PROJECT SUMMARY / ABSTRACT
In Uganda, adolescent girls and young women (AGYW) are disproportionately affected by HIV and have
poor viral suppression rates, increasing their risk of onward transmission. Intimate partner violence (IPV) is a
major barrier to mitigating the impact of HIV among AGYW. AGYW living with HIV (AGYWLHIV) in sub-
Saharan Africa (SSA) who have experienced IPV have worse medication adherence, viral suppression, and
care engagement than those without IPV. Further, male partner alcohol use directly and indirectly increases
IPV risk among AGYW in SSA. Thus, an intervention with components that address heavy alcohol use
among male partners could decrease AGYW’s IPV risk, especially in Uganda, which has the highest alcohol
use per capita in SSA. Couples- based interventions have effectively reduced male partner alcohol use,
relationship conflict IPV, and improved viral suppression and HIV care engagement; yet, none have been
tailored to AGYWLHIV in SSA. We propose to develop and pilot a couples-based intervention that focuses
on improving HIV care engagement and ART adherence among AGYWLHIV by reducing heavy alcohol use
among male partners and couple IPV risk. Additionally, we will explore the intervention’s effects on AGYW
viral load for the additional key benefit of treatment as prevention. Our aims are to: 1) Adapt the behavioral
components of a brief MI-based alcohol intervention to create the proposed Kisoboka Mukwano (“It is
possible, my love!”) intervention. The intervention will promote strategies for reductions in male partner
alcohol use, coping with relationship conflict and stress, changing norms that reduce IPV and support
engagement in HIV care and ART adherence among AGYWLHIV, and, thereby, enhance future sustained
viral suppression and benefits of treatment as prevention. The intervention will be adapted and tailored to be
delivered with heterosexual couples, involve peer navigators, address IPV, and be developmentally
appropriate for AGYWLHIV in Uganda. We will develop and refine the intervention in collaboration with an
intervention steering committee through: qualitative research with married/cohabiting AGYWLHIV,
married/cohabiting men, and key informants and an initial pilot test with 6 couples. 2) We will assess safety,
acceptability, feasibility, and preliminary estimates of the potential for the intervention, as compared to the
control group, to improve HIV, alcohol, and IPV outcomes. We will examine preliminary effects on AGYW
HIV care engagement, AGYW ART adherence, heavy alcohol use among male partners, and couple IPV
risk and explore effects on AGYW viral load as well as intermediate outcomes related to intervention
components. We will assess these outcomes at baseline and then at 3- and 6-month follow-up. Study
findings will be used to guide a subsequent R01 proposal to test the intervention in a larger clinical trial.
