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Effectiveness of a multilevel intervention to reduce violence and increase condom use in intimate partnerships among female sex workers: cluster randomised controlled trial in Karnataka, India.
BMJ Glob Health. 2019; 4(6):e001546.BG

Abstract

Introduction

Samvedana Plus is a multilevel intervention working with sex workers, their intimate partners (IPs) and communities to reduce intimate partner violence (IPV) and to increase condom use within intimate relationships of sex workers in Northern Karnataka, India.

Methods

A cluster randomised controlled trial in 47 villages. Female sex workers with IPs in the last 6 months were eligible for baseline (2014), midline (2016) and endline (2017) surveys. 24 villages were randomised to Samvedana Plus and 23 to a wait-list control. Primary outcomes among sex workers included experience of physical and/or sexual IPV or severe physical/sexual IPV in the last 6 months and consistent condom use with their IP in past 30 days. Analyses adjusted for clustering and baseline cluster-level means of outcomes.

Result

Baseline (n=620) imbalance was observed with respect to age (33.9 vs 35.2) and IPV (31.4% vs 45.0%). No differences in physical/sexual IPV (8.1% vs 9.0%), severe physical/sexual IPV (6.9% vs 8.7%) or consistent condom use with IPs (62.5% vs 57.3%) were observed by trial arm at end line (n=547). Samvedana Plus was associated with decreased acceptance of IPV (adjusted OR (AOR)=0.62, 95% CI 0.40 to 0.94, p=0.025), increased awareness of self-protection strategies (AOR=1.73, 95% CI=1.04-2.89, p=0.035) and solidarity of sex workers around issues of IPV (AOR=1.69, 95% CI=1.02-2.82, p=0.042). We observed an increase in IPV between baseline (25.9%) and midline (63.5%) among women in Samvedana Plus villages but lower in comparison villages (41.8%-44.3%) and a sharp decrease at end line in both arms (~8%).

Conclusion

We found no evidence that Samvedana Plus reduced IPV or increased condom use, but it may impact acceptance of IPV, increase knowledge of self-protection strategies and increase sex worker solidarity. Inconsistencies in reported IPV undermined the ability of the trial to assess effectiveness.

Trial registration number

NCT02807259.

Authors+Show Affiliations

Karnataka Health Promotion Trust, Bengalaru, India.Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.Karnataka Health Promotion Trust, Bengalaru, India.Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.Karnataka Health Promotion Trust, Bengalaru, India.Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.Gender and Health Division, South African Medical Research Council, Pretoria, South Africa.Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.Karnataka Health Promotion Trust, Bengalaru, India.Karnataka Health Promotion Trust, Bengalaru, India.Karnataka Health Promotion Trust, Bengalaru, India.Karnataka Health Promotion Trust, Bengalaru, India.Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31798984

Citation

Javalkar, Prakash, et al. "Effectiveness of a Multilevel Intervention to Reduce Violence and Increase Condom Use in Intimate Partnerships Among Female Sex Workers: Cluster Randomised Controlled Trial in Karnataka, India." BMJ Global Health, vol. 4, no. 6, 2019, pp. e001546.
Javalkar P, Platt L, Prakash R, et al. Effectiveness of a multilevel intervention to reduce violence and increase condom use in intimate partnerships among female sex workers: cluster randomised controlled trial in Karnataka, India. BMJ Glob Health. 2019;4(6):e001546.
Javalkar, P., Platt, L., Prakash, R., Beattie, T. S., Collumbien, M., Gafos, M., Ramanaik, S., Davey, C., Jewkes, R., Watts, C., Bhattacharjee, P., Thalinja, R., Dl, K., Isac, S., & Heise, L. (2019). Effectiveness of a multilevel intervention to reduce violence and increase condom use in intimate partnerships among female sex workers: cluster randomised controlled trial in Karnataka, India. BMJ Global Health, 4(6), e001546. https://doi.org/10.1136/bmjgh-2019-001546
Javalkar P, et al. Effectiveness of a Multilevel Intervention to Reduce Violence and Increase Condom Use in Intimate Partnerships Among Female Sex Workers: Cluster Randomised Controlled Trial in Karnataka, India. BMJ Glob Health. 2019;4(6):e001546. PubMed PMID: 31798984.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effectiveness of a multilevel intervention to reduce violence and increase condom use in intimate partnerships among female sex workers: cluster randomised controlled trial in Karnataka, India. AU - Javalkar,Prakash, AU - Platt,Lucy, AU - Prakash,Ravi, AU - Beattie,Tara S, AU - Collumbien,Martine, AU - Gafos,Mitzy, AU - Ramanaik,Satyanarayana, AU - Davey,Calum, AU - Jewkes,Rachel, AU - Watts,Charlotte, AU - Bhattacharjee,Parinita, AU - Thalinja,Raghavendra, AU - Dl,Kavitha, AU - Isac,Shajy, AU - Heise,Lori, Y1 - 2019/11/06/ PY - 2019/03/02/received PY - 2019/09/05/revised PY - 2019/09/12/accepted PY - 2019/12/5/entrez PY - 2019/12/5/pubmed PY - 2019/12/5/medline KW - cluster randomised controlled trial KW - intimate partner violence KW - sex worker SP - e001546 EP - e001546 JF - BMJ global health JO - BMJ Glob Health VL - 4 IS - 6 N2 - Introduction: Samvedana Plus is a multilevel intervention working with sex workers, their intimate partners (IPs) and communities to reduce intimate partner violence (IPV) and to increase condom use within intimate relationships of sex workers in Northern Karnataka, India. Methods: A cluster randomised controlled trial in 47 villages. Female sex workers with IPs in the last 6 months were eligible for baseline (2014), midline (2016) and endline (2017) surveys. 24 villages were randomised to Samvedana Plus and 23 to a wait-list control. Primary outcomes among sex workers included experience of physical and/or sexual IPV or severe physical/sexual IPV in the last 6 months and consistent condom use with their IP in past 30 days. Analyses adjusted for clustering and baseline cluster-level means of outcomes. Result: Baseline (n=620) imbalance was observed with respect to age (33.9 vs 35.2) and IPV (31.4% vs 45.0%). No differences in physical/sexual IPV (8.1% vs 9.0%), severe physical/sexual IPV (6.9% vs 8.7%) or consistent condom use with IPs (62.5% vs 57.3%) were observed by trial arm at end line (n=547). Samvedana Plus was associated with decreased acceptance of IPV (adjusted OR (AOR)=0.62, 95% CI 0.40 to 0.94, p=0.025), increased awareness of self-protection strategies (AOR=1.73, 95% CI=1.04-2.89, p=0.035) and solidarity of sex workers around issues of IPV (AOR=1.69, 95% CI=1.02-2.82, p=0.042). We observed an increase in IPV between baseline (25.9%) and midline (63.5%) among women in Samvedana Plus villages but lower in comparison villages (41.8%-44.3%) and a sharp decrease at end line in both arms (~8%). Conclusion: We found no evidence that Samvedana Plus reduced IPV or increased condom use, but it may impact acceptance of IPV, increase knowledge of self-protection strategies and increase sex worker solidarity. Inconsistencies in reported IPV undermined the ability of the trial to assess effectiveness. Trial registration number: NCT02807259. SN - 2059-7908 UR - https://www.unboundmedicine.com/medline/citation/31798984/Effectiveness_of_a_multilevel_intervention_to_reduce_violence_and_increase_condom_use_in_intimate_partnerships_among_female_sex_workers:_cluster_randomised_controlled_trial_in_Karnataka_India_ L2 - https://gh.bmj.com/lookup/pmidlookup?view=long&pmid=31798984 DB - PRIME DP - Unbound Medicine ER -
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