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

Figures & data

Figure 1. Conceptual model of the FSI-HIV modules.

Figure 2. FSI-HIV parent trial study flow.

Table 1. Characteristics of family, caregiver and child participants in a RCT of the FSI-HIV.

	Total n = 293	FSI-HIV n = 154	TAU n = 139
Families, no. (%)	82	41 (50)	41 (50)
Dual-caregiver families, no. (%)	40 (48.78)	20 (48.78)	20 (48.78)
Average no. of people per household, mean (SD)	4.86 (1.51)	5.08 (1.46)	4.82 (1.54)
Average no. of children < 18 in household, mean (SD)	3.00 (1.37)	3.17 (1.26)	2.98 (1.36)
SES, mean (SD)	.10 (.08)	.11 (.08)	.10 (.07)
Caregivers, no. (%)	123	61 (49.59)	62 (50.41)
Female, no. (%)	84 (68.29)	42 (68.85)	42 (67.74)
Age, mean (SD)	41.03 (8.76)	41.07 (9.12)	41.00 (8.46)
HIV-positive, no. (%)	103 (83.74)	52 (85.25)	51 (82.26)
Children, no. (%)	170	93 (54.71)	77 (45.29)
Female, no. (%)	83 (48.82)	52 (55.91)	31 (40.26)
Age, mean (SD)	11.76 (2.88)	11.83 (2.84)	11.68 (2.94)
Attends school, no. (%)	151 (93.21)	87 (96.67)	64 (88.89)
HIV-positive, no. (%)	21 (12.35)	6 (6.45)	15 (19.48)

Notes: FSI-HIV family-based intervention adapted for use within Rwandan families affected by HIV. TAU, treatment as usual (usual care or standard of care) comparison group.

Table 2. Alcohol use and IPV report at baseline.

Alcohol use AUDIT score	Total (n = 122)	Women	Men	P-value
0 (none)	59%	67%	41%
1–7 (non-harmful)	25%	23%	31%
8 or more (harmful)^a	16%	10%	28%	< .01
Intimate partner violence (IPV)	Total (n = 63)	Women	Men	P-value
Any IPV	71%	69%	75%	.58
Number of types of IPV (M, SD)	3.24 (3.71)	3.86 (4.37)	2.46 (2.52)	.14
Frequency of IPV (M, SD)	3.49 (5.33)	4.43 (6.59)	2.32 (2.84)	.12
Any perpetration	62%	57%	68%	.38
Number of types of perpetration (M, SD)	1.37 (1.71)	1.57 (1.95)	1.20 (1.49)	.40
Frequency of perpetration (M, SD)	1.46 (2.35)	1.43 (2.45)	1.50 (2.27)	.91
Any emotional abuse perpetration	52%	49%	57%	.46
Number of types of emotional abuse perpetration (M, SD)	0.63 (.68)	0.63 (0.73)	0.64 (0.62)	.93
Frequency of emotional abuse perpetration (M, SD)	0.65 (0.79)	0.66 (0.91)	0.64 (0.62)	.94

^aCut-off for harmful drinking reported here for standard AUDIT score and not reflective of the adapted AUDIT score used in this study.

Table 3. Qualitative findings caregiver alcohol use, IPV and child mental-health scores and experiences during the course of an FSI-HIV.

Qualitative findings	Early intervention (pre-sessions or module 1)	Mid-intervention (modules 2–5)	Late intervention (module 6 or family meeting)
	Example quotes
3a Theme 1: potential of a family-based intervention for reducing alcohol-related problems and family violence in HIV-affected households	“The second child is 11 years old and is very concerned by her family conflicts where the father is not caring toward the family and beats the mother a lot when he gets drunk”		“The father told the family that he took precautions of no longer fighting because it doesn’t help in any way; the mother also decided to not talk much to the husband when he was drunk because this has been generating conflicts”
3b Theme 2: effects of caregiver alcohol use and IPV on child well-being	“Child is very concerned by her family conflicts where the father is not caring toward the family and beats the mother a lot when he gets drunk. She always feared that the father could hurt them. She’s very close to her mother and reported to have emotional problems as well as her siblings”	“The parents’ behavior traumatized the children because they were often scared”	“The family is doing pretty well; they all noticed family conflicts are reduced. No more fights at home and both parents and children feel more at ease”
3c Theme 3: child and family resilience responses to FSI-HIV	“Family was divided, parents were not caring about their children, and nothing was going well in the family, children’s school results dropped, there was no good communication” “It has impacted children schooling, parents were no longer working together or take care of their children” “Children dropped out of school”	“The family had a very productive meeting. They reported a change in family conflicts and children are happier because they’re no longer worried and traumatized by their parents fights” “Child is focusing on schooling well and becoming a leader” “When there is a good relationship, children are happy and parents always share with them their CD4 results and when they increase all family members are happy and children think that parents are getting better.”	“They have time to discuss what they’re planning to do and children are also involved in decision making which makes everyone happy” “Parents plan to continue having family meetings to discuss different issues” “Children also are doing well in school and have scored with satisfaction” “The family is doing well; they all noticed family conflicts are reduced. No more fights at home and both parents and children feel more at ease” “The change in the family has been observed even by the community and they’re thankful to FSI because it has helped them so much! The wife said: “if you didn't come in our family, I might have been murdered by my husband and people could have forgotten about me”