Effectiveness of an Integrated Intimate Partner Violence and HIV Prevention Intervention in Rakai, Uganda: Analysis of an Intervention in an Existing Cluster Randomised Cohort
Background Intimate partner violence (IPV) is associated with HIV infection. We aimed to assess whether provision
of a combination of IPV prevention and HIV services would reduce IPV and HIV incidence in individuals enrolled in
the Rakai Community Cohort Study (RCCS), Rakai, Uganda.
Methods We used pre-existing clusters of communities randomised as part of a previous family planning trial in this
cohort. Four intervention group clusters from the previous trial were provided standard of care HIV services plus a
community-level mobilisation intervention to change attitudes, social norms, and behaviours related to IPV, and a
screening and brief intervention to promote safe HIV disclosure and risk reduction in women seeking HIV
counselling and testing services (the Safe Homes and Respect for Everyone [SHARE] Project). Seven control group
clusters (including two intervention groups from the original trial) received only standard of care HIV services.
Investigators for the RCCS did a baseline survey between February, 2005, and June, 2006, and two follow-up surveys
between August, 2006, and April, 2008, and June, 2008, and December, 2009. Our primary endpoints were selfreported
experience and perpetration of past year IPV (emotional, physical, and sexual) and laboratory-based diagnosis
of HIV incidence in the study population. We used Poisson multivariable regression to estimate adjusted prevalence
risk ratios (aPRR) of IPV, and adjusted incidence rate ratios (aIRR) of HIV acquisition. This study was registered with
ClinicalTrials.gov, number NCT02050763.
Findings Between Feb 15, 2005, and June 30, 2006, we enrolled 11 448 individuals aged 15–49 years. 5337 individuals
(in four intervention clusters) were allocated into the SHARE plus HIV services group and 6111 individuals (in seven
control clusters) were allocated into the HIV services only group. Compared with control groups, individuals in the
SHARE intervention groups had fewer self-reports of past-year physical IPV (346 [16%] of 2127 responders in control
groups vs 217 [12%] of 1812 responders in intervention groups; aPRR 0·79, 95% CI 0·67–0·92) and sexual IPV
(261 [13%] of 2038 vs 167 [10%] of 1737; 0·80, 0·67–0·97). Incidence of emotional IPV did not diff er (409 [20%] of
2039 vs 311 [18%] of 1737; 0·91, 0·79–1·04). SHARE had no eff ect on male-reported IPV perpetration. At follow-up 2
(after about 35 months) the intervention was associated with a reduction in HIV incidence (1·15 cases per 100 personyears
in control vs 0·87 cases per 100 person-years in intervention group; aIRR 0·67, 95% CI 0·46–0·97, p=0·0362).
Interpretation SHARE could reduce some forms of IPV towards women and overall HIV incidence, possibly through
a reduction in forced sex and increased disclosure of HIV results. Findings from this study should inform future
work toward HIV prevention, treatment, and care, and SHARE’s ecological approach could be adopted, at least partly,
as a standard of care for other HIV programmes in sub-Saharan Africa.
Funding Bill & Melinda Gates Foundation, US National Institutes of Health, WHO, President’s Emergency Plan for
AIDS Relief, Fogarty International Center.
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