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

项目总结/摘要 大量饮酒对抗逆转录病毒治疗（ART）依从性和HIV临床 结果，并通过破坏社会支持所需的夫妻关系间接影响健康， 经济生存和幸福。我们最近对马拉维受艾滋病毒影响的夫妇进行的混合方法研究发现， 50%的饮酒者符合重度饮酒的标准。男性同伴的压力，对友谊的渴望， 应对贫困是减少消费的常见障碍。男人们表示需要一个经济 或者同伴干预来减少酒精的使用，女性非常关心酒精是如何流失的， 家庭经济来源和夫妻矛盾的原因。然而，目前没有干预措施， 联合讨论了撒哈拉以南非洲饮酒的经济和关系背景。在其他人群中， 独立的加强关系和加强经济的干预措施一直有效， 解决酗酒、参与艾滋病毒护理、坚持抗逆转录病毒治疗、家庭经济和心理健康问题。 健康然而，这种干预措施并不是为使用酒精的艾滋病毒阳性夫妇设计的， 它们是否被合并为具有潜在协同效应的单一干预措施。我们建议发展 并试点测试经济和关系强化相结合的干预措施，以重新引导用于 酒精进入金融投资（例如，教育、创收企业）和改善夫妇 关系和坚持艺术。我们认为，从事夫妇一起工作，对酒精的使用， 财务目标-配备财务，沟通和解决问题的技能-将减少酒精 使用，并改善关系的动态和坚持艺术。具体目标是：（1）适应和 将Suubi和Uthando Lwethu这两项已被证明有效的干预措施纳入受艾滋病毒影响的 重度酒精使用者（称为Malambe）的夫妇;（2）制定和试点测试研究程序， 评价Malambe;（3）通过试点研究评估Malambe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 与夫妇和主要利益攸关方进行讨论，以获得有关干预措施的投入。在试点研究中，我们将 招募了80对受艾滋病毒影响的夫妇，他们都有严重的酒精使用者，并将这些夫妇随机分配到Malambe或 对照组（常规艾滋病毒护理加上关于饮酒的简短建议）。我们将进行定性访谈， 一个20对夫妇的子集，以上下文的可行性和可接受性数据，然后将分析混合- 方法的可行性和可接受性数据，以完善干预和程序，为未来的试验。醇 在资源有限的情况下，对艾滋病毒感染者的干预措施可能会产生很大的影响， 严重酗酒的经济背景。我们的长期目标是创造一个有文化基础的，可持续的， 和循证干预，以减少酗酒及其对夫妻关系的危害， 家庭贫困和艾滋病毒健康成果。

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.