi and Uthando Lwethu, into a combined intervention for HIV-affected couples with a heavy alcohol user (to be called Malambe); (2) to develop and pilot test the study procedures to evaluate Malambe; and (3) to assess the feasibility and acceptability of Malambe through a pilot study. Using the ADAPT-ITT method, we will develop a draft of the intervention manual and conduct five focus group discussions with couples and key stakeholders to obtain input on the intervention. For the pilot study, we will enroll 80 HIV-affected couples with a heavy alcohol user and randomize the couples to either Malambe or the comparison arm (regular HIV care plus brief advice on alcohol use). We will conduct qualitative interviews with a subset of 20 couples to contextualize feasibility and acceptability data, and then will analyze the mixed- methods feasibility and acceptability data to refine intervention and procedures for a future trial. Alcohol interventions for PLHIV in limited-resource settings may register large impacts by targeting the dyadic and economic context of heavy alcohol use. Our long-term goal is to produce a culturally-grounded, sustainable, and evidence-based intervention to reduce heavy alcohol use and its harms on couple relationships, household poverty, and HIV health outcomes.

项目摘要/摘要 大量饮酒对抗逆转录病毒疗法（ART）依从性和HIV临床具有有害影响 成果，并通过损害社会支持所需的夫妇关系而间接影响健康， 经济生存和幸福。我们最近在马拉维与受艾滋病毒影响的夫妇进行的混合方法研究发现 那50％的酒精饮用者符合大​​量酒精的标准。男性同伴压力，渴望友谊，以及 应对贫困是减少消费的常见障碍。人们表示需要经济 或基于同伴的干预以减少酒精的使用，而妇女非常关心酒精的排水 家庭财政资源并引起夫妻冲突。但是，目前尚无干预措施 共同解决了撒哈拉以南非洲饮酒的经济和关系背景。在其他人群中 独立的关系加强和经济加强干预措施在 解决酒精使用，参与艾滋病毒护理，遵守艺术，家庭经济学和精神 健康。但是，这种干预措施尚未针对使用酒精的艾滋病毒阳性夫妇设计，也不是 它们是否被合并为具有潜在协同作用的单一干预措施。我们建议发展 和试点测试一项合并的经济和关系加密的干预措施，以重定向资金支出 将酒精投资于金融投资（例如，教育，创收业务）并改善夫妇 关系和遵守艺术。我们积极地吸引夫妻共同努力在酒精饮酒和 财务目标（具有财务，沟通和解决问题的技能）将降低酒精 使用并改善关系动态和遵守艺术。具体目的是：（1）适应和 将两项经过验证的干预措施（Suubi和Uthando Lwethu）整合为受艾滋病毒影响的综合干预措施 夫妻伴有重酒精使用者（称为Malambe）； （2）开发和试点测试研究程序 评估Malambe； （3）通过试点研究评估马拉姆的可行性和可接受性。使用 Adapt-Itt方法，我们将制定干预手册草案，并进行五个焦点小组 与夫妇和主要利益相关者的讨论以获取干预措施的意见。对于试点研究，我们将 将80对受艾滋病毒影响的夫妇与沉重的酒精使用者一起招募，并将夫妻随机地与Malambe或Malambe或 比较臂（常规的艾滋病毒护理以及有关饮酒的简短建议）。我们将与 20对夫妇的子集，以将可行性和可接受性数据进行环境化，然后将分析混合 方法可行性和可接受性数据来完善未来试验的干预和程序。酒精 PLHIV在有限资源设置中的干预措施可以通过针对二元组和 大量饮酒的经济背景。我们的长期目标是生产一个具有文化的，可持续的， 以及基于证据的干预措施，以减少大量饮酒及其对夫妇关系的危害， 家庭贫困和艾滋病毒健康结果。