Addressing depression, stress, and hopelessness through an economic and relationship-strengthening intervention: Findings from a pilot randomized controlled trial among people with HIV in Malawi.

Background: Depression disproportionately affects individuals in low- and middle-income countries (LMICs). Economic hardship and family strain exacerbate challenges, particularly for women. This study evaluated effects of Mlambe, an intervention targeting economic empowerment and relationship strengthening, on mental health in couples with HIV and unhealthy alcohol use in Malawi.

"After reducing alcohol, things now work well at home": Perceived impacts of the Mlambe intervention on alcohol use, relationship dynamics, household economics, and HIV treatment adherence in Malawian couples.

Unhealthy alcohol use is prevalent in sub-Saharan Africa and can worsen poverty, couple relationships, and HIV treatment outcomes. In response, we assessed participant experiences with Mlambe, a pilot study of an economic and relationship-strengthening intervention for couples living with unhealthy alcohol use and HIV. Exit interviews were conducted with a subset of 20 couples who participated in a pilot trial of Mlambe in Zomba, Malawi.

The effect of an economic empowerment and relationship strengthening intervention on food insecurity among couples living with HIV in Malawi.

Background: People living with HIV (PLHIV) are highly impacted by food insecurity through pathways including poor adherence to antiretroviral therapy and inadequate nutrition. Limited evidence exists on whether economic empowerment interventions can improve food insecurity among PLHIV in sub-Saharan Africa. We evaluated the effectiveness of Mlambe, an economic empowerment and relationship-strengthening intervention, on food insecurity among couples living with HIV who drink alcohol in Malawi.

Managing multimorbidity together: relationship dynamics and dual medication adherence for hypertension and HIV in Malawi.

Background: Cardiometabolic disorders are highly prevalent among people living with HIV, complicating the medication management of both conditions. Primary partners provide key sources of support for antiretroviral therapy; however, little research has considered their role in the context of comorbidities.

Purpose: Using baseline data from the Healthy Hearts cohort study, we investigated associations between relationship dynamics and dual medication adherence for HIV and hypertension (HTN) in Malawi.

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

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 , 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.

Economic and relationship-strengthening intervention to reduce alcohol use in couples living with HIV in Malawi: a study protocol for a randomised controlled trial of Mlambe.

Introduction: Heavy alcohol use has the potential to derail progress towards UNAIDS 95-95-95 targets for countries in sub-Saharan Africa (SSA). Within couples, alcohol use is closely linked with factors such as intimate partner violence and economic insecurity and can result in poor adherence to antiretroviral therapy (ART) and HIV clinical outcomes. We hypothesise that a combined economic and relationship intervention for couples that builds on the prior success of standalone economic and relationship-strengthening interventions will be efficacious for improving HIV clinical outcomes and reducing alcohol use.

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.

Barriers to accessing care for cardiometabolic disorders in Malawi: partners as a source of resilience for people living with HIV.

Background: People living with HIV (PLWH) are at increased risk of cardiometabolic disorders (CMD). Adequate access to care for both HIV and CMD is crucial to improving health outcomes; however, there is limited research that have examined couples' experiences accessing such care in resource-constrained settings. We aimed to identify barriers to accessing CMD care among PLWH in Malawi and the role of partners in mitigating these barriers.

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

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).

"I too have a responsibility for my partner's life": Communal coping among Malawian couples living with HIV and cardiometabolic disorders.

Rationale: HIV and cardiometabolic disorders including hypertension and diabetes pose a serious double threat in Malawi. Supportive couple relationships may be an important resource for managing these conditions. According to the theory of communal coping, couples will more effectively manage illness if they view the illness as "our problem" (shared illness appraisal) and are united in shared behavioral efforts.

"High blood pressure comes from thinking too much": Understandings of illness among couples living with cardiometabolic disorders and HIV in Malawi.

Cardiometabolic disorders (CMD) such as hypertension and diabetes are increasingly prevalent in sub-Saharan Africa, placing people living with HIV at risk for cardiovascular disease and threatening the success of HIV care. Spouses are often the primary caregivers for people living with CMD, and understanding patients' and partners' conceptions of CMD could inform care. We conducted semi-structured interviews with 25 couples having a partner living with HIV and either hypertension or diabetes.

A conceptual framework for understanding child marriage, marriage markets, and marriageability.

The term 'marriageability' is used frequently in child marriage literature but is rarely defined. We propose a conceptual framework to define marriageability and use qualitative case studies to illustrate how ideas about marriageability contribute to child marriage. Pressure to capitalize on a girl's marriageability before it declines in order to secure the 'best' partner may explain why child marriage persists.

"Then I will say that we have to marry each other": A qualitative view of premarital pregnancy as a driver of child marriage in Malawi".

Child marriage is common in Malawi, with 42.1% of women ages 20-24 marrying before age 18. Although global research on child marriage has increased in recent years, the reasons are context-specific and there is limited evidence on specific drivers of child marriage in Malawi.

Community-based empowerment program to delay marriage: Results from the More Than Brides Alliance intervention in India, Malawi, Mali and Niger.

The More Than Brides Alliance (MTBA) implemented an intervention in India, Malawi, Mali and Niger from 2017 to 2020. The holistic community-based program included girls' clubs focused on empowerment and sexual and reproductive health knowledge; work with parents and educators; community edutainment events; and local-, regional-, and national-level advocacy efforts related to child marriage. Using a cluster randomized trial design (India and Malawi), and a matched comparison design (Niger and Mali), we evaluated the effectiveness of the program on age at marriage among girls ages 12-19 in intervention communities.

Development and Validation of the Couple Sexual Satisfaction Scale for HIV and Sexual Health Research.

Sexual satisfaction is an important dimension of relationship quality with implications for sexual and reproductive health (SRH), and HIV prevention, care, and treatment. We developed and validated the Couple Sexual Satisfaction Scale (CSSS) with heterosexual couples in sub-Saharan Africa. Using data from qualitative interviews with 94 partnered women and men in Swaziland and Malawi, we generated a 22-item scale and administered it to 211 couples with at least one partner living with HIV in Malawi.

Perceptions of minimum age at marriage laws and their enforcement: qualitative evidence from Malawi.

Background: Child marriage in Malawi is a significant problem with 42.1% of women 20-24 married by age 18. In 2017 the Malawi government formalized legislation to make marriage under age 18 illegal; violators are subject to fines.

Cohort profile: the mature adults cohort of the Malawi longitudinal study of families and health (MLSFH-MAC).

Purpose: The Mature Adults Cohort of the Malawi Longitudinal Study of Families and Health (MLSFH-MAC) contributes to global ageing studies by providing a rare opportunity to study the processes of individual and population ageing, the public health and social challenges associated with ageing and the coincident shifts in disease burdens, in a low-income, high HIV prevalence, sub-Saharan African (SSA) context.

Participants: The MLSFH-MAC is an open population-based cohort study of mature adults aged 45+ years living in rural communities in three districts in Malawi. Enrolment at baseline is 1266 individuals in 2012.

Bidirectional Violence Is Associated with Poor Engagement in HIV Care and Treatment in Malawian Couples.

Growing evidence suggests that intimate partner violence (IPV) is a barrier to engagement in HIV care. Bidirectional IPV-being both a perpetrator and victim-may be the most common pattern of IPV, yet no research has examined its effect on engagement in care, which could identify couples in most need of interventions. Married couples ( = 211) with at least one partner on antiretroviral therapy were recruited from HIV clinic waiting rooms in Zomba, Malawi.

The Unaddressed Needs of Alcohol-Using Couples on Antiretroviral Therapy in Malawi: Formative Research on Multilevel Interventions.

Alcohol use among HIV-positive individuals in sub-Saharan Africa directly impacts adherence to antiretroviral therapy and HIV outcomes. Few studies have examined approaches to reduce alcohol use among HIV-affected couples, despite evidence that alcohol use is a couple-level concern. We conducted a qualitative study with 23 alcohol-using couples to identify multilevel barriers and facilitators of alcohol use, and potential intervention options with couples.

Evaluating Sampling Biases from Third-party Reporting as a Method for Improving Survey Measures of Sensitive Behaviors.

Survey participants often misreport their sensitive behaviors (e.g., smoking, drinking, having sex) during interviews.

A Dyadic Investigation of Relationship Dynamics and Depressive Symptoms in HIV-Affected Couples in Malawi.

Depression is the leading cause of disability worldwide with health implications for people living with HIV. Primary partnerships like marriage could be protective against depression but may worsen depression depending on the relationship quality. We examined depression and its association with relationship dynamics in a cross-sectional sample of 211 HIV-affected married couples in Malawi.

Marital infidelity, food insecurity, and couple instability: A web of challenges for dyadic coordination around antiretroviral therapy.

Rationale: Despite the importance of primary partners for health, little is known about factors that constrain the ability of couples to work collaboratively towards HIV care and treatment (dyadic coordination). This study examined the interplay of marital infidelity, food insecurity, and couple instability on dyadic coordination and adherence to antiretroviral therapy (ART) in Malawi.

Methods: In 2016, we conducted 80 in-depth interviews with 25 couples with at least one partner on ART.

A new approach to measuring partnership concurrency and its association with HIV risk in couples.

Empirical estimates of the association between concurrent partnerships (CP) and HIV risk are affected by non-sampling errors in survey data on CPs, e.g., because respondents misreport the extent of their CPs.