Effects of economic empowerment and relationship strengthening intervention on financial behaviors among couples living with HIV: The Mlambe pilot trial in Malawi

IF 3.1 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Ssm-Population Health Pub Date : 2025-03-01 DOI:10.1016/j.ssmph.2025.101768

Lakshmi Gopalakrishnan , Nancy Mulauzi , James Mkandawire , Fred M. Ssewamala , Scott Tebbetts , Torsten B. Neilands , Amy A. Conroy

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引用次数: 0

Abstract

Introduction

Economic insecurity, relationship issues, and gender-based financial disparities pose significant challenges for couples living with HIV in sub-Saharan Africa, potentially undermining treatment adherence and health outcomes. We evaluated Mlambe, an integrated economic empowerment with relationship strengthening intervention for couples living with HIV.

Methods

We conducted a pilot randomized controlled trial in Zomba, Malawi with 78 married couples (156 individuals) living with HIV and reporting unhealthy alcohol use based on the AUDIT-C. Couples were recruited from HIV care clinics and randomized to either the Mlambe intervention (n = 39 couples) or enhanced usual care (EUC) control (n = 39 couples). The 10-month Mlambe intervention combined incentivized savings accounts, financial literacy education, relationship education, and couples' counseling. EUC included brief alcohol counseling. We used linear mixed-effects models to evaluate Mlambe's impact on (i) confidence to save, (ii) attitudes towards savings, (iii) equitable financial decision-making.

Results

At 10 months follow-up, participants in the Mlambe intervention showed significantly higher confidence to save compared to EUC (coefficient = 0.18, 95% CI: 0.05, 0.32, p < 0.001), with women having greater improvements than men (p < 0.001). However, these effects were not sustained at 15 months. No significant differences were observed between arms in attitudes towards savings. Participants in the intervention showed greater equitable financial decision-making at 10 months (coefficient = 0.13, 95%CI: 0.11, 0.25; p = 0.03) compared to EUC, with effects sustained at 15-months (coefficient = 0.21, 95% CI: 0.11, 0.32, p < 0.001).

Conclusion

Our findings suggest that Mlambe intervention holds promise, underscoring the benefits of an integrated economic and relationship strengthening interventions among HIV-affected couples.

Clinical trial number

NCT04906616

查看原文本刊更多论文

经济赋权和关系强化干预对艾滋病毒感染者夫妻财务行为的影响：马拉维Mlambe试点试验

经济不安全、关系问题和基于性别的经济差异对撒哈拉以南非洲地区感染艾滋病毒的夫妇构成了重大挑战，可能破坏治疗依从性和健康结果。我们对Mlambe进行了评估，这是一项针对感染艾滋病毒的夫妇的综合经济赋权和关系加强干预。方法我们在马拉维Zomba进行了一项随机对照试验，78对携带艾滋病毒的已婚夫妇（156人）根据AUDIT-C报告不健康饮酒。从艾滋病毒护理诊所招募夫妇，随机分为Mlambe干预组（n = 39对夫妇）和强化常规护理（EUC）对照组（n = 39对夫妇）。为期10个月的Mlambe干预包括激励储蓄账户、金融知识教育、关系教育和夫妻咨询。EUC包括简短的酒精咨询。我们使用线性混合效应模型来评估Mlambe对(i)储蓄信心、（ii）对储蓄的态度、（iii）公平财务决策的影响。结果在10个月的随访中，Mlambe干预组的患者比EUC组的患者有更高的信心(系数= 0.18,95% CI: 0.05, 0.32, p <；0.001)，女性比男性有更大的改善(p <；0.001)。然而，这些效果在15个月后并没有持续。不同兵种对储蓄的态度没有显著差异。干预组的参与者在10个月时表现出更公平的财务决策(系数= 0.13,95%CI: 0.11, 0.25；p = 0.03)，效果持续15个月(系数= 0.21,95% CI: 0.11, 0.32, p <；0.001)。结论：我们的研究结果表明，Mlambe干预措施是有希望的，强调了对受艾滋病毒影响的夫妇进行综合经济和关系加强干预的好处。临床试验编号：bernct04906616

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来源期刊

Ssm-Population Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-

CiteScore

6.50

自引率

2.10%

发文量

298

审稿时长

101 days

期刊介绍： SSM - Population Health. The new online only, open access, peer reviewed journal in all areas relating Social Science research to population health. SSM - Population Health shares the same Editors-in Chief and general approach to manuscripts as its sister journal, Social Science & Medicine. The journal takes a broad approach to the field especially welcoming interdisciplinary papers from across the Social Sciences and allied areas. SSM - Population Health offers an alternative outlet for work which might not be considered, or is classed as ''out of scope'' elsewhere, and prioritizes fast peer review and publication to the benefit of authors and readers. The journal welcomes all types of paper from traditional primary research articles, replication studies, short communications, methodological studies, instrument validation, opinion pieces, literature reviews, etc. SSM - Population Health also offers the opportunity to publish special issues or sections to reflect current interest and research in topical or developing areas. The journal fully supports authors wanting to present their research in an innovative fashion though the use of multimedia formats.