Effectiveness of the Common Elements Treatment Approach (CETA) in reducing intimate partner violence and hazardous alcohol use in Zambia (VATU): A randomized controlled trial

Abstract

Background: Both 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 findings: This 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 d effect 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 d effect 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.

Conclusions: Results 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.

Trial registration: The trial was registered on ClinicalTrials.gov (NCT02790827).

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Trial flow diagram.

CETA, Common Elements Treatment Approach; TAU-Plus, treatment as usual plus safety checks.

Fig 2. Change in female reporting of recent physical and sexual violence among those receiving CETA and TAU-Plus.

The difference in change from baseline to post-treatment and from baseline to 12 months post-baseline between the groups was statistically significant for both physical and sexual violence (p < 0.05). Baseline and 12-month post-baseline assessments had an intimate partner violence reference period of the past 12 months; the post-treatment assessment had a reference period of the past 3 months. CETA, Common Elements Treatment Approach; TAU-Plus, treatment as usual plus safety checks.

Fig 3. Change in male drinking among those receiving CETA and TAU-Plus as self-reported by the male and partner-reported by the female on AUDIT.

The difference in change from baseline to post-treatment and from baseline to 12 months post-baseline between the groups was statistically significant for both male self-report and female partner-report (p < 0.05). AUDIT, Alcohol Use Disorders Identification Test; CETA, Common Elements Treatment Approach; TAU-Plus, treatment as usual plus safety checks.