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
Gender Violence and Health Centre, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, United Kingdom; Raising Voices, 16 Tufnell Drive, Kamwokya, Kampala, Uganda; Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, United States; Department of Obstetrics and Gynaecology, School of Medicine, Makerere University, Kampala, Uganda; Centre for Domestic Violence Prevention, 16 Tufnell Drive, Kamwokya, Kampala, Uganda
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.Trial registration: ClinicalTrials.gov #NCT00790959,. Study protocol available at http://www.trialsjournal.com/content/13/1/96. © 2014 Abramsky et al.; licensee BioMed Central Ltd.
adult; Article; community care; concurrent sexual partnership; controlled study; cross-sectional study; female; follow up; health care survey; human; Human immunodeficiency virus infection; infection risk; intention to treat analysis; intervention study; male; outcome assessment; partner violence; random sample; randomized controlled trial; risk reduction; sexual behavior; sexual violence; social acceptance; Uganda; adolescent; cluster analysis; community care; HIV Infections; middle aged; partner violence; prevention and control; risk factor; statistics and numerical data; treatment outcome; Adolescent; Adult; Cluster Analysis; Community Health Services; Community Networks; Cross-Sectional Studies; Female; HIV Infections; Humans; Male; Middle Aged; Risk Factors; Spouse Abuse; Treatment Outcome; Uganda