Relationship Factors and Engagement in HIV Care in Malawi: A Dyadic Investigation
As access to antiretroviral therapy (ART) rapidly increases across sub-Saharan Africa, optimal use of HIV care and treatment remains paramount to prevent transmission of HIV within ongoing sexual relationships: the setting where most new HIV infections occur. This research will conduct a dyadic investigation to better understand the influence of relationship factors such as communication, partner social support, and marital conflict on engagement in the HIV care continuum (CC) in Malawi. Research on the HIV CC in sub-Saharan Africa (SSA) has largely focused on structural and individual-level barriers and facilitators, resulting in a weak understanding of factors at the relationship level. The proposed research will be situated in Malawi, a resource-poor country in SSA where 11% of adults are HIV-infected and an estimated 8,000 Malawians die each year from AIDS-related illness. The majority of new HIV infections occur within marriage or cohabiting unions. Despite the success of ART programs in Malawi, large numbers of HIV+ individuals who are eligible for ART and who have initiated ART continue to drop out of the HIV CC. Furthermore, as more HIV+ individuals access ART while healthier, there are growing concerns about long-term adherence to ART. Using a dyadic, mixed-methods study design, the specific aims of the research are:
1) to describe how the relationship context influences engagement in the HIV CC within Malawian couples;
2) to identify the relationship-level barriers and facilitators that affect engagement in the HIV CC; and,
3) to develop a preliminary intervention to optimize engagement in the HIV CC for Malawian couples.
For Aim 1, qualitative interviews will be conducted with 25 couples (50 individuals) with at least one partner who is either starting or already on ART. Medical record data and hair specimens will also be collected from respondents on ART to supplement self-reported measures of engagement in care. For Aim 3, 20 semi-structured interviews with community members and stakeholders, and 4 focus group discussions with couples will be conducted to inform the development of a relationship-focused intervention targeting optimal use of HIV care and treatment. Findings will culminate in an R-level NIH grant application to test the efficacy of the intervention developed through this project.