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. 2025 Feb 25:29:101768.
doi: 10.1016/j.ssmph.2025.101768. eCollection 2025 Mar.

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

Lakshmi Gopalakrishnan  1 , Nancy Mulauzi  2 , James Mkandawire  2 , Fred M Ssewamala  3 , Scott Tebbetts  4 , Torsten B Neilands  4 , Amy A Conroy  4
Affiliations

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

Lakshmi Gopalakrishnan et al. SSM Popul Health. .

Abstract

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 Mlambe, 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. Couples were recruited from HIV care clinics and randomized to either the Mlambe intervention (n = 39 couples) or enhanced usual care (EUC) control (n = 39 couples). The 10-month Mlambe intervention combined incentivized savings accounts, financial literacy education, relationship education, and couples' counseling. EUC included brief alcohol counseling. We used linear mixed-effects models to evaluate Mlambe's impact on (i) confidence to save, (ii) attitudes towards savings, (iii) equitable financial decision-making.

Results: At 10 months follow-up, participants in the Mlambe intervention showed significantly higher confidence to save compared to EUC (coefficient = 0.18, 95% CI: 0.05, 0.32, p < 0.001), with women having greater improvements than men (p < 0.001). However, these effects were not sustained at 15 months. No significant differences were observed between arms in attitudes towards savings. Participants in the intervention showed greater equitable financial decision-making at 10 months (coefficient = 0.13, 95%CI: 0.11, 0.25; p = 0.03) compared to EUC, with effects sustained at 15-months (coefficient = 0.21, 95% CI: 0.11, 0.32, p < 0.001).

Conclusion: Our findings suggest that Mlambe intervention holds promise, underscoring the benefits of an integrated economic and relationship strengthening interventions among HIV-affected couples.

Clinical trial number: NCT04906616.

Keywords: Antiretroviral therapy; Couples-based intervention; Financial literacy education; HIV/AIDS; Sub-Saharan Africa; couples; economic-strengthening interventions.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Confidence to save at 10-month follow-up: Interactions with gender.
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