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

项目摘要/摘要 大量饮酒会对抗逆转录病毒治疗(ART)的依从性和HIV临床产生有害影响 结果，并通过破坏社会支持所需的夫妻关系间接影响健康， 经济生存和福祉。我们最近对马拉维感染艾滋病毒的夫妇进行的混合方法研究发现 50%的饮酒者达到了重度饮酒的标准。男性同龄人的压力，对友谊的渴望，以及 应对贫困是减少消费的常见障碍。男性表示需要一种经济上的 或基于同伴的干预以减少酒精使用，女性非常关心酒精是如何排出的 家庭经济来源，并造成夫妻间的矛盾。然而，目前还没有干预措施 共同讨论了撒哈拉以南非洲饮酒的经济和关系背景。在其他种群中， 单独的加强关系和加强经济的干预措施在 解决酗酒、参与艾滋病毒护理、坚持艺术、家庭经济和精神问题 健康。然而，这样的干预措施并不是为酗酒的艾滋病毒阳性夫妇设计的，也不是为他们设计的 它们是否被合并为具有潜在协同效应的单一干预措施。我们建议开发 并试点测试经济和加强关系的综合干预措施，以将资金用于 将酒精纳入金融投资(例如，教育、创收企业)并改善夫妻关系 人际关系和对艺术的执着。我们假设在饮酒和饮酒问题上合作的夫妻 财务目标--具备财务、沟通和解决问题的能力--会减少酒精 使用，并提高关系活力和对艺术的坚守。具体目标是：(1)适应和 将两种行之有效的干预措施Suubi和Uthan do Lwethu整合为针对艾滋病毒感染者的联合干预措施 酗酒夫妇(将被称为马拉姆贝)；(2)制定和试行研究程序，以 评估马兰贝；以及(3)通过试点研究评估马兰贝的可行性和可接受性。vbl.使用 采用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进行讨论，以获得对干预措施的意见。对于试点研究，我们将 招募80对酗酒的受艾滋病毒感染的夫妇，并将这些夫妇随机分配到Malambe或 对照ARM(定期艾滋病毒护理加上关于饮酒的简短建议)。我们将对以下人员进行定性采访 由20对夫妇组成的子集将可行性和可接受性数据联系起来，然后将分析混合的- 方法可行性和可接受性数据，以完善干预措施和未来试验的程序。酒精 在资源有限的情况下对PLHIV的干预可能会产生巨大的影响，因为它针对的是二元性和 大量饮酒的经济背景。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后果。

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.