Effectiveness of a culturally appropriate intervention to prevent intimate partner violence and HIV transmission among men, women, and couples in rural Ethiopia: Findings from a cluster-randomized controlled trial

Sharma, Vandana; Leight, Jessica; Verani, Fabio; Tewolde, Samuel; Deyessa, Negussie

doi:10.1371/journal.pmed.1003274

Cited by 47 publications

(86 citation statements)

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“…In particular, there is evidence of increased reported male perpetration of past-year physical IPV and physical and/or sexual IPV among indirect beneficiaries in couples’ UBL communities, while there was no evidence of this effect among the sample of direct beneficiaries. 22 Importantly, this increase is not corroborated by women indirect beneficiaries in the couples’ UBL communities, who do not report any statistically significant increase in past-year experience of physical IPV.…”

Section: Discussionmentioning

confidence: 91%

“…Full details of the trial design, data collection, methodology, intervention and main results are provided elsewhere. 22 23 The trial was conducted between 2014 and 2018 by the Abdul Latif Jameel Poverty Action Lab at the Massachusetts Institute of Technology, the Addis Ababa University School of Public Health (AAU), the Ethiopian Public Health Association (EPHA) and EngenderHealth.…”

Section: Methodsmentioning

confidence: 99%

“… 22 UBL was also associated with positive effects on a range of other outcomes, including HIV risk behaviours, intrahousehold decision-making, and male involvement in household tasks. 22 23 …”

Section: Introductionmentioning

confidence: 97%

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

et al. 2021

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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).

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Section: Discussionmentioning

confidence: 91%

Section: Methodsmentioning

confidence: 99%

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

et al. 2021

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“…When UBL was delivered to couples, there was a reduction in experience of IPV that was not statistically significant at conventional levels; there was no observed reduction in IPV when UBL was delivered to women. 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.…”

Section: Randomised Controlled Trialmentioning

confidence: 99%

“…Previous evidence suggests the intervention when delivered to men was effective in reducing women’s reported past-year experience of physical and/or sexual IPV and men’s reported past-year perpetration of physical and/or sexual IPV, in addition to promoting equitable gender norms and reducing HIV risk behaviours when delivered to men and couples. 22 23 This paper reports on the overall cost of the programme, and its cost-effectiveness relative to the number of direct beneficiaries, the number of community-level beneficiaries and the cases of past-year physical and/or sexual IPV averted.…”

Section: Introductionmentioning

confidence: 99%

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

2021

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ObjectivesExperience of intimate partner violence (IPV) is associated with adverse health and psychosocial outcomes for women. However, rigorous economic evaluations of interventions targeting IPV prevention are rare. This paper analyses the cost-effectiveness of Unite for a Better Life (UBL), a gender-transformative intervention designed to prevent IPV and HIV risk behaviours among men, women and couples.DesignWe use an economic evaluation nested within a large-scale cluster randomised controlled trial, analysing financial and economic costs tracked contemporaneously.SettingUBL was implemented in rural southern Ethiopia between 2013 and 2015.ParticipantsThe randomised controlled trial included 6770 households in 64 villages.InterventionsUBL is an intervention delivered within the context of the Ethiopian coffee ceremony, a culturally established forum for community discussion, and designed to assist participants to build skills for healthy, non-violent, equitable relationships.Primary and secondary outcome measuresThis paper reports on the unit cost and cost-effectiveness of the interventions implemented. Cost-effectiveness is measured as the cost per case of past-year physical and/or sexual IPV averted.ResultsThe estimated annualised cost of developing and implementing UBL was 2015 US$296 772, or approximately 2015 US$74 per individual directly participating in the intervention and 2015 US$5 per person annually for each community-level beneficiary (woman of reproductive age in intervention communities). The estimated cost per case of past-year physical and/or sexual IPV averted was 2015 US$2726 for the sample of direct beneficiaries, and 2015 US$194 for the sample of all community-level beneficiaries.ConclusionsUBL is an effective and cost-effective intervention for the prevention of IPV in a low and middle-income country setting. Further research should explore strategies to quantify the positive effects of the intervention across other domains.Trial registration numberNCT02311699 (ClinicalTrials.gov); AEARCTR-0000211 (AEA Registry)

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

Lwamba¹,

Shisler²,

Ridlehoover³

et al. 2022

Campbell Systematic Reviews

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Background Across the globe, gender disparities still exist with regard to equitable access to resources, participation in decision‐making processes, and gender and sexual‐based violence. This is particularly true in fragile and conflict‐affected settings, where women and girls are affected by both fragility and conflict in unique ways. While women have been acknowledged as key actors in peace processes and post‐conflict reconstruction (e.g., through the United Nations Security Council Resolution 1325 and the Women, Peace and Security Agenda) evidence on the effectiveness of gender‐specific and gender‐transformative interventions to improve women's empowerment in fragile and conflict‐affected states and situations (FCAS) remains understudied. Objectives The purpose of this review was to synthesize the body of evidence around gender‐specific and gender‐transformative interventions aimed at improving women's empowerment in fragile and conflict‐affected settings with high levels of gender inequality. We also aimed to identify barriers and facilitators that could affect the effectiveness of these interventions and to provide implications for policy, practice and research designs within the field of transitional aid. Methods We searched for and screened over 100,000 experimental and quasi‐experimental studies focused on FCAS at the individual and community levels. We used standard methodological procedures outlined by the Campbell Collaboration for the data collection and analysis, including quantitative and qualitative analyses, and completed the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) methodology to assess the certainty around each body of evidence. Results We identified 104 impact evaluations (75% randomised controlled trials) assessing the effects of 14 different types of interventions in FCAS. About 28% of included studies were assessed as having a high risk of bias (45% among quasi‐experimental designs). Interventions supporting women's empowerment and gender equality in FCAS produced positive effects on the outcomes related to the primary focus of the intervention. There are no significant negative effects of any included interventions. However, we observe smaller effects on behavioural outcomes further along the causal chain of empowerment. Qualitative syntheses indicated that gender norms and practices are potential barriers to intervention effectiveness, while working with local powers and institutions can facilitate the uptake and legitimacy of interventions. Conclusions We observe gaps of rigorous evidence in certain regions (notably MENA and Latin America) and in interventions specifically targeting women as actors of peacebuilding. Gender norms and practices are important elements to consider in programme design and implementation to maximise potential benefits: focusing on empowerment only might not be enough in the absence of targeting the restrictive gender norms and practices that may undermine intervention effectiveness. Lastly, programme designers and im...

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Effectiveness of a culturally appropriate intervention to prevent intimate partner violence and HIV transmission among men, women, and couples in rural Ethiopia: Findings from a cluster-randomized controlled trial

Cited by 47 publications

References 39 publications

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

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

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

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

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