Effectiveness of an integrated intimate partner violence and HIV prevention intervention in Rakai, Uganda

Analysis of an intervention in an existing cluster randomised cohort

Dados Bibliográficos

ID23339545
AutoresJennifer A Wagman (0000-0002-9957-1932, University of California San Diego, autor correspondente), Ronald H Gray (0000-0003-1952-6507, Johns Hopkins University), Jacquelyn C Campbell (0000-0003-3689-4547, Johns Hopkins University), Marie Thoma, Marie E Thoma (0000-0001-9267-4384, Johns Hopkins University), Anthony Ndyanabo (0000-0002-0087-9292, Rakai Health Sciences Program), Joseph Ssekasanvu (0000-0002-3721-2299, Rakai Health Sciences Program), Fred Nalugoda (0000-0001-6119-9293, Rakai Health Sciences Program), Joseph Kagaayi (0000-0003-4101-3038, Rakai Health Sciences Program), Gertrude Nakigozi (0000-0001-6193-2790, Rakai Health Sciences Program), David Serwadda (0000-0001-6532-6587, Mulago Hospital), Heena Brahmbhatt (0000-0002-6514-2347, Johns Hopkins University)
Ano2015
Volume3
Fascículo1
Páginase23-e33
Data de publicação2015-01-01
Peer ReviewedSim
Open AccessSim
TipoARTICLE
PeriódicoThe Lancet Global Health (JOURNAL)
Identificadores do periódicoISSN: 2214-109X • E-ISSN: 2572-116X
EditoraElsevier BV (PUBLISHER)
DOI10.1016/s2214-109x(14)70344-4
PMID25539966
PMCIDPMC4370228
OpenAlexW2126544305
IdiomaEN
Citações recebidas92
Referências citadas38

BACKGROUND: Intimate partner violence (IPV) is associated with HIV infection. We aimed to assess whether provision of a combination of IPV prevention and HIV services would reduce IPV and HIV incidence in individuals enrolled in the Rakai Community Cohort Study (RCCS), Rakai, Uganda. METHODS: We used pre-existing clusters of communities randomised as part of a previous family planning trial in this cohort. Four intervention group clusters from the previous trial were provided standard of care HIV services plus a community-level mobilisation intervention to change attitudes, social norms, and behaviours related to IPV, and a screening and brief intervention to promote safe HIV disclosure and risk reduction in women seeking HIV counselling and testing services (the Safe Homes and Respect for Everyone [SHARE] Project). Seven control group clusters (including two intervention groups from the original trial) received only standard of care HIV services. Investigators for the RCCS did a baseline survey between February, 2005, and June, 2006, and two follow-up surveys between August, 2006, and April, 2008, and June, 2008, and December, 2009. Our primary endpoints were self-reported experience and perpetration of past year IPV (emotional, physical, and sexual) and laboratory-based diagnosis of HIV incidence in the study population. We used Poisson multivariable regression to estimate adjusted prevalence risk ratios (aPRR) of IPV, and adjusted incidence rate ratios (aIRR) of HIV acquisition. This study was registered with ClinicalTrials.gov, number NCT02050763. FINDINGS: Between Feb 15, 2005, and June 30, 2006, we enrolled 11 448 individuals aged 15-49 years. 5337 individuals (in four intervention clusters) were allocated into the SHARE plus HIV services group and 6111 individuals (in seven control clusters) were allocated into the HIV services only group. Compared with control groups, individuals in the SHARE intervention groups had fewer self-reports of past-year physical IPV (346 [16%] of 2127 responders in control groups vs 217 [12%] of 1812 responders in intervention groups; aPRR 0·79, 95% CI 0·67-0·92) and sexual IPV (261 [13%] of 2038 vs 167 [10%] of 1737; 0·80, 0·67-0·97). Incidence of emotional IPV did not differ (409 [20%] of 2039 vs 311 [18%] of 1737; 0·91, 0·79-1·04). SHARE had no effect on male-reported IPV perpetration. At follow-up 2 (after about 35 months) the intervention was associated with a reduction in HIV incidence (1·15 cases per 100 person-years in control vs 0·87 cases per 100 person-years in intervention group; aIRR 0·67, 95% CI 0·46-0·97, p=0·0362). INTERPRETATION: SHARE could reduce some forms of IPV towards women and overall HIV incidence, possibly through a reduction in forced sex and increased disclosure of HIV results. Findings from this study should inform future work toward HIV prevention, treatment, and care, and SHARE's ecological approach could be adopted, at least partly, as a standard of care for other HIV programmes in sub-Saharan Africa. FUNDING: Bill & Melinda Gates Foundation, US National Institutes of Health, WHO, President's Emergency Plan for AIDS Relief, Fogarty International Center.

Cluster randomised controlled trial · Cohort · Domestic violence · Environmental health · Family medicine · Incidence (geometry) · Intervention (counseling) · Poison control · Poisson regression · Population · Psychiatry · Randomized controlled trial · Rate ratio · Suicide prevention · Adolescent Sexual and Reproductive Health · Demography · HIV/AIDS Research and Interventions · Internal Medicine · Intimate Partner and Family Violence · Medicine