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

行政副刊项目摘要/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。然而，目前还没有任何干预措施共同解决 撒哈拉以南非洲地区饮酒的经济和关系背景。Mlambe研究的总体目标是 (R34-AA027983)是开发和试点加强经济和加强关系的综合干预措施 将用于饮酒的资金重新用于金融投资(例如，教育、创收企业)和 以改善夫妻关系和对艺术的坚持。具体目标是：(1)适应和整合两个 经证实的干预措施，Suubi和Uthan do Lwethu，对患有艾滋病的艾滋病毒感染夫妇进行联合干预 重酒使用者(Mlambe)；(2)开发和试行评估Mlambe的研究程序；以及(3) 评估Mlambe的可行性和可接受性。我们已经完成了干预开发阶段 (目标1)，并已招募夫妇参加目前正在进行的试点试验(目标2)。剩余活动 包括完成所有干预会议，进行为期10个月和15个月随访，进行 对20对夫妇进行离职面谈，评估可行性和可接受性。我们要求 在我们财政困难的情况下，为实现项目的原定目标提供补充资金 由于新冠肺炎大流行而经历的情况，以及马拉维因以下原因导致的费用意外增加 通货膨胀。没有提出新的活动建议。具体而言，资金将用于支付马拉维工作人员的工资。 通过适当的生活费调整，使我们能够完成干预会议和后续行动 来访。我们还寻求资金来支付马拉维燃料和运输费用的上涨，这对我们的 团队前往临床地点和农村地区跟踪参与者，并为以下项目支付交通费 参加者参加考察访问。最后，补充资金也将用于支持Mlambe项目 协调员、首席调查员和一名数据分析员，以有效完成剩余的研究活动 我们最初的提议。到目前为止，我们已经非常成功地登记了样本，保持了很高的水平 参与率和保留率，以及夫妇对干预课程的高度满意度。 因此，到目前为止，姆兰贝干预措施表现出了巨大的希望，因为它是可行和可接受的， 减少大量饮酒、家庭贫困和生活中不坚持艺术的夫妇的潜力 马拉维的艾滋病毒携带者。行政资金将使我们能够通过留住工作人员来保持最高水平的严谨 他们与夫妇建立了融洽的关系，并精通Mlambe干预，并允许我们完成 对夫妇进行跟踪访问，以建立更长期的学习保留。这将是R01成功的关键 申请进行Mlambe的全面疗效试验，并满足我们实施高效... 在撒哈拉以南非洲解决酒精使用和艾滋病毒治疗结果的可持续干预措施的影响。

Administrative Supplement 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. Yet, there are currently no interventions that have jointly addressed the economic and relationship context of drinking in sub-Saharan Africa. The overall goal of the Mlambe study (R34-AA027983) is 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. 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 (Mlambe); (2) to develop and pilot test the study procedures to evaluate Mlambe; and (3) to assess the feasibility and acceptability of Mlambe. We have completed the intervention development phase (aim 1) and have enrolled couples for the pilot trial (aim 2), which is currently underway. Remaining activities include completing all intervention sessions, conducting 10-month and 15-month follow-up visits, conducting exit interviews with a subset of 20 couples, and evaluating feasibility and acceptability. We are requesting supplemental funding to carry out the original goals of the project given the financial hardships we have experienced as a result of the COVID-19 pandemic and unanticipated increases in expenses in Malawi due to inflation. No new activities are proposed. Specifically, funds will be used to provide salaries for staff in Malawi with appropriate cost-of-living adjustments, allowing us to complete the intervention sessions and follow-up visits. We also seek funds to cover the rise in fuel and transport expenses in Malawi, which is essential for our team to travel to clinical sites and rural areas to track participants, and for transport reimbursements for participants to attend study visits. Finally, supplemental funds will also be used to support the Mlambe project coordinator, principal investigator, and a data analyst to effectively complete the remaining research activities of our original proposal. We have been very successful thus far with enrolling the sample, maintaining high participation rates and retention rates, and couples have reported high satisfaction with intervention sessions. Thus, the Mlambe intervention has shown great promise thus far as being feasible and acceptable, with the potential to reduce heavy alcohol use, household poverty, and non-adherence to ART among couples living with HIV in Malawi. The administrative funds will allow us to maintain the highest level of rigor by retaining staff who have built rapport with couples and are proficient in the Mlambe intervention, and allow us to complete follow-up visits with couples to establish longer-term study retention. This will be critical for a successful R01 application to conduct a full-scale efficacy trial of Mlambe and meet our long-term goal of implementing a high- impact, sustainable intervention to address alcohol use and HIV treatment outcomes in sub-Saharan Africa.