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

Sumona Chaudhury,Felicity L Brown,Catherine M Kirk,Sylvere Mukunzi,Beatha Nyirandagijimana,Josee Mukandanga,Christian Ukundineza,Kalisa Godfrey,Lauren C Ng,Robert T Brennan,Theresa S Betancourt

doi:10.1080/09540121.2016.1176686

Abstract

ABSTRACTHIV-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.

Highlights

Family-based interventions hold promise for promoting child mental health and well-being for families affected by HIV in low- and middle-income countries (Rochat, Bland, Coovadia, Stein, & Newell, 2011; Rochat, Mkwanazi, & Bland 2013; Rotheram-Borus et al, 2003; Visser et al, 2012)
Few studies have examined the impact of family intervention on caregiver alcohol use, intimate partner violence (IPV) and child well-being
A mixed methods approach was used to analyze data collected during the randomized controlled trials (RCTs) of FSI-HIV versus treatment as usual

Summary

Introduction

Family-based interventions hold promise for promoting child mental health and well-being for families affected by HIV in low- and middle-income countries (Rochat, Bland, Coovadia, Stein, & Newell, 2011; Rochat, Mkwanazi, & Bland 2013; Rotheram-Borus et al, 2003; Visser et al, 2012). HIV-affected caregivers experience higher rates of mental-health problems, harmful alcohol use, conflict and intimate partner violence (IPV) (Li et al, 2014; Longmire-Avital, Holder, Golub, & Parsons, 2012; WHO, 2010). HIVrelated stressors increase the risk of mental-health concerns and related problems in children, such as anxiety, depression, high-risk sexual behavior, social isolation, stigma, low self-esteem and poor school performance (Betancourt, Meyers-Ohki, Charrow, & Hansen, 2013; Orban et al, 2010). Few studies have examined the impact of family intervention on caregiver alcohol use, IPV and child well-being

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Conclusion