Effectiveness of the Common Elements Treatment Approach (CETA) in reducing intimate partner violence and hazardous alcohol use in Zambia (VATU): A randomized controlled trial


Autoři: Laura K. Murray aff001;  Jeremy C. Kane aff001;  Nancy Glass aff003;  Stephanie Skavenski van Wyk aff001;  Flor Melendez aff001;  Ravi Paul aff004;  Carla Kmett Danielson aff005;  Sarah M. Murray aff001;  John Mayeya aff006;  Francis Simenda aff007;  Paul Bolton aff008
Působiště autorů: Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America aff001;  Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, United States of America aff002;  Johns Hopkins University School of Nursing, Baltimore, Maryland, United States of America aff003;  Department of Psychiatry, School of Medicine, University of Zambia, University Teaching Hospital, Lusaka, Zambia aff004;  National Crime Victims Research and Treatment Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, United States of America aff005;  Ministry of Health–Zambia, Chainama Hills College Hospital, Lusaka, Zambia aff006;  Chainama Hills College Hospital, Lusaka, Zambia aff007;  Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America aff008
Vyšlo v časopise: Effectiveness of the Common Elements Treatment Approach (CETA) in reducing intimate partner violence and hazardous alcohol use in Zambia (VATU): A randomized controlled trial. PLoS Med 17(4): e32767. doi:10.1371/journal.pmed.1003056
Kategorie: Research Article
doi: 10.1371/journal.pmed.1003056

Souhrn

Background

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.

Methods and findings

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.

Conclusions

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.

Trial registration

The trial was registered on ClinicalTrials.gov (NCT02790827).

Klíčová slova:

Alcohol consumption – Alcohols – Behavioral and social aspects of health – Employment – Intimate partner violence – Mental health and psychiatry – Randomized controlled trials – Zambia


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