Findings from the SASA! Study: a cluster randomized controlled trial to assess the impact of a community mobilization intervention to prevent violence against women and reduce HIV risk in Kampala, Uganda
Findings from the SASA! Study: a cluster randomized controlled trial to assess the impact of a community mobilization intervention to prevent violence against women and reduce HIV risk in Kampala, Uganda
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DOI：
10.1186/s12916-014-0122-5
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发表时间：
2014-07-31
期刊：
影响因子：
9.3
通讯作者：
Watts, Charlotte
中科院分区：
文献类型：
--
作者：
Abramsky, Tanya;Devries, Karen;Watts, Charlotte
背景：亲密伴侣暴力（IPV）和艾滋病毒是重要的和相互关联的公共卫生问题。虽然人们认识到这些问题有着共同的社会驱动因素，但社区干预措施在社区一级减少暴力和艾滋病毒风险的潜力方面的证据有限。莎莎！研究评估了SASA！的社区影响，方法：从2007年到2012年，在乌干达坎帕拉的8个社区（4个干预和4个对照）进行了配对分组随机对照试验（CRT）。在基线（n = 1，583）和干预实施后四年（n = 2，532）对18至49岁的社区成员进行随机抽样横断面调查。六个暴力和艾滋病毒相关的主要结果被事先定义。一项调整后的聚类水平的意向治疗分析比较了干预和对照社区在随访时的结果。结果：干预与女性对IPV的社会接受度显着降低相关（调整后的风险比为0.54，95%置信区间（CI）为0.38至0.79），男性接受度较低（0.13，95% CI 0.01 - 1.15）;女性中女性可以拒绝性行为的接受程度显著更高（1.28，95% CI 1.07 - 1.52）和男性（1.31，95% CI 1.00 - 1.70）;女性过去一年的IPV经历降低52%（0.48，95% CI 0.16至1.39）;过去一年性IPV经历水平较低（0.76，95% CI 0.33至1.72）。在干预社区遭受暴力的妇女更有可能得到社区的支持性回应。报告过去一年的男性性并发症显着降低干预相比，控制communities（0.57，95%CI 0.36至0.91）。结论：这是第一个CRT在撒哈拉以南非洲评估社会影响的动员计划对IPV的社会可接受性，过去一年IPV的患病率和性并发症的水平。莎莎取得了重要的社区影响，目前正在控制社区实施，并在15个国家推广。
Background: Intimate partner violence (IPV) and HIV are important and interconnected public health concerns. While it is recognized that they share common social drivers, there is limited evidence surrounding the potential of community interventions to reduce violence and HIV risk at the community level. The SASA! study assessed the community-level impact of SASA!, a community mobilization intervention to prevent violence and reduce HIV-risk behaviors.Methods: From 2007 to 2012 a pair-matched cluster randomized controlled trial (CRT) was conducted in eight communities (four intervention and four control) in Kampala, Uganda. Cross-sectional surveys of a random sample of community members, 18- to 49-years old, were undertaken at baseline (n = 1,583) and four years post intervention implementation (n = 2,532). Six violence and HIV-related primary outcomes were defined a priori. An adjusted cluster-level intention-to-treat analysis compared outcomes in intervention and control communities at follow-up.Results: The intervention was associated with significantly lower social acceptance of IPV among women (adjusted risk ratio 0.54, 95% confidence interval (CI) 0.38 to 0.79) and lower acceptance among men (0.13, 95% CI 0.01 to 1.15); significantly greater acceptance that a woman can refuse sex among women (1.28, 95% CI 1.07 to 1.52) and men (1.31, 95% CI 1.00 to 1.70); 52% lower past year experience of physical IPV among women (0.48, 95% CI 0.16 to 1.39); and lower levels of past year experience of sexual IPV (0.76, 95% CI 0.33 to 1.72). Women experiencing violence in intervention communities were more likely to receive supportive community responses. Reported past year sexual concurrency by men was significantly lower in intervention compared to control communities (0.57, 95% CI 0.36 to 0.91).Conclusions: This is the first CRT in sub-Saharan Africa to assess the community impact of a mobilization program on the social acceptability of IPV, the past year prevalence of IPV and levels of sexual concurrency. SASA! achieved important community impacts, and is now being delivered in control communities and replicated in 15 countries.