Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, United States of America.
PLoS Med. 2020 Apr 17;17(4):e1003056. doi: 10.1371/journal.pmed.1003056. eCollection 2020 Apr.
Both intimate partner violence (IPV) and alcohol misuse are highly prevalent, and partner alcohol misuse is a significant contributor to women's risk for IPV. There are few evidence-based interventions to address these problems in low- and middle-income countries (LMICs). We evaluated the effectiveness of an evidence-based, multi-problem, flexible, transdiagnostic intervention, the Common Elements Treatment Approach (CETA) in reducing (a) women's experience of IPV and (b) their male partner's alcohol misuse among couples in urban Zambia.
This was a single-blind, parallel-assignment randomized controlled trial in Lusaka, Zambia. Women who reported moderate or higher levels of IPV and their male partners with hazardous alcohol use were enrolled as a couple and randomized to CETA or treatment as usual plus safety checks (TAU-Plus). The primary outcome, IPV, was assessed by the Severity of Violence Against Women Scale (SVAWS) physical/sexual violence subscale, and the secondary outcome, male alcohol misuse, by the Alcohol Use Disorders Identification Test (AUDIT). Assessors were blinded. Analyses were intent-to-treat. Primary outcome assessments were planned at post-treatment, 12 months post-baseline, and 24 months post-baseline. Enrollment was conducted between May 23, 2016, and December 17, 2016. In total, 123 couples were randomized to CETA, 125 to TAU-Plus. The majority of female (66%) and a plurality of male (48%) participants were between 18 and 35 years of age. Mean reduction in IPV (via SVAWS subscale score) at 12 months post-baseline was statistically significantly greater among women who received CETA compared to women who received TAU-Plus (-8.2, 95% CI -14.9 to -1.5, p = 0.02, Cohen's d effect size = 0.49). Similarly, mean reduction in AUDIT score at 12 months post-baseline was statistically significantly greater among men who received CETA compared to men who received TAU (-4.5, 95% CI -6.9 to -2.2, p < 0.001, Cohen's d effect size = 0.43). The Data and Safety Monitoring Board recommended the trial be stopped early due to treatment effectiveness following the 12-month post-baseline assessment, and CETA was offered to control participants. Limitations of the trial included the lack of a true control condition (i.e., that received no intervention), self-reported outcomes that may be subject to social desirability bias, and low statistical power for secondary IPV outcomes.
Results showed that CETA was more effective than TAU-Plus in reducing IPV and hazardous alcohol use among high-risk couples in Zambia. Future research and programming should include tertiary prevention approaches to IPV, such as CETA, rather than offering only community mobilization and primary prevention.
The trial was registered on ClinicalTrials.gov (NCT02790827).
亲密伴侣暴力（IPV）和酒精滥用的发生率都很高，而伴侣的酒精滥用是女性遭受 IPV 风险的一个重要因素。在中低收入国家（LMICs），几乎没有针对这些问题的循证干预措施。我们评估了一种基于证据的、多问题的、灵活的、跨诊断的干预措施——共同要素治疗方法（CETA），以减少（a）女性经历的 IPV 和（b）她们在赞比亚城市的伴侣中的男性伴侣的酒精滥用。
这是在赞比亚卢萨卡进行的一项单盲、平行分组随机对照试验。报告中度或更高水平 IPV 的女性及其有危险饮酒行为的男性伴侣作为一对夫妇被纳入研究，并随机分配到 CETA 或常规治疗加安全检查（TAU-Plus）。主要结局是通过严重暴力侵害妇女量表（SVAWS）的身体/性暴力分量表评估的 IPV，次要结局是男性酒精滥用，通过酒精使用障碍识别测试（AUDIT）评估。评估者被设盲。分析采用意向治疗。主要结局评估计划在治疗后、基线后 12 个月和基线后 24 个月进行。招募工作于 2016 年 5 月 23 日至 12 月 17 日进行。共有 123 对夫妇随机分配到 CETA，125 对分配到 TAU-Plus。大多数女性（66%）和大多数男性（48%）参与者年龄在 18 至 35 岁之间。与接受 TAU-Plus 的女性相比，接受 CETA 的女性在基线后 12 个月时的 IPV（通过 SVAWS 分量表评分）减少幅度具有统计学意义（-8.2，95%CI-14.9 至-1.5，p=0.02，Cohen's d 效应量=0.49）。同样，与接受 TAU-Plus 的男性相比，接受 CETA 的男性在基线后 12 个月时 AUDIT 评分的减少幅度具有统计学意义（-4.5，95%CI-6.9 至-2.2，p<0.001，Cohen's d 效应量=0.43）。数据和安全监测委员会建议由于基线后 12 个月的评估显示出治疗效果，试验提前停止，并向对照组提供 CETA。试验的局限性包括缺乏真正的对照条件（即未接受任何干预）、自我报告的结果可能受到社会期望偏差的影响，以及次要 IPV 结局的统计效力较低。
结果表明，与 TAU-Plus 相比，CETA 在减少赞比亚高危夫妇中的 IPV 和危险饮酒方面更有效。未来的研究和规划应包括 IPV 的三级预防方法，如 CETA，而不仅仅是提供社区动员和初级预防。
该试验在 ClinicalTrials.gov 上注册（NCT02790827）。
