Exploring the potential of a family-based prevention intervention to reduce alcohol use and violence within HIV-affected families in Rwanda.
Exploring the potential of a family-based prevention intervention to reduce alcohol use and violence within HIV-affected families in Rwanda.
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DOI：
10.1080/09540121.2016.1176686
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发表时间：
2016-03
期刊：
影响因子：
1.7
通讯作者：
Betancourt TS
中科院分区：
文献类型：
--
作者：
Chaudhury S;Brown FL;Kirk CM;Mukunzi S;Nyirandagijimana B;Mukandanga J;Ukundineza C;Godfrey K;Ng LC;Brennan RT;Betancourt TS
受艾滋病毒影响的家庭报告有害饮酒、亲密伴侣暴力和家庭冲突的比率较高，这些都可能对儿童产生有害影响。在撒哈拉以南非洲，解决这些复杂问题的循证干预措施很少。这项混合方法研究探讨了以家庭为基础的干预措施的潜力，以减少种族灭绝后卢旺达受艾滋病毒影响家庭中的IPV、家庭冲突和与饮酒有关的问题，促进儿童心理健康和家庭功能。在卢旺达，一项旨在确定和加强家庭复原力和沟通以促进儿童心理健康的以证据为基础的家庭家访已被改编和发展，以便在这方面用于受照料者艾滋病毒影响的家庭。该干预措施经过一系列试点研究阶段的调整和发展，然后在卢旺达对受照料者艾滋病毒影响的家庭进行公开和随机对照试验（rct）测试。从RCT的定量和定性数据进行了探索，这里使用混合方法的方法来整合研究结果。在干预组中，有关改善家庭功能、降低暴力和问题饮酒水平以及改善儿童心理健康的定性报告支持了照顾者中酒精使用和IPV的减少。这种混合方法分析支持以家庭为基础的干预措施的潜力，以减少不良照顾者行为，作为改善儿童福祉的主要机制。需要进一步的研究，在有充分证据的试验中检验这些机制，以扩大以家庭为基础的干预措施在低收入和中等收入国家应用的前景的证据基础。
HIV-affected families report higher rates of harmful alcohol use, intimate partner violence (IPV) and family conflict, which can have detrimental effects on children. Few evidence-based interventions exist to address these complex issues in Sub-Saharan Africa. This mixed methods study explores the potential of a family-based intervention to reduce IPV, family conflict and problems related to alcohol use to promote child mental health and family functioning within HIV-affected families in post-genocide Rwanda. A family home-visiting, evidence-based intervention designed to identify and enhance resilience and communication in families to promote mental health in children was adapted and developed for use in this context for families affected by caregiver HIV in Rwanda. The intervention was adapted and developed through a series of pilot study phases prior to being tested in open and randomized controlled trials (RCTs) in Rwanda for families affected by caregiver HIV. Quantitative and qualitative data from the RCT are explored here using a mixed methods approach to integrate findings. Reductions in alcohol use and IPV among caregivers are supported by qualitative reports of improved family functioning, lower levels of violence and problem drinking as well as improved child mental health, among the intervention group. This mixed methods analysis supports the potential of family-based interventions to reduce adverse caregiver behaviors as a major mechanism for improving child well-being. Further studies to examine these mechanisms in well-powered trials are needed to extend the evidence-base on the promise of family-based intervention for use in low- and middle-income countries.