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

> **NIH NIH R34** · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · 2020 · $270,155

## Abstract

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. Our recent mixed-methods study with HIV-affected couples in Malawi found
that 50% of alcohol drinkers met criteria for heavy alcohol use. Male peer pressure, desires for friendship, and
coping with poverty were common barriers to reducing consumption. Men expressed the need for an economic
or peer-based intervention to reduce alcohol use, and women were very concerned with how alcohol drains
family financial resources and causes conflict in the couple. Yet, there are currently no interventions that have
jointly addressed the economic and relationship context of drinking in sub-Saharan Africa. In other populations,
standalone relationship-strengthening and economic-strengthening interventions have been effective at
addressing alcohol use, engagement in HIV care, adherence to ART, household economics, and mental
health. However, such interventions have not been designed for HIV-positive couples who use alcohol, nor
have they been combined into a single intervention with potentially synergistic effects. We propose 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. We posit that engaging couples to work together on alcohol use and
financial goals—equipped with financial, communication, and problem-solving skills—will decrease alcohol
use, and improve relationship dynamics 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 (to be called Malambe); (2) to develop and pilot test the study procedures to
evaluate Malambe; and (3) to assess the feasibility and acceptability of Malambe through a pilot study. Using
the ADAPT-ITT method, we will develop a draft of the intervention manual and conduct five focus group
discussions with couples and key stakeholders to obtain input on the intervention. For the pilot study, we will
enroll 80 HIV-affected couples with a heavy alcohol user and randomize the couples to either Malambe or the
comparison arm (regular HIV care plus brief advice on alcohol use). We will conduct qualitative interviews with
a subset of 20 couples to contextualize feasibility and acceptability data, and then will analyze the mixed-
methods feasibility and acceptability data to refine intervention and procedures for a future trial. Alcohol
interventions for PLHIV in limited-resource settings may register large impacts by targeting the dyadic and
economic context of heavy alcohol use. Our long-term goal is to produce a culturally-grou...

## Key facts

- **NIH application ID:** 9996439
- **Project number:** 5R34AA027983-02
- **Recipient organization:** UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
- **Principal Investigator:** Amy Anne Conroy
- **Activity code:** R34 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $270,155
- **Award type:** 5
- **Project period:** 2019-08-15 → 2022-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9996439

## Citation

> US National Institutes of Health, RePORTER application 9996439, An economic and relationship-strengthening intervention for HIV-affected couples who drink alcohol in Malawi (5R34AA027983-02). Retrieved via AI Analytics 2026-07-08 from https://api.ai-analytics.org/grant/nih/9996439. Licensed CC0.

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