Mlambe 针对饮酒的经济和关系强化干预措施可减少马拉维感染艾滋病毒夫妇的暴力行为并改善关系质量

IF 4.9 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine Pub Date : 2024-10-09 DOI:10.1016/j.socscimed.2024.117407

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引用次数: 0

摘要

导言：在撒哈拉以南非洲地区，不健康饮酒、亲密伴侣暴力（IPV）和经济不安全的综合症有可能破坏联合国艾滋病规划署 95-95-95 目标的实现。我们开发了一种名为 "Mlambe "的经济和关系强化综合干预措施，以减少不健康饮酒，提高马拉维夫妇对抗逆转录病毒疗法的依从性。本研究评估了 Mlambe 对 IPV 和关系动态的额外影响。方法在一项试点随机对照试验中，从马拉维松巴市的 HIV 护理诊所招募了 78 对感染 HIV 并根据 AUDIT-C 报告不健康饮酒（至少一方）的已婚夫妇（156 人）。干预组（39 对夫妇）接受了一项为期 10 个月的计划，包括带有金融知识教育的激励性储蓄账户、关系教育以及旨在培养夫妻关系技巧的夫妻咨询课程。对照组（39 对夫妇）接受增强型常规护理（EUC）和简短的酒精咨询。我们使用线性混合效应模型来评估 Mlambe 对夫妻关系质量的影响（例如，建设性沟通、团结、性生活）、结果在 10 个月和 15 个月的随访中，与 EUC 相比，接受 Mlambe 治疗的夫妇在夫妻沟通、团结、性满意度、亲密感和信任度方面有更大的提高（Cohen's d 从 0.36 到 0.56 不等；p<0.05）。与 EUC 相比，Mlambe 治疗组的夫妇在身体和情感 IPV 方面也有显著下降（Cohen's d 为 0.33 至 0.49；p<0.05）。随后的调节分析表明，除性满意度（p<0.05）外，女性报告的夫妻关系质量改善幅度明显高于男性（p<0.05），而身体上的 IPV 下降幅度也高于男性（p<0.05）。经济和关系强化干预措施有可能打破感染艾滋病病毒的夫妇中暴力、药物使用和贫困等有害综合症。

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Mlambe economic and relationship-strengthening intervention for alcohol use decreases violence and improves relationship quality in couples living with HIV in Malawi

Introduction

A syndemic of unhealthy alcohol use, intimate partner violence (IPV), and economic insecurity threatens to derail progress towards UNAIDS 95-95-95 targets in sub-Saharan Africa. We developed a combined economic and relationship-strengthening intervention called Mlambe to reduce unhealthy alcohol use and increase adherence to antiretroviral therapy for couples in Malawi. This study evaluates the additional impact of Mlambe on IPV and relationship dynamics.

Methods

In a pilot randomized controlled trial, 78 married couples (156 individuals) living with HIV and reporting unhealthy alcohol use based on the AUDIT-C (at least one partner) were recruited from HIV care clinics in Zomba, Malawi. The intervention arm (39 couples) received a 10-month program consisting of incentivized savings accounts with financial literacy education, relationship education, and couples counseling sessions to build relationship skills. The control arm (39 couples) received enhanced usual care (EUC) with brief alcohol counseling. We used linear mixed-effects models to assess the effects of Mlambe on relationship quality (e.g., constructive communication, unity, sexual satisfaction) and IPV (physical, sexual, and emotional) by including fixed effects for treatment arm and a random effect for dyad, and tested whether effects on IPV and relationship quality differed by gender.

Results

At 10- and 15-month follow-up visits, couples in the Mlambe arm showed greater increases in couple communication, unity, sexual satisfaction, intimacy, and trust (Cohen’s d ranged from 0.36 to 0.56; p<0.05) as compared to EUC. Couples in the Mlambe arm also showed significant decreases in physical and emotional IPV (Cohen’s d ranged from 0.33 to 0.49; p<0.05) as compared to EUC. Subsequent moderation analyses indicated that women reported significantly greater improvements in relationship quality than men, except for sexual satisfaction (p<0.05), and greater declines in physical IPV than men (p<0.05).

Conclusions

Mlambe resulted in significant improvements in relationship quality and decreased IPV in couples, particularly for women who as a group reported lower relationship quality at baseline. Economic and relationship-strengthening interventions have potential to disrupt harmful syndemics of violence, substance use, and poverty among couples living with HIV.

Clinical Trial Number

NCT#04906616

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来源期刊

Social Science & Medicine PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-

CiteScore

9.10

自引率

5.60%

发文量

762

审稿时长

38 days

期刊介绍： Social Science & Medicine provides an international and interdisciplinary forum for the dissemination of social science research on health. We publish original research articles (both empirical and theoretical), reviews, position papers and commentaries on health issues, to inform current research, policy and practice in all areas of common interest to social scientists, health practitioners, and policy makers. The journal publishes material relevant to any aspect of health from a wide range of social science disciplines (anthropology, economics, epidemiology, geography, policy, psychology, and sociology), and material relevant to the social sciences from any of the professions concerned with physical and mental health, health care, clinical practice, and health policy and organization. We encourage material which is of general interest to an international readership.