Effects of couples motivational interviewing with mobile breathalyzers on mental health among HIV-affected couples in South Africa: A pilot randomized study

Introduction Mental health conditions are prevalent among people living with HIV and unhealthy alcohol use, negatively impacting HIV treatment outcomes. This secondary analysis examines preliminary mental health outcomes from a pilot randomized trial of couples motivational interviewing (MI) with mobile breathalyzer technology (Masibambisane) among couples affected by HIV and unhealthy alcohol use in South Africa. Methods Ninety couples participated in the Masibambisane randomized controlled trial in KwaZulu-Natal, South Africa. Eligibility criteria included age 18-49, relationship duration ≥6 months, ≥1 partner with positive AUDIT-C screen (≥3 for women, ≥4 for men) and on antiretroviral therapy. Couples were randomized to enhanced usual care (EUC), MI-only (3 sessions), or MI-plus (3 sessions plus twice-daily breathalyzer tests). Depressive symptoms (PHQ-8) and hopelessness (Beck's Hopelessness Scale) were assessed at baseline, 2 and 6-months. Linear mixed-effects regression models evaluated intervention effects. Results Mean age was 37.6 years; 21.7% had mild-to-moderately severe depressive symptoms at baseline. Depressive symptoms decreased significantly at 2-months (b = −1.02, p = 0.023) and 6-months (b = −1.38, p < 0.001) across groups. Hopelessness declined significantly at 2-months in MI-only (b = −0.92, p = 0.047) and MI-plus (b = −1.23, p = 0.008) versus EUC. Moderation analysis revealed significant depressive symptom reductions at 6-months in MI-only (b = −0.23, p = 0.018) and MI-plus (b = −0.25, p = 0.003) among participants with higher baseline symptoms. Conclusion Hopelessness declined significantly at 2-months in intervention arms compared to EUC. Participants with elevated baseline depressive symptoms benefited from MI interventions. A full-scale efficacy trial is warranted.