{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T05:04:00Z","timestamp":1781154240282,"version":"3.54.1"},"reference-count":96,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T00:00:00Z","timestamp":1756425600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000025","name":"National Institute of Mental Health","doi-asserted-by":"publisher","award":["K01MH132435"],"award-info":[{"award-number":["K01MH132435"]}],"id":[{"id":"10.13039\/100000025","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000027","name":"National Institute on Alcohol Abuse and Alcoholism","doi-asserted-by":"publisher","award":["R34-AA027983"],"award-info":[{"award-number":["R34-AA027983"]}],"id":[{"id":"10.13039\/100000027","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>Unhealthy alcohol use is prevalent in sub-Saharan Africa and can worsen poverty, couple relationships, and HIV treatment outcomes. In response, we assessed participant experiences with <jats:italic><jats:italic>Mlambe<\/jats:italic><\/jats:italic>, a pilot study of an economic and relationship-strengthening intervention for couples living with unhealthy alcohol use and HIV. Exit interviews were conducted with a subset of 20 couples who participated in a pilot trial of <jats:italic><jats:italic>Mlambe<\/jats:italic><\/jats:italic> in Zomba, Malawi. A 10-month intervention consisted of financial literacy and couples counseling sessions and incentivized savings accounts. Eligible couples were married,\u2009\u2265\u200918, with at least one partner with unhealthy alcohol use (according to AUDIT-C screen), and currently on antiretroviral therapy (ART). Interviews were recorded, transcribed, translated, and analyzed using dyadic framework analysis. Intervention couples reported that alcohol use caused many problems and that reducing or quitting use brought improvements to their physical and emotional health, and the well-being of their marriages and households. Before <jats:italic><jats:italic>Mlambe<\/jats:italic><\/jats:italic>, couples reported that quarrels about alcohol use were common<jats:italic>.<\/jats:italic> After the intervention, couples reported improvements to their relationships and less alcohol use, which led to more open and respectful couple communication and other marital improvements including increased sexual satisfaction and trust. Women and men described that post-intervention, men reduced spending on alcohol which improved availability of money for household needs such as food and clothing, and that feeling more economically secure reduced stress and led to a more \u201cpeaceful family.\u201d After <jats:italic><jats:italic>Mlambe<\/jats:italic><\/jats:italic>, male drinkers described more motivation to pursue income-generating activities, and that reduced alcohol use led to greater medication adherence as they no longer forgot to take ART when drinking. <jats:italic><jats:italic>Mlambe<\/jats:italic><\/jats:italic> may contribute to positive change for couple relationships and health behaviors through mechanisms including reduced conflict and poverty related to reduced alcohol use. The model appears promising for couples in resource-poor settings where HIV, poverty, and alcohol use are mutually reinforcing.<\/jats:p>","DOI":"10.1371\/journal.pone.0331202","type":"journal-article","created":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T17:36:27Z","timestamp":1756488987000},"page":"e0331202","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["\u201cAfter reducing alcohol, things now work well at home\u201d: Perceived impacts of the Mlambe intervention on alcohol use, relationship dynamics, household economics, and HIV treatment adherence in Malawian couples"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7634-1296","authenticated-orcid":true,"given":"Sarah A.","family":"Gutin","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nancy","family":"Mulauzi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane","family":"Jere","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cobbener","family":"Sungani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott","family":"Tebbetts","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allison","family":"Ruark","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Mkandawire","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy A.","family":"Conroy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,8,29]]},"reference":[{"key":"pone.0331202.ref001","volume-title":"Global status report on alcohol and health 2018","author":"World Health Organization","year":"2019"},{"issue":"7","key":"pone.0331202.ref002","doi-asserted-by":"crossref","first-page":"1641","DOI":"10.1016\/j.socscimed.2005.08.021","article-title":"Associations of poverty, substance use, and HIV transmission risk behaviors in three South African communities","volume":"62","author":"SC Kalichman","year":"2006","journal-title":"Soc Sci Med"},{"issue":"8","key":"pone.0331202.ref003","doi-asserted-by":"crossref","first-page":"1581","DOI":"10.1016\/j.socscimed.2004.02.003","article-title":"Transactional sex among women in Soweto, South Africa: prevalence, risk factors and association with HIV infection","volume":"59","author":"KL Dunkle","year":"2004","journal-title":"Soc Sci Med"},{"key":"pone.0331202.ref004","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1080\/16070658.2010.11734296","article-title":"The social aspects of alcohol misuse\/abuse in South Africa","volume":"23","author":"B Setlalentoa","year":"2010","journal-title":"South Afr J Clin Nutr"},{"issue":"6","key":"pone.0331202.ref005","doi-asserted-by":"crossref","first-page":"1599","DOI":"10.1007\/s10461-019-02653-y","article-title":"The unaddressed needs of alcohol-using couples on antiretroviral therapy in Malawi: formative research on multilevel interventions","volume":"24","author":"AA Conroy","year":"2020","journal-title":"AIDS Behav"},{"issue":"3","key":"pone.0331202.ref006","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0017591","article-title":"A systematic review of African studies on intimate partner violence against pregnant women: prevalence and risk factors","volume":"6","author":"S Shamu","year":"2011","journal-title":"PLoS One"},{"issue":"1","key":"pone.0331202.ref007","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1007\/s10508-009-9516-4","article-title":"Alcohol use and high-risk sexual behavior in Sub-Saharan Africa: a narrative review","volume":"40","author":"SE Woolf-King","year":"2011","journal-title":"Arch Sex Behav"},{"issue":"3","key":"pone.0331202.ref008","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1016\/j.drugalcdep.2005.10.017","article-title":"Alcohol use, alcohol problems, and depressive symptomatology among newly married couples","volume":"83","author":"GG Homish","year":"2006","journal-title":"Drug Alcohol Depend"},{"issue":"1","key":"pone.0331202.ref009","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1080\/03057070500035679","article-title":"Food security in northern Malawi: gender, kinship relations and entitlements in historical context","volume":"31","author":"RB Kerr","year":"2005","journal-title":"J Southern African Stud"},{"issue":"1","key":"pone.0331202.ref010","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1007\/s10461-018-2275-2","article-title":"Couple interdependence impacts alcohol use and adherence to antiretroviral therapy in Malawi","volume":"23","author":"AA Conroy","year":"2019","journal-title":"AIDS Behav"},{"issue":"4","key":"pone.0331202.ref011","doi-asserted-by":"crossref","first-page":"294","DOI":"10.3109\/16066359.2013.841890","article-title":"Problematic alcohol use and marital distress: an interdependence theory perspective","volume":"22","author":"LM Rodriguez","year":"2014","journal-title":"Addict Res Theory"},{"key":"pone.0331202.ref012","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1186\/s12889-017-4350-4","article-title":"Alcohol use and sexual risk behaviour among men and women in inner-city Johannesburg, South Africa","volume":"17","author":"B Bello","year":"2017","journal-title":"BMC Public Health"},{"key":"pone.0331202.ref013","doi-asserted-by":"crossref","first-page":"112637","DOI":"10.1016\/j.socscimed.2019.112637","article-title":"Gendered syndemic of intimate partner violence, alcohol misuse, and HIV risk among peri-urban, heterosexual men in South Africa","volume":"295","author":"AM Hatcher","year":"2022","journal-title":"Soc Sci Med"},{"issue":"11","key":"pone.0331202.ref014","doi-asserted-by":"crossref","first-page":"3758","DOI":"10.1007\/s10461-021-03263-3","article-title":"Associations between patterns of alcohol use and viral load suppression amongst women living with HIV in South Africa","volume":"25","author":"B Myers","year":"2021","journal-title":"AIDS Behav"},{"issue":"6","key":"pone.0331202.ref015","doi-asserted-by":"crossref","first-page":"1727","DOI":"10.1007\/s10461-019-02716-0","article-title":"Alcohol use and antiretroviral therapy non-adherence among adults living with HIV\/AIDS in Sub-Saharan Africa: a systematic review and meta-analysis","volume":"24","author":"J Velloza","year":"2020","journal-title":"AIDS Behav"},{"issue":"1","key":"pone.0331202.ref016","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1111\/tmi.12618","article-title":"The impact of alcohol consumption on African people in 2012: an analysis of burden of disease","volume":"21","author":"C Ferreira-Borges","year":"2016","journal-title":"Trop Med Int Health"},{"issue":"1","key":"pone.0331202.ref017","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1186\/s13011-019-0240-3","article-title":"The prevalence of alcohol use disorders among people living with HIV\/AIDS: a systematic review and meta-analysis","volume":"14","author":"B Duko","year":"2019","journal-title":"Subst Abuse Treat Prev Policy"},{"issue":"2","key":"pone.0331202.ref018","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1097\/QAD.0000000000000922","article-title":"Prevalence of non-HIV cancer risk factors in persons living with HIV\/AIDS: a meta-analysis","volume":"30","author":"LS Park","year":"2016","journal-title":"AIDS"},{"issue":"4","key":"pone.0331202.ref019","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1007\/s11904-010-0060-6","article-title":"Alcohol and HIV disease progression: weighing the evidence","volume":"7","author":"JA Hahn","year":"2010","journal-title":"Curr HIV\/AIDS Rep"},{"issue":"4","key":"pone.0331202.ref020","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2016-000125","article-title":"Determinants of adherence to antiretroviral therapy among HIV-positive adults in sub-Saharan Africa: a systematic review","volume":"1","author":"T Heestermans","year":"2016","journal-title":"BMJ Glob Health"},{"issue":"2","key":"pone.0331202.ref021","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1007\/s10461-017-1886-3","article-title":"Behavioral interventions targeting alcohol use among people living with HIV\/AIDS: a systematic review and meta-analysis","volume":"21","author":"LA Scott-Sheldon","year":"2017","journal-title":"AIDS Behav"},{"issue":"10","key":"pone.0331202.ref022","doi-asserted-by":"crossref","first-page":"2056","DOI":"10.1111\/acer.13204","article-title":"Alcohol use and human immunodeficiency virus (HIV) infection: current knowledge, implications, and future directions","volume":"40","author":"EC Williams","year":"2016","journal-title":"Alcohol Clin Exp Res"},{"issue":"3","key":"pone.0331202.ref023","first-page":"280","article-title":"Influence of alcohol consumption on adherence to and toxicity of antiretroviral therapy and survival","volume":"33","author":"RS Braithwaite","year":"2010","journal-title":"Alcohol Res Health"},{"issue":"6","key":"pone.0331202.ref024","doi-asserted-by":"crossref","first-page":"799","DOI":"10.1016\/j.jhep.2005.01.022","article-title":"Liver disease as a major cause of death among HIV infected patients: role of hepatitis C and B viruses and alcohol","volume":"42","author":"D Salmon-Ceron","year":"2005","journal-title":"J Hepatol"},{"key":"pone.0331202.ref025","doi-asserted-by":"crossref","first-page":"109005","DOI":"10.1016\/j.drugalcdep.2021.109005","article-title":"Alcohol use and alcohol-related consequences are associated with not being virally suppressed among persons living with HIV in the Rakai region of Uganda","volume":"228","author":"AP Miller","year":"2021","journal-title":"Drug Alcohol Depend"},{"issue":"1","key":"pone.0331202.ref026","doi-asserted-by":"crossref","first-page":"59","DOI":"10.3390\/ijerph16010059","article-title":"Prevalence of alcohol and tobacco use among men and women in Namibia","volume":"16","author":"Z He","year":"2018","journal-title":"Int J Environ Res Public Health"},{"issue":"8","key":"pone.0331202.ref027","doi-asserted-by":"crossref","DOI":"10.1016\/S2352-3018(16)30034-0","article-title":"Heterogeneity of the HIV epidemic in agrarian, trading, and fishing communities in Rakai, Uganda: an observational epidemiological study","volume":"3","author":"LW Chang","year":"2016","journal-title":"Lancet HIV"},{"key":"pone.0331202.ref028","volume-title":"Global status report on alcohol and health","author":"World Health Organization","year":"2014"},{"issue":"7","key":"pone.0331202.ref029","doi-asserted-by":"crossref","first-page":"1885","DOI":"10.1007\/s10461-017-1697-6","article-title":"\u201cIf she is drunk, i don\u2019t want her to take it\u201d: partner beliefs and influence on use of alcohol and antiretroviral therapy in South African couples","volume":"21","author":"AA Conroy","year":"2017","journal-title":"AIDS Behav"},{"key":"pone.0331202.ref030","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1016\/j.drugalcdep.2016.02.017","article-title":"The male factor: outcomes from a cluster randomized field experiment with a couples-based HIV prevention intervention in a South African township","volume":"161","author":"WM Wechsberg","year":"2016","journal-title":"Drug Alcohol Depend"},{"issue":"4","key":"pone.0331202.ref031","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1097\/QAI.0000000000001948","article-title":"Results of a couples-based randomized controlled trial aimed to increase testing for HIV","volume":"80","author":"LA Darbes","year":"2019","journal-title":"J Acquir Immune Defic Syndr"},{"key":"pone.0331202.ref032","volume-title":"Efficacy of home visits for pregnant couples to promote couple HIV testing and family health","author":"J Turan","year":"2025"},{"issue":"3","key":"pone.0331202.ref033","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1002\/ijgo.13442","article-title":"Male partner involvement and successful completion of the prevention of mother-to-child transmission continuum of care in Kenya","volume":"152","author":"K Hampanda","year":"2021","journal-title":"Int J Gynaecol Obstet"},{"issue":"1","key":"pone.0331202.ref034","doi-asserted-by":"crossref","first-page":"21224","DOI":"10.7448\/IAS.19.1.21224","article-title":"Couple interdependence impacts HIV-related health behaviours among pregnant couples in southwestern Kenya: a qualitative analysis","volume":"19","author":"AJ Rogers","year":"2016","journal-title":"J Int AIDS Soc"},{"issue":"11","key":"pone.0331202.ref035","doi-asserted-by":"crossref","first-page":"1239","DOI":"10.1080\/13691058.2017.1309460","article-title":"\u201cI told her this is your life\u201d: relationship dynamics, partner support and adherence to antiretroviral therapy among South African couples","volume":"19","author":"A Conroy","year":"2017","journal-title":"Cult Health Sex"},{"key":"pone.0331202.ref036","article-title":"Couple interdependence impacts alcohol use and adherence to antiretroviral therapy in Malawi","author":"AA Conroy","year":"2018","journal-title":"AIDS Behav"},{"key":"pone.0331202.ref037","unstructured":"World Bank Group. Republic of Malawi Poverty Assessment. 2017. https:\/\/openknowledge.worldbank.org\/handle\/10986\/26488"},{"key":"pone.0331202.ref038","unstructured":"UNCTAD. Access to Financial Services in Malawi: Policies and Challenges. 2014."},{"issue":"1","key":"pone.0331202.ref039","first-page":"39","article-title":"A dose of drugs, a touch of violence, a case of AIDS, part 2: further conceptualizing the SAVA syndemic","volume":"34","author":"M Singer","year":"2006","journal-title":"Free Inq Creat Sociol"},{"issue":"2","key":"pone.0331202.ref040","first-page":"99","article-title":"A dose of drugs, a touch of violence, a case of AIDS: conceptualizing the SAVA syndemic","volume":"24","author":"M Singer","year":"1996","journal-title":"Free Inq Creat Sociol"},{"issue":"7","key":"pone.0331202.ref041","doi-asserted-by":"crossref","first-page":"2255","DOI":"10.1007\/s10461-022-03956-3","article-title":"Development of an economic and relationship-strengthening intervention for alcohol drinkers living with HIV in Malawi","volume":"27","author":"AA Conroy","year":"2023","journal-title":"AIDS Behav"},{"key":"pone.0331202.ref042","article-title":"Pilot trial results of Mlambe: an economic and relationship-strengthening intervention to address heavy drinking and adherence to antiretroviral therapy in Malawi","author":"AA Conroy","year":"2024","journal-title":"AIDS Behav"},{"issue":"6","key":"pone.0331202.ref043","doi-asserted-by":"crossref","first-page":"1369","DOI":"10.1016\/j.socscimed.2005.08.006","article-title":"Understanding health behavior change among couples: an interdependence and communal coping approach","volume":"62","author":"MA Lewis","year":"2006","journal-title":"Soc Sci Med"},{"key":"pone.0331202.ref044","volume-title":"Can the poor save?: Saving & asset building in individual development accounts","author":"M Schreiner","year":"2007"},{"issue":"4","key":"pone.0331202.ref045","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1086\/603797","article-title":"Stakeholding: Notes on a theory of welfare based on assets","volume":"64","author":"M Sherraden","year":"1990","journal-title":"Soc Serv Rev"},{"key":"pone.0331202.ref046","unstructured":"Ruark A, Tebbetts S, Darbes L, Hahn JA, Neilands TB, Mulauzi N. Mlambe economic and relationship-strengthening intervention increases relationship quality and decreases violence among couples in Malawi. In: AIDS Impact, Stockholm, Sweden, 2023."},{"issue":"5","key":"pone.0331202.ref047","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1007\/s40271-019-00369-8","article-title":"Analysis of clinical trial exit interview data in patients with treatment-resistant depression","volume":"12","author":"S Lewis","year":"2019","journal-title":"Patient"},{"issue":"5","key":"pone.0331202.ref048","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1177\/2168479013495686","article-title":"Role of patient-reported outcome measures in the assessment of central nervous system agents","volume":"47","author":"A Gnanasakthy","year":"2013","journal-title":"Ther Innov Regul Sci"},{"key":"pone.0331202.ref049","volume-title":"Malawi demographic and health survey 2015-16","author":"MDHS","year":"2016"},{"key":"pone.0331202.ref050","volume-title":"Researching violence against women: practical guidelines for researchers and activists","author":"World Health Organization","year":"2005"},{"key":"pone.0331202.ref051","volume-title":"Qualitative research practice: a guide for social science students and researchers","author":"J Ritchie","year":"2013"},{"key":"pone.0331202.ref052","doi-asserted-by":"crossref","first-page":"101768","DOI":"10.1016\/j.ssmph.2025.101768","article-title":"Effects of economic empowerment and relationship strengthening intervention on financial behaviors among couples living with HIV: The Mlambe pilot trial in Malawi","volume":"29","author":"L Gopalakrishnan","year":"2025","journal-title":"SSM Popul Health"},{"issue":"12","key":"pone.0331202.ref053","doi-asserted-by":"crossref","first-page":"1706","DOI":"10.1177\/0146167210388420","article-title":"Daily alcohol use and romantic relationship functioning: evidence of bidirectional, gender-, and context-specific effects","volume":"36","author":"A Levitt","year":"2010","journal-title":"Pers Soc Psychol Bull"},{"issue":"2","key":"pone.0331202.ref054","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1007\/s11121-016-0716-6","article-title":"Exploring couples\u2019 processes of change in the context of SASA!, a violence against women and HIV prevention intervention in Uganda","volume":"18","author":"E Starmann","year":"2017","journal-title":"Prev Sci"},{"issue":"12","key":"pone.0331202.ref055","doi-asserted-by":"crossref","first-page":"1700","DOI":"10.1080\/13691058.2020.1801843","article-title":"Pathways of change: qualitative evaluations of intimate partner violence prevention programmes in Ghana, Rwanda, South Africa and Tajikistan","volume":"23","author":"E Stern","year":"2021","journal-title":"Cult Health Sex"},{"key":"pone.0331202.ref056","doi-asserted-by":"crossref","first-page":"102233","DOI":"10.1016\/j.eclinm.2023.102233","article-title":"Long-term impacts of the Bandebereho programme on violence against women and children, maternal health-seeking, and couple relations in Rwanda: a six-year follow-up of a randomised controlled trial","volume":"64","author":"K Doyle","year":"2023","journal-title":"EClinicalMedicine"},{"key":"pone.0331202.ref057","doi-asserted-by":"crossref","first-page":"517","DOI":"10.2147\/IJWH.S77398","article-title":"Relationship power, communication, and violence among couples: results of a cluster-randomized HIV prevention study in a South African township","volume":"7","author":"AM Minnis","year":"2015","journal-title":"Int J Womens Health"},{"issue":"7","key":"pone.0331202.ref058","doi-asserted-by":"crossref","first-page":"2091","DOI":"10.1007\/s10461-019-02774-4","article-title":"Pathways for HIV prevention behaviors following a home-based couples intervention for pregnant women and male partners in Kenya","volume":"24","author":"AM Hatcher","year":"2020","journal-title":"AIDS Behav"},{"issue":"1","key":"pone.0331202.ref059","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1007\/s10461-019-02546-0","article-title":"Development of a novel scale to measure male partner involvement in the prevention of mother-to-child transmission of HIV in Kenya","volume":"24","author":"K Hampanda","year":"2020","journal-title":"AIDS Behav"},{"issue":"4","key":"pone.0331202.ref060","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1080\/13691058.2014.883645","article-title":"\u201cIt means there is doubt in the house\u201d: perceptions and experiences of HIV testing in rural Malawi","volume":"16","author":"AA Conroy","year":"2014","journal-title":"Cult Health Sex"},{"issue":"3","key":"pone.0331202.ref061","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1080\/00224499.2014.883590","article-title":"The influence of relationship power dynamics on HIV testing in rural Malawi","volume":"52","author":"AA Conroy","year":"2015","journal-title":"J Sex Res"},{"issue":"12","key":"pone.0331202.ref062","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2020-002439","article-title":"Effective prevention of intimate partner violence through couples training: a randomised controlled trial of Indashyikirwa in Rwanda","volume":"5","author":"K Dunkle","year":"2020","journal-title":"BMJ Glob Health"},{"issue":"3","key":"pone.0331202.ref063","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1089\/apc.2017.0285","article-title":"Development and piloting of a home-based couples intervention during pregnancy and postpartum in Southwestern Kenya","volume":"32","author":"JM Turan","year":"2018","journal-title":"AIDS Patient Care STDS"},{"key":"pone.0331202.ref064","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1186\/s13011-015-0005-6","article-title":"Adapting an evidence-based HIV behavioral intervention for South African couples","volume":"10","author":"WM Wechsberg","year":"2015","journal-title":"Subst Abuse Treat Prev Policy"},{"key":"pone.0331202.ref065","first-page":"1","article-title":"Alcohol use and relationship quality among South African couples","author":"SE Woolf-King","year":"2018","journal-title":"Subst Use Misuse"},{"key":"pone.0331202.ref066","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.socscimed.2016.01.035","article-title":"Power and the association with relationship quality in South African couples: Implications for HIV\/AIDS interventions","volume":"153","author":"AA Conroy","year":"2016","journal-title":"Soc Sci Med"},{"key":"pone.0331202.ref067","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1016\/j.socscimed.2016.08.020","article-title":"Expanding the relationship context for couple-based HIV prevention: Elucidating women\u2019s perspectives on non-traditional sexual partnerships","volume":"166","author":"TL Crankshaw","year":"2016","journal-title":"Soc Sci Med"},{"issue":"1","key":"pone.0331202.ref068","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1037\/a0031859","article-title":"Marital quality and health: a meta-analytic review","volume":"140","author":"TF Robles","year":"2014","journal-title":"Psychol Bull"},{"issue":"4","key":"pone.0331202.ref069","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1080\/00224499.2011.568127","article-title":"Sexual satisfaction, perceived availability of alternative partners, and marital quality in newlywed African American couples","volume":"49","author":"CE Stanik","year":"2012","journal-title":"J Sex Res"},{"issue":"7","key":"pone.0331202.ref070","doi-asserted-by":"crossref","first-page":"3297","DOI":"10.1007\/s10508-021-02098-2","article-title":"Development and validation of the couple sexual satisfaction scale for HIV and sexual health research","volume":"50","author":"AA Conroy","year":"2021","journal-title":"Arch Sex Behav"},{"issue":"3","key":"pone.0331202.ref071","doi-asserted-by":"crossref","first-page":"249","DOI":"10.2989\/16085906.2020.1811357","article-title":"Assessment of an HIV-prevention intervention for couples in peri-urban Uganda: pervasive challenges to relationship quality also challenge intervention effectiveness","volume":"19","author":"P Kajubi","year":"2020","journal-title":"Afr J AIDS Res"},{"issue":"4","key":"pone.0331202.ref072","doi-asserted-by":"crossref","first-page":"1273","DOI":"10.1007\/s10461-017-1937-9","article-title":"Couple relationship functioning as a source or mitigator of HIV risk: associations between relationship quality and sexual risk behavior in Peri-urban Uganda","volume":"22","author":"A Ruark","year":"2018","journal-title":"AIDS Behav"},{"issue":"1","key":"pone.0331202.ref073","doi-asserted-by":"crossref","first-page":"1878","DOI":"10.1186\/s12889-023-16762-w","article-title":"Supportive couple relationships buffer against the harms of HIV stigma on HIV treatment adherence","volume":"23","author":"SA Gutin","year":"2023","journal-title":"BMC Public Health"},{"issue":"2","key":"pone.0331202.ref074","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1016\/j.socscimed.2009.05.019","article-title":"Asset ownership and health and mental health functioning among AIDS-orphaned adolescents: findings from a randomized clinical trial in rural Uganda","volume":"69","author":"FM Ssewamala","year":"2009","journal-title":"Soc Sci Med"},{"issue":"11","key":"pone.0331202.ref075","doi-asserted-by":"crossref","first-page":"3763","DOI":"10.1007\/s10461-018-2173-7","article-title":"Does economic strengthening improve viral suppression among adolescents living with HIV? Results from a cluster randomized trial in Uganda","volume":"22","author":"LG Bermudez","year":"2018","journal-title":"AIDS Behav"},{"key":"pone.0331202.ref076","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1016\/j.jdeveco.2015.12.003","article-title":"Impact of village savings and loan associations: evidence from a cluster randomized trial","volume":"120","author":"C Ksoll","year":"2016","journal-title":"J Dev Econ"},{"issue":"3","key":"pone.0331202.ref077","doi-asserted-by":"crossref","first-page":"462","DOI":"10.1007\/s10461-009-9532-3","article-title":"Microfinance and HIV\/AIDS prevention: assessing its promise and limitations","volume":"13","author":"SL Dworkin","year":"2009","journal-title":"AIDS Behav"},{"key":"pone.0331202.ref078","unstructured":"Leatherman S, Dunford C, Metcalfe M, Reinsch M, Gash M. Integrating Microfinance and Health: Benefits, challenges and reflections for moving forward. Global Microcredit Summit; 2011 November 14\u201317, 2011."},{"issue":"145","key":"pone.0331202.ref079","doi-asserted-by":"crossref","first-page":"414","DOI":"10.1080\/03056244.2015.1064369","article-title":"Exploring the complexity of microfinance and HIV in fishing communities on the shores of Lake Malawi","volume":"42","author":"E MacPherson","year":"2015","journal-title":"Rev Afr Polit Econ"},{"issue":"2","key":"pone.0331202.ref080","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1080\/10852351003640849","article-title":"Findings from SHAZ!: a feasibility study of a microcredit and life-skills HIV prevention intervention to reduce risk among adolescent female orphans in Zimbabwe","volume":"38","author":"MS Dunbar","year":"2010","journal-title":"J Prev Interv Community"},{"issue":"1","key":"pone.0331202.ref081","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1080\/13552074.2013.767495","article-title":"I can do women\u2019s work: reflections on engaging men as allies in women\u2019s economic empowerment in Rwanda","volume":"21","author":"H Slegh","year":"2013","journal-title":"Gend Dev"},{"issue":"3","key":"pone.0331202.ref082","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1016\/j.drugalcdep.2010.06.014","article-title":"A systematic review of the impact of alcohol use disorders on HIV treatment outcomes, adherence to antiretroviral therapy and health care utilization","volume":"112","author":"MM Azar","year":"2010","journal-title":"Drug Alcohol Depend"},{"issue":"7","key":"pone.0331202.ref083","doi-asserted-by":"crossref","first-page":"1040","DOI":"10.1080\/17441692.2020.1724314","article-title":"Stigmatisation of alcohol use among people receiving antiretroviral therapy for HIV infection, Cape Town, South Africa","volume":"15","author":"S Kalichman","year":"2020","journal-title":"Glob Public Health"},{"issue":"2","key":"pone.0331202.ref084","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1080\/09540121.2016.1211244","article-title":"The association between substance use and sub-optimal HIV treatment engagement among HIV-infected female sex workers in Lilongwe, Malawi","volume":"29","author":"KE Lancaster","year":"2017","journal-title":"AIDS Care"},{"issue":"11","key":"pone.0331202.ref085","doi-asserted-by":"crossref","DOI":"10.1016\/S2352-3018(22)00237-5","article-title":"Viral suppression and self-reported ART adherence after 3 years of universal testing and treatment in the HPTN 071 (PopART) community-randomised trial in Zambia and South Africa: a cross-sectional analysis","volume":"9","author":"D Macleod","year":"2022","journal-title":"Lancet HIV"},{"issue":"11","key":"pone.0331202.ref086","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1002183","article-title":"Patient-reported barriers to adherence to antiretroviral therapy: a systematic review and meta-analysis","volume":"13","author":"Z Shubber","year":"2016","journal-title":"PLoS Med"},{"issue":"5","key":"pone.0331202.ref087","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1080\/09540121.2023.2299324","article-title":"Epidemiology of alcohol use and alcohol use disorders among people living with HIV on antiretroviral therapy in Northwest Tanzania: implications for ART adherence and case management","volume":"36","author":"P Ayieko","year":"2024","journal-title":"AIDS Care"},{"issue":"6","key":"pone.0331202.ref088","doi-asserted-by":"crossref","first-page":"1612","DOI":"10.1007\/s10461-018-2340-x","article-title":"Gender differences and psychosocial factors associated with problem drinking among adults enrolling in HIV care in Tanzania","volume":"23","author":"AM Parcesepe","year":"2019","journal-title":"AIDS Behav"},{"issue":"11","key":"pone.0331202.ref089","doi-asserted-by":"crossref","DOI":"10.1002\/jia2.26029","article-title":"Hazardous alcohol use and HIV indicators in six African countries: results from the population-based HIV impact assessments, 2015-2017","volume":"25","author":"GC Chang","year":"2022","journal-title":"J Int AIDS Soc"},{"issue":"2","key":"pone.0331202.ref090","article-title":"Why did i stop? Barriers and facilitators to uptake and adherence to ART in Option B+ HIV care in Lilongwe, Malawi","volume":"11","author":"MH Kim","year":"2016","journal-title":"PLoS One"},{"issue":"1","key":"pone.0331202.ref091","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1186\/s12889-017-4611-2","article-title":"Acceptability of lifelong treatment among HIV-positive pregnant and breastfeeding women (Option B+) in selected health facilities in Zimbabwe: a qualitative study","volume":"18","author":"A Chadambuka","year":"2017","journal-title":"BMC Public Health"},{"issue":"7","key":"pone.0331202.ref092","doi-asserted-by":"crossref","DOI":"10.1002\/hsr2.1404","article-title":"Adherence to option B PMTCT program and its predictors among HIV-positive women in Ethiopia","volume":"6","author":"H Geremew","year":"2023","journal-title":"Health Sci Rep"},{"issue":"2","key":"pone.0331202.ref093","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0212587","article-title":"Low adherence to Option B antiretroviral therapy among pregnant women and lactating mothers in eastern Tanzania","volume":"14","author":"KM Zacharius","year":"2019","journal-title":"PLoS One"},{"issue":"11","key":"pone.0331202.ref094","doi-asserted-by":"crossref","first-page":"3551","DOI":"10.1007\/s10461-022-03636-2","article-title":"Relationship dynamics are associated with self-reported adherence but not an objective adherence measure in Malawi","volume":"26","author":"AA Conroy","year":"2022","journal-title":"AIDS Behavior"},{"key":"pone.0331202.ref095","doi-asserted-by":"crossref","first-page":"117407","DOI":"10.1016\/j.socscimed.2024.117407","article-title":"Mlambe economic and relationship-strengthening intervention for alcohol use decreases violence and improves relationship quality in couples living with HIV in Malawi","volume":"362","author":"AA Conroy","year":"2024","journal-title":"Soc Sci Med"},{"issue":"7","key":"pone.0331202.ref096","doi-asserted-by":"crossref","first-page":"2296","DOI":"10.1007\/s10461-024-04326-x","article-title":"Pilot trial results of mlambe: an economic and relationship-strengthening intervention to address heavy drinking and adherence to antiretroviral therapy in Malawi","volume":"28","author":"AA Conroy","year":"2024","journal-title":"AIDS Behav"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0331202","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T17:36:38Z","timestamp":1756488998000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0331202"}},"subtitle":[],"editor":[{"given":"Joseph KB","family":"Matovu,","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,8,29]]},"references-count":96,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2025,8,29]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0331202","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,29]]}}}