Exploring the potential of a family-based prevention intervention to reduce alcohol use and violence within HIV-affected families in Rwanda

Abstract

HIV-affected families report higher rates of harmful alcohol use, intimate partner violence (IPV) and family conflict, which can have detrimental effects on children. Few evidence-based interventions exist to address these complex issues in Sub-Saharan Africa. This mixed methods study explores the potential of a family-based intervention to reduce IPV, family conflict and problems related to alcohol use to promote child mental health and family functioning within HIV-affected families in post-genocide Rwanda. A family home-visiting, evidence-based intervention designed to identify and enhance resilience and communication in families to promote mental health in children was adapted and developed for use in this context for families affected by caregiver HIV in Rwanda. The intervention was adapted and developed through a series of pilot study phases prior to being tested in open and randomized controlled trials (RCTs) in Rwanda for families affected by caregiver HIV. Quantitative and qualitative data from the RCT are explored here using a mixed methods approach to integrate findings. Reductions in alcohol use and IPV among caregivers are supported by qualitative reports of improved family functioning, lower levels of violence and problem drinking as well as improved child mental health, among the intervention group. This mixed methods analysis supports the potential of family-based interventions to reduce adverse caregiver behaviors as a major mechanism for improving child well-being. Further studies to examine these mechanisms in well-powered trials are needed to extend the evidence-base on the promise of family-based intervention for use in low- and middle-income countries.

Keywords: Children affected by HIV/AIDS; IPV; Rwanda; alcohol; family-based prevention; resilience.

Figure 1.

Conceptual model of the FSI-HIV modules.

Figure 2.

FSI-HIV parent trial study flow.

Figure 3.

Graphical representation of mean participant self-reported scores at baseline, post-intervention and at three-month follow-up following a family-based prevention intervention in HIV-affected families in Rwanda. (a) Caregiver self-reports of alcohol and IPV mean caregiver alcohol and IPV scores over baseline, post-intervention and three-month follow-up intervals with 95% confidence intervals and adjusted Poisson regression findings. (b) Child self-reports of mental health and well-being mean child anxiety and depression and depression scores over baseline, post-intervention and three-month follow-up intervals with 95% confidence intervals. (c) Child self-reports of resilience and pro-social behavior mean child resilience and pro-social behavior scores over baseline, post-intervention and three-month follow-up intervals with 95% confidence intervals.

Figure 3.

Graphical representation of mean participant self-reported scores at baseline, post-intervention and at three-month follow-up following a family-based prevention intervention in HIV-affected families in Rwanda. (a) Caregiver self-reports of alcohol and IPV mean caregiver alcohol and IPV scores over baseline, post-intervention and three-month follow-up intervals with 95% confidence intervals and adjusted Poisson regression findings. (b) Child self-reports of mental health and well-being mean child anxiety and depression and depression scores over baseline, post-intervention and three-month follow-up intervals with 95% confidence intervals. (c) Child self-reports of resilience and pro-social behavior mean child resilience and pro-social behavior scores over baseline, post-intervention and three-month follow-up intervals with 95% confidence intervals.