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.

Family‐based promotion of mental health in children affected byHIV: a pilot randomized controlled trial

“…Future trials should be powered to investigate both differential effects by family configuration and to examine outcomes over a longer time horizon to understand potential preventative effects of FSI‐HIV. Although retention and attendance were strong, participation was affected by time constraints of families as well as caregiver alcohol abuse (Chaudhury, Brown et al., ) and addressing traumatic stress responses related to the Rwandan genocide.…”

Alcohol-Related Physical Abuse of Children in the Slums of Kampala, Uganda

“…Future research should also identify strategies to prevent early alcohol initiation among those who experience child abuse. Evidence based interventions addressing alcohol use at the community (media and alcohol availability) [ 44 , 45 , 46 ], family [ 47 ], and individual level (brief interventions) [ 48 ] have had limited implementation or evaluations in a Sub-Saharan African setting; further cultural adaptation and implementation of these multi-level interventions is warranted [ 49 ]. Reducing the violence and alcohol use among the children would greatly decrease their high risk exposures with an ultimate goal of subsequently decreasing adverse health outcomes and the often cyclical relationship of alcohol use and violence.…”

Emerging partner violence among young adolescents in a low-income country: Perpetration, victimization and adversity

“…Either way, IPV prevention could start in childhood. Parenting programs, for example, show potential to prevent childhood violence and reduce IPV in high income contexts, and are currently being testing in LMIC [76,77]. To accelerate these efforts, the WHO published the INSPIRE package outlining seven evidence-based interventions to prevent childhood violence [78].…”