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

作者：Joshua Kiyingi, Fred M. Ssewamala, Torsten B. Neilands, Scott Tebbetts, Nancy Mulauzi, James Mkandawire, Amy A. Conroy · 发表于：BMC Public Health · 年份：2025 · DOI：10.1186/s12889-025-23911-w · 被引用次数：6 · 研究领域：Food Security and Health in Diverse Populations、HIV/AIDS Research and Interventions、HIV-related health complications and treatments

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. METHODS: We analyzed data from 78 couples who participated in the Mlambe study, implemented in Zomba, Malawi. The study enrolled married couples living with HIV and unhealthy alcohol use (based on the AUDIT-C) from HIV care settings: an urban hospital, a rural private community, and a peri-urban health center. Couples were randomized into two groups: the Mlambe intervention or enhanced usual care (EUC). Mlambe intervention included incentivized savings accounts and sessions on financial literacy training and relationship skills over ten months. Study assessments occurred at baseline, 10- and 15-months. Food insecurity was assessed using the Household Food Insecurity Access Scale (HFIAS), which was categorized into four levels (food secure, mild, moderate, and severe food insecurity). We fit two-level, logistic mixed effects models testing the effect of Mlambe on severe food insecurity, given that most couples reported being food insecure. RESULTS: The mean age of participants at baseline...