Community-level spillover effects of an intervention to prevent intimate partner violence and HIV transmission in rural Ethiopia

Abstract

BackgroundIntimate partner violence (IPV) is associated with adverse health and psychosocial outcomes. We analysed the spillover effects of Unite for a Better Life (UBL), an intervention evaluated in a cluster randomised controlled trial using a double-randomised design; previous evidence suggests UBL reduced IPV in rural Ethiopia among direct beneficiaries.MethodsVillages (n=64) were randomly allocated to control, or to receive UBL delivered to men, women or couples. Each cluster comprised 106 surveyed households, including 21 randomly selected indirect beneficiary households who were not included in the intervention. Primary and secondary IPV outcomes included women’s experience and men’s perpetration of past-year physical or sexual IPV 24 months postintervention. An intention-to-treat analysis was conducted comparing indirect beneficiaries to sampled households in control communities. The analysis includes 2516 households surveyed at baseline in 2014–2015 (1680 households in the control arm, 258 indirect beneficiary households in the couples’ arm, 287 indirect beneficiary households in the women’s arm and 291 indirect beneficiary households in the men’s arm). Follow-up data were available from 88% of baseline respondents and 86% of baseline spouses surveyed in 2017–2018, a total of 4379 individuals.ResultsAmong indirect beneficiaries, there was no statistically significant intervention effect on women’s past-year experience of physical or sexual IPV, while men’s UBL significantly reduced reported perpetration of past-year sexual IPV (Adjusted Odds Ratio: 0.55; 95% CI 0.38 to 0.80, p=0.002). The intervention effects among indirect beneficiaries were statistically similar to those reported for the direct beneficiaries. In general, the hypothesis of equal effects cannot be rejected.ConclusionA gender-transformative intervention delivered to men was effective in reducing reported IPV even among indirect beneficiaries, suggesting that the programme had positive spillover effects in diffusing information and changing behaviours within the broader community.Trial registration numbersNCT02311699 and American Economic Association Registry (AEARCTR-0000211).

Strengthening women's empowerment and gender equality in fragile contexts towards peaceful and inclusive societies: A systematic review and meta‐analysis

“…In line with this review's specific focus on interventions that commenced on or after 2000, the earliest included publication was Legovini (2005) and the most recent was Leight et al (2021). The annual number of publications saw a steady increase over the years with 89 (65% of the total) published between 2016 and 2021.…”

“…According to the $$Q$$‐test, there was no significant amount of heterogeneity in the true outcomes ($$Q(7)=6.47$$, $$p=0.49$$, $${\hat{\tau }}^{2}=0.00$$, $${I}^{2}=0.00$$%), thus we did not test for moderation. One study (Leight et al, 2021) had a relatively large weight compared to the rest of the studies (i.e., $$\text{weight}\ge 3/k$$, so a weight at least 3 times as large as having equal weights across studies). An examination of the studentized residuals revealed that none of the studies had a value larger than $$\pm 2.73$$ and hence there was no indication of outliers in the context of this model.…”

“…Tanner and O'Connor (2017a) reports on a study taking place in Democratic Republic of Congo, while Tanner and O'Connor (2017b) reports on a study taking place in Ethiopia. In addition, the two Leight et al (2021) effects are independent, with one effect for women ( g = 0.03) and one for men ( g = 0.09).…”

“…These included Sharma and colleagues (2020; g = −0.01 for women and g = 0.00 for men), Halim (2019; g = 0.09 for men and g = 0.17 for women), and Murray and colleagues (2020; g = 0.26 for both women and men). Leight et al (2021) and Sharma and colleagues (2020) were assessed as low risk of bias, while the other studies were assessed as high risk of bias.…”

Cost-effectiveness analysis of an intimate partner violence prevention intervention targeting men, women and couples in rural Ethiopia: evidence from the Unite for a Better Life randomised controlled trial

“…22 In addition, a separate analysis examined the diffusion of the intervention effects to the 20% of individuals enrolled in the trial who were not invited to participate in the intervention. 24 Evidence suggests that women in the intervention communities who were not sampled for participation in the intervention reported a decline in experience of past-year IPV of comparable magnitude to that reported for intervention participants. In fact, the hypothesis that the direct and indirect effects are identical cannot be rejected.…”