Effectiveness of the Common Elements Treatment Approach (CETA) in reducing intimate partner violence and hazardous alcohol use in Zambia (VATU): A randomized controlled trial
Effectiveness of the Common Elements Treatment Approach (CETA) in reducing intimate partner violence and hazardous alcohol use in Zambia (VATU): A randomized controlled trial
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DOI：
10.1371/journal.pmed.1003056
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发表时间：
2020-04-01
期刊：
影响因子：
15.8
通讯作者：
Bolton, Paul
中科院分区：
文献类型：
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作者：
Murray, Laura K.;Kane, Jeremy C.;Bolton, Paul
背景亲密伴侣暴力（IPV）和酗酒都非常普遍，伴侣酗酒是女性IPV风险的一个重要因素。在低收入和中等收入国家，解决这些问题的循证干预措施很少。我们评估的有效性，以证据为基础，多问题，灵活，transdiagnosis干预，共同要素治疗方法（CETA）在减少（a）妇女的经验IPV和（B）他们的男性伴侣的酒精滥用之间的夫妇在城市Zambia.Methods和findingsThis是一个单盲，平行分配随机对照试验在卢萨卡，赞比亚。报告中度或更高水平IPV的女性及其危险酒精使用的男性伴侣作为一对夫妇入选，并随机接受CETA或常规治疗加安全检查（TAU-Plus）。主要结局IPV通过暴力侵害妇女量表（SVAWS）身体/性暴力分量表进行评估，次要结局男性酒精滥用通过酒精使用障碍识别测试（AUDIT）进行评估。对评估者设盲。主要结果评估计划在治疗后、基线后12个月和基线后24个月进行。入组于2016年5月23日至2016年12月17日期间进行。共有123对夫妇被随机分配到CETA组，125对被随机分配到TAU-Plus组。大多数女性（66%）和多名男性（48%）参与者的年龄在18至35岁之间。基线后12个月时，接受CETA的女性的IPV平均降低（通过SVAWS子量表评分）在统计学上显著大于接受TAU-Plus的女性（-8.2，95% CI -14.9至-1.5，p = 0.02，Cohen偏转尺寸= 0.49）。类似地，与接受TAU的男性相比，接受CETA的男性在基线后12个月时AUDIT评分的平均降低在统计学上显著更大（-4.5，95% CI -6.9至-2.2，p < 0.001，Cohen偏转尺寸= 0.43）。数据和安全监测委员会建议，由于基线后12个月评估后的治疗有效性，应提前停止试验，并向对照受试者提供CETA。试验的局限性包括缺乏真正的对照条件（即，没有收到任何干预），自我报告的结果，可能会受到社会期望偏差，和低统计功率的二次IPV outcome.ConclusionsResults结果表明，CETA是更有效的比TAU加在减少IPV和危险的酒精使用在赞比亚的高风险夫妇。未来的研究和规划应包括IPV的三级预防方法，如CETA，而不仅仅是提供社区动员和初级预防。
BackgroundBoth 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 findingsThis 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 deflect 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 deflect 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.ConclusionsResults 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.