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

IF 3.6 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

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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.