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

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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.