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Pilot Trial Results of Mlambe: An Economic and Relationship-Strengthening Intervention to Address Heavy Drinking and Adherence to Antiretroviral Therapy in Malawi

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Abstract

We evaluated the feasibility, acceptability, and preliminary efficacy of an economic and relationship-strengthening intervention to reduce heavy alcohol use among couples living with HIV in Malawi (Mlambe). Mlambe consisted of training on financial literacy and relationship skills, combined with 1:1 matched savings accounts to invest in an income-generating activity. In a randomized controlled trial, we compared Mlambe to enhanced usual care (EUC). We enrolled 78 married couples having a partner on antiretroviral therapy (ART) who reported heavy alcohol use based on the AUDIT-C. Using targets of 75%, primary outcomes included retention rates at 10 and 15-months, session attendance rates, and satisfaction with Mlambe. Exploratory outcomes were heavy alcohol use (AUDIT-C and/or PEth positive), number of drinking days in the past month, AUDIT-C score, optimal adherence to ART (95% or higher), and viral suppression. We exceeded our targets for feasibility and acceptability metrics. Retention rates were 96% at 15-months. Session attendance and satisfaction levels were both 100%. From baseline to 15-months, Mlambe participants reported decreases in mean number of drinking days (from 6.8 to 2.1) and AUDIT-C scores (from 7.5 to 3.1); while ART adherence rates improved across the same period (from 63.2 to 73.9%). Participants in Mlambe, as compared to those in EUC, had lower rates of heavy alcohol use (89.5% vs. 97.2%) and higher rates of viral suppression (100% vs. 91.9%) at 10-months. Differences between arms were not statistically significant in this small pilot study. Mlambe was highly feasible and acceptable, and shows promise for reducing heavy alcohol use and viral non-suppression among couples with HIV in a larger efficacy study.

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Funding

This study was funded by the National Institutes of Health under grants R34-AA027983 and K24-AA22586.

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Authors and Affiliations

  1. Department of Medicine, University of California San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, USA

    Amy A. Conroy, Judith A. Hahn, Torsten B. Neilands & Scott Tebbetts

  2. Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA

    Lynae A. Darbes

  3. Invest in Knowledge, Zomba, Malawi

    Nancy Mulauzi & James Mkandawire

  4. Brown School, Washington University, St. Louis, MO, USA

    Fred M. Ssewamala

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  1. Amy A. Conroy
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  2. Judith A. Hahn
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  4. Lynae A. Darbes
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  8. Fred M. Ssewamala
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Contributions

AC led the conceptualization and design of this study, led the analysis, and drafted this manuscript. LD, JH, TN, JM, and FS conceptualized the study and edited the manuscript. ST, NM, and JM assisted with data collection and edited the manuscript. All authors contributed to the interpretation of findings and approved this manuscript.

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Correspondence to Amy A. Conroy.

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Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by the UCSF Human Research Protection Program (HRPP) and the National Health Sciences Research Committee (NHSRC) in Malawi.

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Informed consent was obtained from all participants included in the study.

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There are no conflicts of interest for any of the study authors.

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Conroy, A.A., Hahn, J.A., Neilands, T.B. et al. Pilot Trial Results of Mlambe: An Economic and Relationship-Strengthening Intervention to Address Heavy Drinking and Adherence to Antiretroviral Therapy in Malawi. AIDS Behav (2024). https://doi.org/10.1007/s10461-024-04326-x

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