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

Abstract

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 evidencebased 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-PLOS MEDICINE

Two-year treatment effects of the common elements treatment approach (CETA) for reducing intimate partner violence and unhealthy alcohol use in Zambia

“…The results from the primary trial analysis showed that CETA was clinically and statistically significantly superior to TAU-Plus in reducing both IPV and unhealthy alcohol use among heterosexual couples in Zambia at a one-year follow-up (Murray et al, 2020). The present study extends those findings to suggest that the treatment gains attributable to CETA persist for at least up to two years.…”

“…Of the 123 couples randomized to CETA, N = 97 (78.9%) women and N = 93 men (75.6%) completed a 24-month post-assessment. Table 1 shows the 24-month post-baseline assessment results for CETA participants and the reference values from baseline, posttreatment and 12 months post-baseline (Murray et al, 2020). For the primary study outcome, SVAWS physical/sexual violence subscale, the predicted mean at 24 month post-baseline (37.5, 95% CI 33.8-41.2) was similar and slightly lower than the mean for 12 months post-baseline (41.9, 95% CI 37.6-46.2) and the within-group effect size for change in SVAWS score from baseline to 24 months was 1.37 (p < 0.0001).…”

“…In addition to the limitations described in the original trial paper (Murray et al, 2020), the main limitation of the present analysis is the lack of a control group at 24 months. Given that there was not a significant reduction in symptoms among control participants between post-treatment and 12 months post-baseline, it is unlikely that such a reduction would have occurred between 12 and 24 months with no additional intervention.…”

“…The original trial methods are published in a protocol paper (Kane et al, 2017), the primary outcomes paper (Murray et al, 2020), and registered on ClincialTrials.gov (NCT02790827). Ethical approval was obtained from the Johns Hopkins Bloomberg School of Public Health IRB and the University of Zambia Biomedical Research Ethics Committee.…”

Examining the relationship between physical and sexual violence and psychosocial health in young people living with HIV in rural South Africa

“…economic interventions, parental support and coaching interventions, gender and violence norms interventions, etc.) have yielded mixed effects [71][72][73][74][75][76][77]. While the Responsible, Engaged and Loving Fathers intervention decreased perpetration of physical violence against children in Uganda [75], and the Common Elements Treatment Approach intervention decreased intimate partner violence against young women in Zambia [76], the Creating Opportunities through Mentorship, Parental Involvement and Safe Spaces caregiver training had no effect on violence against adolescent girls and young women in the Democratic Republic of the Congo [77].…”