Javalkar Prakash, Platt Lucy, Prakash Ravi, Beattie Tara S, Collumbien Martine, Gafos Mitzy, Ramanaik Satyanarayana, Davey Calum, Jewkes Rachel, Watts Charlotte, Bhattacharjee Parinita, Thalinja Raghavendra, Dl Kavitha, Isac Shajy, Heise Lori
Karnataka Health Promotion Trust, Bengalaru, India.
Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
BMJ Glob Health. 2019 Nov 6;4(6):e001546. doi: 10.1136/bmjgh-2019-001546. eCollection 2019.
Samvedana Plus is a multilevel intervention working with sex workers, their intimate partners (IPs) and communities to reduce intimate partner violence (IPV) and to increase condom use within intimate relationships of sex workers in Northern Karnataka, India.
A cluster randomised controlled trial in 47 villages. Female sex workers with IPs in the last 6 months were eligible for baseline (2014), midline (2016) and endline (2017) surveys. 24 villages were randomised to Samvedana Plus and 23 to a wait-list control. Primary outcomes among sex workers included experience of physical and/or sexual IPV or severe physical/sexual IPV in the last 6 months and consistent condom use with their IP in past 30 days. Analyses adjusted for clustering and baseline cluster-level means of outcomes.
Baseline (n=620) imbalance was observed with respect to age (33.9 vs 35.2) and IPV (31.4% vs 45.0%). No differences in physical/sexual IPV (8.1% vs 9.0%), severe physical/sexual IPV (6.9% vs 8.7%) or consistent condom use with IPs (62.5% vs 57.3%) were observed by trial arm at end line (n=547). Samvedana Plus was associated with decreased acceptance of IPV (adjusted OR (AOR)=0.62, 95% CI 0.40 to 0.94, p=0.025), increased awareness of self-protection strategies (AOR=1.73, 95% CI=1.04-2.89, p=0.035) and solidarity of sex workers around issues of IPV (AOR=1.69, 95% CI=1.02-2.82, p=0.042). We observed an increase in IPV between baseline (25.9%) and midline (63.5%) among women in Samvedana Plus villages but lower in comparison villages (41.8%-44.3%) and a sharp decrease at end line in both arms (~8%).
We found no evidence that Samvedana Plus reduced IPV or increased condom use, but it may impact acceptance of IPV, increase knowledge of self-protection strategies and increase sex worker solidarity. Inconsistencies in reported IPV undermined the ability of the trial to assess effectiveness.
NCT02807259.
“感知增强项目”（Samvedana Plus）是一项多层次干预措施，旨在与性工作者、她们的亲密伴侣及社区合作，以减少印度卡纳塔克邦北部性工作者亲密关系中的亲密伴侣暴力行为（IPV），并增加避孕套的使用。
在47个村庄进行了一项整群随机对照试验。在过去6个月内有亲密伴侣的女性性工作者符合基线（2014年）、中线（2016年）和终线（2017年）调查的条件。24个村庄被随机分配到“感知增强项目”组，23个村庄被分配到等待名单对照组。性工作者的主要结局包括过去6个月内遭受身体和/或性方面的亲密伴侣暴力行为或严重身体/性暴力行为的经历，以及在过去30天内与亲密伴侣始终使用避孕套的情况。分析对聚类和结局的基线聚类水平均值进行了调整。
观察到基线（n = 620）时在年龄（33.9对35.2）和亲密伴侣暴力行为（31.4%对45.0%）方面存在不平衡。在终线时（n = 547），试验组在身体/性方面的亲密伴侣暴力行为（8.1%对9.0%）、严重身体/性暴力行为（6.9%对8.7%）或与亲密伴侣始终使用避孕套的情况（62.5%对57.3%）方面未观察到差异。“感知增强项目”与亲密伴侣暴力行为接受度降低相关（调整后的比值比（AOR）= 0.62，95%置信区间0.40至0.94，p = 0.025），自我保护策略意识增强（AOR = 1.73，95%置信区间 = 1.04 - 2.89，p = 0.035）以及性工作者围绕亲密伴侣暴力行为问题的团结意识增强（AOR = 1.69，95%置信区间 = 1.02 - 2.82，p = 0.042）。我们观察到“感知增强项目”组村庄的女性在基线（25.9%）和中线（63.5%）之间亲密伴侣暴力行为有所增加，但对照村庄较低（41.8% - 44.3%），且两组在终线时均急剧下降（约8%）。
我们没有发现证据表明“感知增强项目”减少了亲密伴侣暴力行为或增加了避孕套的使用，但它可能会影响对亲密伴侣暴力行为的接受度，增加自我保护策略的知识，并增强性工作者的团结意识。所报告的亲密伴侣暴力行为的不一致性削弱了试验评估有效性的能力。
NCT02807259。
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