Efficacy of a Computerized Intervention on HIV and Intimate Partner Violence Among Substance-Using Women in Community Corrections: A Randomized Controlled Trial

Histories of violence among clients seeking substance use disorder treatment: a systematic mapping review

Introduction

There is a limited literature base regarding the intersection of drug and alcohol treatment, violence, and trauma. While research substantiates that exposure to violence and trauma impacts the propensity to misuse substances, the conceptualization in clinical trials and practice has largely been narrow and gendered, referring only to intimate partner or domestic violence. Our systematic mapping review explored a more inclusive and expansive review of survivors of and perpetrators of violence and trauma (e.g., intimate partner violence, sexual assault, stalking, child abuse, political and community violence, criminal violence, micro violence, structural violence, and oppression) to establish: 1) the types of treatment settings included in intervention studies, 2) the common indicators of success or common outcomes recorded, and 3) understanding who is seeking treatment for drug and alcohol use with histories of violence.

Methods

A systematic mapping review was conducted to identify any peer-reviewed articles published from 2011 to 2022. The Web of Science database was searched using a broad set of Boolean search terms related to violence, substance use disorders, and treatment. Over 8,800 records were identified from the systematic review with a total of 48 articles meeting inclusion criteria.

Results

Most studies in this review included populations reporting perpetration of violence (n=23, 48%) versus participants reporting survival of trauma/violence (n=17, 35%). Results also indicated female identifying populations (n=19; 40%) were predominantly served, were treated in the US (n=33; 69%) and seen in an outpatient setting (n=24; 50%). Authors also were attentive to studies that included sexual and gender minorities and discovered only three studies (6%) explicitly acknowledging inclusion of transgender participants or participants in relationship with partners of the same sex; three more studies (6%) were focused on participants with histories of or engaging in sex work.

Discussion

This review outlines treatment and research implications directly situated in the gap of service delivery found in this review. Specifically, the results elucidate the impact on minoritized and excluded identities based on gender, sexual preference, criminal legal status and directions for research and treatment to increase inclusion, representation, and equity across research and treatment settings.

Interventions to Prevent Intimate Partner Violence: A Systematic Review and Meta-Analysis

Intimate partner violence (IPV) remains a global health and human rights problem. This systematic review assesses the effects of preventive interventions on the occurrence of IPV experience or perpetration. Twenty-six studies published between January 1, 2008 and March 31, 2022 were included, contributing 91 effect sizes. Multilevel meta-analysis showed a protective pooled effect (risk ratio = 0.85, 95% CI [0.77, 0.99]). Interventions (also) including men were more effective than interventions for women only. No other moderators were found. Findings underscore that various IPV prevention interventions are now available that can improve the health and rights of women in diverse settings.

Identifying and Treating Incarcerated Women Experiencing Substance Use Disorders: A Review

While research on substance use disorder (SUD) treatment among justice-involved populations has grown in recent years, the majority of corrections-based SUD studies have predominantly included incarcerated men or men on community supervision. This review 1) highlights special considerations for incarcerated women that may serve as facilitating factors or barriers to SUD treatment; 2) describes selected evidence-based practices for women along the cascade of care for SUD including screening and assessment, treatment and intervention strategies, and referral to services during community re-entry; and 3) discusses conclusions and implications for SUD treatment for incarcerated women.

'Sometimes, we don't know if we're getting abused': discussions of intimate partner violence and HIV risk among transgender women

Transgender women are among the populations at highest risk for HIV in the USA and have elevated risk for intimate partner violence (IPV). There is an urgent need for integrated HIV-IPV prevention interventions for transgender women. Using qualitative methods, we explored transgender women's lived experiences of IPV and the relationship between IPV and HIV risk. Using thematic analysis, we identified four key concepts that warrant inclusion in the development of models for IPV and HIV interventions: (1) considering the boundaries of IPV; (2) normalising expectations of chronic violence; (3) relationship safety; (4) calls for trans-affirming and empowering services.

Intervening on the Intersecting Issues of Intimate Partner Violence, Substance Use, and HIV: A Review of Social Intervention Group's (SIG) Syndemic-Focused Interventions for Women

Intimate partner violence (IPV), HIV, and substance use are serious intersecting public health issues. This paper aims to describe the Social Intervention Group (SIG)'s syndemic-focused interventions for women that address the co-occurrence of IPV, HIV, and substance use, referred to as the SAVA syndemic. We reviewed SIG intervention studies from 2000 to 2020 that evaluated the effectiveness of syndemic-focused interventions which addressed two or more outcomes related to reducing IPV, HIV, and substance use among different populations of women who use drugs. This review identified five interventions that co-targeted SAVA outcomes. Of the five interventions, four showed a significant reduction in risks for two or more outcomes related to IPV, substance use, and HIV. The significant effects of SIG's interventions on IPV, substance use, and HIV outcomes among different populations of women demonstrate the potential of using syndemic theory and methods in guiding effective SAVA-focused interventions.

Information and communications technology use to prevent and respond to sexual and gender-based violence in low- and middle-income countries: An evidence and gap map

BACKGROUND

The use of information and communications technologies (ICT) in low- and middle-income countries (LMIC) has increased significantly in the last several years, particularly in health, including related areas such as preventing and responding to sexual and gender-based violence (SGBV) against women and children. While the evidence for ICT effectiveness has grown significantly in the past 5 years in other aspects of health, it has not for effectiveness of using ICT for the prevention and response to SGBV against women and children in LMIC.

OBJECTIVES

The primary goal of this evidence and gap map (EGM) is to establish a baseline for the state of the evidence connected with the use of ICT for preventing and responding to SGBV against women and children in LMIC. Objectives that contribute to the achievement of this goal are: (1)identifying evidence of effectiveness for the use of ICT targeting the prevention of, and response to, SGBV against women and children in LMIC;(2)identifying key gaps in the available ICT for SGBV prevention and/or response evidence;(3)identifying research methodology issues reflected in the current evidence;(4)identifying any clusters of evidence in one or more ICT interventions suitable for systematic review;(5)identifying enabling factors associated with effective interventions using ICT for the prevention of, and response to, SGBV against women and children in LMIC; and(6)providing a structured and accessible guide to stakeholders for future investment into interventions and research using ICT for SGBV prevention and response in LMIC.

SEARCH METHODS

The date of the last search from which records were evaluated, and any studies identified were incorporated into the EGM was July 11, 2021. Twenty (20) databases were searched, and identified under "Methods."

SELECTION CRITERIA

We conducted systematic searches of multiple academic databases using search terms and criteria related to the use of ICT for prevention and/or response to SGBV against women and children. Although excluded, we did consider studies conducted in higher-income countries (HIC) only to provide context and contrast for the EGM discussion of the eligible studies from LMIC.

DATA COLLECTION AND ANALYSIS

The EGM search process included five phases: (1) initial search of academic databases conducted by two researchers simultaneously; (2) comparison of search results, and abstract screening by two researchers collaboratively; (3) second screening by reviewing full articles of the studies identified in the first screening by two reviewers independently; (4) comparison of results of second screening; resolution of discrepancies of screening results; and (5) data extraction and analysis.

MAIN RESULTS

The EGM includes 10 studies published in English of which 4 were systematic, literature or scoping reviews directly addressing some aspect of the use of ICT for SGBV prevention and/or response in women and girls. The six individual studies were, or are being, conducted in LMIC (a condition for eligibility). No eligible studies addressed children as a target group, although a number of the ineligible studies reported on the use of ICT for intermediate outcomes connected with violence against children (e.g., digital parenting). Yet, such studies did not explicitly attach those intermediate outcomes to SGBV prevention or response outcomes. Countries represented among the eligible individual studies include Cambodia, Kenya, Nepal Democratic Republic of Congo (DRC), and Lebanon. Of the 10 eligible studies (individual and reviews), most focused on intimate partner violence against women (IPV). Intervention areas among the eligible studies include safety planning using decision algorithms, educational and empowerment messaging regarding norms and attitudes towards gender-based violence (GBV), multi-media radio drama for social behavior change, the collection of survivor experience to inform SGBV/GBV services, and the collection of forensic evidence connected to the perpetration of SGBV. Thirty-one studies which otherwise would have been eligible for the evidence and gap map (EGM) were conducted in HIC (identified under "Excluded Reviews"). None of the eligible studies reported results related to effectiveness of using ICT in a control setting, for the primary prevention of SGBV as an outcome, but rather reported on outcomes such as usability, secondary and tertiary prevention, feasibility, access to services and other outcomes primarily relating to the development of the interventions. Two studies identified IPV prevention as a measurable outcome within their protocols, but one of these had not yet formally published results regarding primary prevention as an outcome. The other study, while reporting on the protocol (and steps to adapt the ICT application, previously reported as effective in HIC contexts to a specific LMIC context), has not yet as of the date of writing this EGM, published outcome results related to the reduction of IPV. Of the four reviews identified as eligible, two are better characterized as either a literature review or case study rather than as traditional systematic reviews reporting on impact outcomes with methodologically rigorous protocols.

AUTHORS' CONCLUSIONS

The evidence baseline for using ICT to prevent and/or respond to SGBV against women and children in LMIC is nascent. Promising areas for future study include: (1) how ICT can contribute changing gender and social norms related to SGBV and primary prevention; (2) mobile phone applications that promote safety and security; (3) mobile technology for the collection and analysis of survivors' experience with SGBV response services; and (4) digital tools that support the collection of forensic evidence for SGBV response and secondary prevention. Most striking is the paucity of eligible studies examining the use of ICT in connection with preventing or responding to SGBV against children. In light of the exponential increase in the use of ICT by children and adolescents, even in LMIC, greater attention should be given to examining how ICT can be used during adolescence to address gender norms that lead to SGBV. While there appears to be interest in using ICT for SGBV prevention and/or response in LMIC, other than several ad hoc studies, there is little evidence of if, and how effective these interventions are. Further inquiry should be made regarding if and how interventions proven effective in HIC can be adapted to LMIC contexts.

Association Between Multiple Experiences of Violence and Drug Overdose Among Black Women in Community Supervision Programs in New York City

Research has documented associations between all types of violence and substance misuse among Black women. However, research has yet to examine how different experiences of violence may be contributing to the surging epidemic of drug overdose among Black women. This study was conducted between 2015 and 2018 among 296 Black women who were mandated to community supervision programs (CSPs) in New York City (NYC). We used generalized linear modeling (GLM) to estimate associations of the adjusted relative risk (aRR) of experiencing a non-fatal overdose based on exposure to each type of violence after controlling for potentially confounding variables. Lifetime prevalence of a non-fatal drug overdose was 13.9% (n = 41). Lifetime severe physical/sexual violence by a male intimate partner (prevalence rate = 61.8%, n = 181) was associated with an overdose (aRR = 3.41, 95%CI = 1.19, 9.73). Severe violence by a female partner (prevalence rate = 7.4%, n = 22) was also associated with an overdose (aRR = 2.61, 95%CI = 1.46, 4.65). Lifetime sexual violence by a non-intimate partner (prevalence rate: 29.1%, n = 86) was associated with an overdose (aRR = 2.23, 95%CI = 1.32, 3.77). Sexual abuse by police/CSP staff (prevalence rate: 14.9%, n = 44) was associated with an overdose (aRR = 2.29, 95%CI = 1.27, 4.12). For each increase in the number of types of violence experienced, there was a 27% increase in the risk for an overdose (aRR = 1.27, 95%CI = 1.14, 1.42). This study found high rates of multiple types of violence that are associated with drug overdose among this sample of Black women in CSPs. These findings highlight the urgent public health need to address violence associated with overdose in this population.

Safety Planning With Marginalized Survivors of Intimate Partner Violence: Challenges of Conducting Safety Planning Intervention Research With Marginalized Women

Intimate partner violence (IPV) disproportionately affects marginalized women in the United States. This calls for effective safety planning strategies to reduce the risk for future revictimization and address safety needs of survivors from marginalized groups. This review identified types of interventions that incorporated safety planning and were successful in reducing the risk for future revictimization among IPV survivors from diverse groups, examined elements of safety planning in effective interventions, and described challenges or limitations in safety planning intervention research with marginalized women. A systematic search of five databases was performed. The search resulted in inclusion of 17 studies for synthesis. The included studies were quantitative, U.S.-based, evaluated interventions with a safety planning component, and had an outcome of change in IPV. Effective interventions that incorporated safety planning were empowerment and advocacy focused. Elements included were comprehensive assessments of survivors' unique needs and situations, educating them about IPV, helping them identify threats to safety, developing a concrete safety plan, facilitating linkage with resources, providing advocacy services as needed, and conducting periodic safety check-ins. For survivors with mental and behavioral health issues, effective interventions included psychotherapeutic approaches along with safety planning to address survivors' co-occurring health care needs. Although most studies reported positive findings, there were limitations related to designs, methods, adequate inclusion, and representation of marginalized women and cultural considerations. This calls for additional research using rigorous and culturally informed approaches to establish an evidence base for effective interventions that specifically address the safety planning needs of marginalized survivors of IPV.

Technology-based and digital interventions for intimate partner violence: A systematic review and meta-analysis

BACKGROUND

A growing body of research shows the promise and efficacy of technology-based or digital interventions in improving the health and well-being of survivors of intimate partner violence (IPV). In addition, mental health comorbidities such as anxiety, post-traumatic stress disorder (PTSD), and depression occur three to five times more frequently in survivors of IPV than non-survivors, making these comorbidities prominent targets of technology-based interventions. Still, research on the long-term effectiveness of these interventions in reducing IPV victimization and adverse mental health effects is emergent. The significant increase in the number of trials studying technology-based therapies on IPV-related outcomes has allowed us to quantify the effectiveness of such interventions for mental health and victimization outcomes in survivors. This meta-analysis and systematic review provide critical insight from several randomized controlled trials (RCTs) on the overall short and long-term impact of technology-based interventions on the health and well-being of female IPV survivors.

OBJECTIVES

To synthesize current evidence on the effects of technology-based or digital interventions on mental health outcomes (depression, anxiety, and PTSD) and victimization outcomes (physical, psychological, and sexual abuse) among IPV survivors.

SEARCH METHODS

We examined multiple traditional and grey databases for studies published from 2007 to 2021. Traditional databases (such as PubMed Central, Web of Science, CINAHL Plus, and PsychINFO) and grey databases were searched between April 2019 and February 2021. In addition, we searched clinical trial registries, government repositories, and reference lists. Authors were contacted where additional data was needed. We identified 3210 studies in traditional databases and 1257 from grey literature. Over 2198 studies were determined to be duplicates and eliminated, leaving 64 studies after screening titles and abstracts. Finally, 17 RCTs were retained for meta-analysis. A pre-registered protocol was developed and published before conducting this meta-analysis.

SELECTION CRITERIA

We included RCTs targeting depression, anxiety, PTSD outcomes, and victimization outcomes (physical, sexual, and psychological violence) among IPV survivors using a technology-based intervention. Eligible RCTs featured a well-defined control group. There were no study restrictions based on participant gender, study setting, or follow-up duration. Included studies additionally supplied outcome data for calculating effect sizes for our desired outcome. Studies were available in full text and published between 2007 and 2021 in English.

DATA COLLECTION AND ANALYSIS

We extracted relevant data and coded eligible studies. Using Cochrane's RevMan software, summary effect sizes (Outcome by Time) were assessed using an independent fixed-effects model. Standardized mean difference (SMD) effect sizes (or Cohen's d) were evaluated using a Type I error rate and an alpha of 0.05. The overall intervention effects were analyzed using the Z-statistic with a p-value of 0.05. Cochran's Q test and Higgins' I ² statistics were utilized to evaluate and confirm the heterogeneity of each cumulative effect size. The Cochrane risk of bias assessment for randomized trials (RoB 2) was used to assess the quality of the studies. Campbell Systematic Reviews registered and published this study's protocol in January 2021. No exploratory moderator analysis was conducted; however, we report our findings with and without outlier studies in each meta-analysis.

MAIN RESULTS

Pooled results from 17 RCTs yielded 18 individual effect size comparisons among 4590 survivors (all females). Survivors included college students, married couples, substance-using women in community prisons, pregnant women, and non-English speakers, and sample sizes ranged from 15 to 672. Survivors' ages ranged from 19 to 41.5 years. Twelve RCTs were conducted in the United States and one in Canada, New Zealand, China (People's Republic of), Kenya, and Australia. The results of this meta-analysis found that technology-based interventions significantly reduced depression among female IPV survivors at 0-3 months only (SMD = -0.08, 95% confidence interval [CI] = -0.17 to -0.00), anxiety among IPV survivors at 0-3 months (SMD = -0.27, 95% CI = -0.42 to -0.13, p = 0.00, I ² = 25%), and physical violence victimization among IPV survivors at 0-6 months (SMD = -0.22, 95% CI = -0.38 to -0.05). We found significant reductions in psychological violence victimization at 0-6 months (SMD = -0.34, 95% CI = -0.47 to -0.20) and at >6 months (SMD = -0.29, 95% CI = -0.39 to -0.18); however, at both time points, there were outlier studies. At no time point did digital interventions significantly reduce PTSD (SMD = -0.04, 95% CI = -0.14 to 0.06, p = .46, I ² = 0%), or sexual violence victimization (SMD = -0.02, 95% CI = -0.14 to 0.11, I ² = 21%) among female IPV survivors for all. With outlier studies removed from our analysis, all summary effect sizes were small, and this small number of comparisons prevented moderator analyses.

AUTHORS' CONCLUSIONS

The results of this meta-analysis are promising. Our findings highlight the effectiveness of IPV-mitigating digital intervention as an add-on (not a replacement) to traditional modalities using a coordinated response strategy. Our findings contribute to the current understanding of "what works" to promote survivors' mental health, safety, and well-being. Future research could advance the science by identifying active intervention ingredients, mapping out intervention principles/mechanisms of action, best modes of delivery, adequate dosage levels using the treatment intensity matching process, and guidelines to increase feasibility and acceptability.

Effectiveness of Digital Health Interventions on Unintentional Injury, Violence, and Suicide: Meta-Analysis

Digital technologies are increasingly used in health-care delivery and are being introduced into work to prevent unintentional injury, violence, and suicide to reduce mortality. To understand the potential of digital health interventions (DHIs) to prevent and reduce these problems, we conduct a meta-analysis and provide an overview of their effectiveness and characteristics related to the effects. We searched electronic databases and reference lists of relevant reviews to identify randomized controlled trials (RCTs) published in or before March 2020 evaluating DHIs on injury, violence, or suicide reduction. Based on the 34 RCT studies included in the meta-analysis, the overall random effect size was 0.21, and the effect sizes for reducing suicidal ideation, interpersonal violence, and unintentional injury were 0.17, 0.24, and 0.31, respectively, which can be regarded as comparable to the effect sizes of traditional face-to-face interventions. However, there was considerable heterogeneity between the studies. In conclusion, DHIs have great potential to reduce unintentional injury, violence, and suicide. Future research should explore DHIs' successful components to facilitate future implementation and wider access.

Intertwined epidemics: progress, gaps, and opportunities to address intimate partner violence and HIV among key populations of women

The intersection of intimate partner violence and HIV is a public health problem, particularly among key populations of women, including female sex workers, women who use drugs, and transgender women, and adolescent girls and young women (aged 15-24 years). Intimate partner violence results in greater risk of HIV acquisition and creates barriers to HIV prevention, testing, treatment, and care for key populations of women. Socioecological models can be used to explain the unique multilevel mechanisms linking intimate partner violence and HIV. Few interventions, modelling studies, and economic evaluations that concurrently address both intimate partner violence and HIV exist, with no interventions tailored for transgender populations. Most combination interventions target individual-level risk factors, and rarely consider community or structural factors, or evaluate cost-efficacy. Addressing intimate partner violence is crucial to ending the HIV epidemic; this Review highlights the gaps and opportunities for future research to address the intertwined epidemics of intimate partner violence and HIV among key populations of women.

Availability of informal social support and the impact on health services utilization among women in community corrections who engage in substance use and risky sexual behavior: New York City, 2009-2012

BACKGROUND

Women under community supervision in the U.S. experience high rates of substance use and HIV/STDs and face multiple barriers to healthcare services. Informal social support, provided by family, friends, and other peers, is important for reducing drug and sexual risk behaviors and improving utilization of healthcare services. The availability of informal social support and the impact on receipt of healthcare services among the growing and highly vulnerable population of sexually-active and drug- and justice-involved women has not been documented. Among this population, this study aims to: 1) describe characteristics of informal social support, including the prevalence of different types, size of networks, and frequency of receiving support; and 2) longitudinally examine the impact of informal social support on receipt of healthcare services, including drug or alcohol counseling/treatment, HIV or STD counseling/education, birth control counseling/education, reproductive healthcare, and individual counseling over a 12-month period.

RESULTS

The sample included 306 women in community supervision programs in New York, New York, USA, with a recent history of substance use and risky sexual behavior. At baseline, 96.1% of women reported having at least one friend or family member with whom they could discuss personal or emotional problems, 92.5% had support for tangible aid or service, 83.0% had support for sexual risk reduction, and 80.0% had support for substance use risk reduction. Women with support for substance use risk reduction were more likely than women without this type of support to receive all health services analyzed in this study. Having support for sexual risk reduction was also positively associated will receipt of all services, except reproductive healthcare. Having support for personal or emotional problems was only associated with receiving drug or alcohol counseling or treatment, while having support for tangible aid or service did not impact receipt of any health services.

CONCLUSIONS

Engagement of sexually-active and drug- and justice-involved women in health services should address the availability and strengthening of informal social support, particularly ensuring individuals' informal networks allow for discussions on the harms of risky sexual and drug use behaviors.

TRIAL REGISTRATION

ClinicalTrials.gov NCT01784809 . Registered 6 February 2013 - Retrospectively registered.

Prevalence of Intimate Partner Violence, Substance Use Disorders and Depression among Incarcerated Women in Lima, Perú

Background: Globally, there is evidence supporting the co-occurrence of intimate partner violence (IPV), substance use disorders (SUD) and mental health disorders among women in prisons, however, there is limited research investigating these domains in the Andean region where rates of female incarceration have increased. The study objective was to explore the prevalence of IPV, SUD and depression among incarcerated women in a Peruvian prison and explore associations among these variables and related correlates. Methods: 249 incarcerated women responded to a questionnaire about IPV, substance use, depression, and sexual behavior, and were screened for HIV/sexually transmitted diseases (STDs). Univariate analysis and logistic regression were used to estimate relative risk and the influence of substance use and depression on IPV rates. Results: Twelve months prior to incarceration, of the women with sexual partners pre-incarceration (n = 212), 69.3% experienced threats of violence, 61.4% experienced ≥1 acts of physical violence, and 28.3% reported ≥1 act of sexual aggression. Pre-incarceration, 68.1% of drug-using women had a SUD, and 61.7% of those who consumed alcohol reported hazardous/harmful drinking. There were 20 (8.0%) HIV/STD cases; and 67.5% of the women reported depressive symptoms. Compared to women with no experiences of physical violence, a greater proportion of women who experienced least l violent act had depressive symptoms and engaged in sex work pre-incarceration. Depression was associated with physical violence (adjusted relative risk = 1.35, 95% confidence interval: 1.14–1.58). Recommendations: The findings provide evidence of a syndemic of IPV, substance abuse and depression among incarcerated women in a Peruvian prison. To help guide policy makers, further research is needed to determine if this is indicative of trends for other at-risk women in the region, and viable options to treat these women during incarceration to prevent recidivism and other long-term negative sequalae.

Web-Based and mHealth Interventions for Intimate Partner Violence Victimization Prevention: A Systematic Review

Mobile health (mHealth) technologies are increasingly used across health programming including intimate partner violence (IPV) prevention to optimize screening, educational outreach, and linkages to care via telehealth. We systematically evaluated current web-based and mHealth interventions, which include web- or mobile-based delivery methods for primary, secondary, and tertiary IPV victimization prevention. We searched MEDLINE/PubMed, Embase, CINAHL, PsycINFO, Open Grey, and Google Scholar for empirical studies published 1998-2019. Studies were included if they considered empirical data, participants in adult romantic relationships, IPV as a primary or secondary outcome, and an mHealth component. The Mixed Methods Appraisal Tool was used to record critical ratings of quality among studies selected for inclusion. We assessed variation in targeted populations, types of IPV addressed, and mHealth approaches used. Of 133 studies identified for full-text review, 31 were included. Computer-based screening with or without integrated education was the most common mHealth approach (n = 8, 26%), followed by safety decision aids (n = 7, 23%). Feasibility and acceptability were found to be generally high where assessed (23% of studies, n = 7). There was limited evidence around whether mHealth interventions better addressed population needs compared to conventional interventions. mHealth tools for IPV prevention are especially acceptable in health-care settings, on mobile phone platforms, or when connecting victims to health care. Despite enthusiasm in pilot projects, evidence for efficacy compared to conventional IPV prevention approaches is limited. A major strength of mHealth IPV prevention programming is the ability to tailor interventions to individual victim needs without extensive human resource expenditure by providers.

Effectiveness of a Culturally Tailored HIV and Sexually Transmitted Infection Prevention Intervention for Black Women in Community Supervision Programs: A Randomized Clinical Trial

IMPORTANCE

Concentrated epidemics of HIV and sexually transmitted infections (STIs) have persisted among Black women in community supervision programs (CSPs) in the United States. Accumulating research has highlighted the effectiveness of culturally tailored HIV/STI interventions for Black women; however, there is a dearth of such interventions for the large number of Black women in CSPs.

OBJECTIVE

To determine the effectiveness of a 5-session culturally tailored group-based intervention (Empowering African-American Women on the Road to Health [E-WORTH]) with individualized computerized modules and streamlined HIV testing in reducing STIs and condomless sex vs a 1-session streamlined HIV testing control condition.

DESIGN, SETTING, AND PARTICIPANTS

This randomized clinical trial was conducted from November 18, 2015, (first recruitment) to August 20, 2019 (last 12-month follow-up). Black women mandated to probation, parole, or alternative-to-incarceration programs in New York City who had a history of drug use were recruited and randomized to receive either E-WORTH or a streamlined HIV testing control condition. Both conditions were delivered by Black female staff at a large CSP. The analysis took an intention-to-treat approach.

INTERVENTION

E-WORTH included a 1-hour individual HIV testing and orientation session and 4 weekly 90-minute group sessions. The control condition included one 30-minute session of HIV testing and information.

MAIN OUTCOMES AND MEASURES

Primary outcomes were incidence of any STI (biologically assayed chlamydia, gonorrhea, and Trichomonas vaginalis) at the 12-month assessment and the number of condomless acts of vaginal or anal intercourse in the past 90 days during the 12-month period.

RESULTS

A total of 352 participants who identified as Black or African American were enrolled, including 79 (22.5%) who also identified as Latinx. The mean (SD) age was 32.4 (11.0) years. A total of 172 participants (48.9%) were assigned to the E-WORTH condition, and 180 (51.1%) were assigned to the control condition. Compared with control participants, participants assigned to the E-WORTH condition had 54% lower odds of testing positive for any STI at the 12-month follow-up (odds ratio, 0.46; 95% CI, 0.25-0.88; P = .01) and reported 38% fewer acts of condomless vaginal or anal intercourse during the 12-month period (incidence rate ratio, 0.62; 95% CI, 0.39-0.97; P = .04).

CONCLUSIONS AND RELEVANCE

The magnitudes of effects found across biological and behavioral outcomes in this randomized clinical trial indicate the feasibility and effectiveness of implementing E-WORTH in real-world CSPs. The findings lend further evidence to the promise of culturally tailored HIV/STI interventions for Black women.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02391233.

PROTOCOL: Technology-based and digital interventions for intimate partner violence: A meta-analysis and systematic review

INTRODUCTION

Studies show digital interventions such as mobile and wireless platforms (e.g., smartphone apps, text messaging) and web-based platforms (online support groups and telehealth services) can improve the mental health outcomes for victims/survivors of partner abuse. Depression, posttraumatic stress disorder (PTSD), and anxiety are three to five times higher among victims than nonvictims and are thus popular targets of digital interventions. Even then, the evidence is scant. The current review uses both narrative and quantitative (meta-analysis) techniques to present extensive evidence on the effects of intimate partner violence (IPV) digital interventions on the mental health outcomes among survivors of partner violence across all genders and ages, specifically, depression, anxiety, and PTSD. This is the first meta-analysis on IPV-related mental health outcomes targeted by digital interventions.

OBJECTIVES

To synthesize current evidence on the intervention and treatment effects of digital and technology-based interventions (mHealth and eHealth) addressing IPV mental health outcomes (depression, anxiety, and PTSD) among survivors of IPV. This study's research questions are as follows: (a) What are the overall average treatment effects of IPV digital interventions on IPV survivors' mental health outcomes? (b) Do these mental health outcomes vary based on methodological study designs, sample characteristics, and intervention characteristics?

METHODS

An extensive search strategy will be utilized to find qualifying studies. Various electronic bibliographic databases will be searched for studies since 2009 (coinciding with the onset of mobile health interventions). Other databases, such as government databases, grey literature databases, trial registers, specialty journals, and citations in other studies will be searched. Also, we will search "grey databases," such as Google Scholar. Ethical and safety concerns preclude the randomization of IPV survivors to specific intervention conditions. Therefore, we will not exclude studies based on a lack of random assignment. Studies will be full-text accessible, published in any language (translatable into English). We will also contact researchers where needed data is missing in their report. Neither language, study location, nor study settings will be a limiter for searches. Keyword and MeSH headings will be used. Effect sizes (Hedges' g) will be estimated with a Type I error rate set at an alpha of .05.

RESULTS

All studies will measure IPV-related mental health as an outcome and provide outcome data to calculate effect sizes for PTSD, anxiety, depression, and victimization (physical, psychological, and sexual violence).

CONCLUSION

Digital interventions may clinically reduce depression, anxiety, PTSD, and IPV victimization. Summary effect sizes ranging from small to large will signal the usefulness of digital interventions to IPV survivors contending with common mental health issues. Future studies beyond this one may identify other active intervention ingredients of digital interventions, best modes of delivery, and guidelines to increase their feasibility and acceptability.

Effectiveness of ICT-based intimate partner violence interventions: a systematic review

BACKGROUND

Intimate Partner Violence is a "global pandemic". Meanwhile, information and communication technologies (ICT), such as the internet, mobile phones, and smartphones, are spreading worldwide, including in low- and middle-income countries. We reviewed the available evidence on the use of ICT-based interventions to address intimate partner violence (IPV), evaluating the effectiveness, acceptability, and suitability of ICT for addressing different aspects of the problem (e.g., awareness, screening, prevention, treatment, mental health).

METHODS

We conducted a systematic review, following PRISMA guidelines, using the following databases: PubMed, PsycINFO, and Web of Science. Key search terms included women, violence, domestic violence, intimate partner violence, information, communication technology, ICT, technology, email, mobile, phone, digital, ehealth, web, computer, online, and computerized. Only articles written in English were included.

RESULTS

Twenty-five studies addressing screening and disclosure, IPV prevention, ICT suitability, support and women's mental health were identified. The evidence reviewed suggests that ICT-based interventions were effective mainly in screening, disclosure, and prevention. However, there is a lack of homogeneity among the studies' outcome measurements and the sample sizes, the control groups used (if any), the type of interventions, and the study recruitment space. Questions addressing safety, equity, and the unintended consequences of the use of ICT in IPV programming are virtually non-existent.

CONCLUSIONS

There is a clear need to develop women-centered ICT design when programming for IPV. Our study showed only one study that formally addressed software usability. The need for more research to address safety, equity, and the unintended consequences of the use of ICT in IPV programming is paramount. Studies addressing long term effects are also needed.

Psychological therapies for women who experience intimate partner violence

BACKGROUND

Intimate partner violence (IPV) against women is prevalent and strongly associated with mental health problems. Women experiencing IPV attend health services frequently for mental health problems. The World Health Organization recommends that women who have experienced IPV and have a mental health diagnosis should receive evidence-based mental health treatments. However, it is not known if psychological therapies work for women in the context of IPV and whether they cause harm.

OBJECTIVES

To assess the effectiveness of psychological therapies for women who experience IPV on the primary outcomes of depression, self-efficacy and an indicator of harm (dropouts) at six- to 12-months' follow-up, and on secondary outcomes of other mental health symptoms, anxiety, quality of life, re-exposure to IPV, safety planning and behaviours, use of healthcare and IPV services, and social support.

SEARCH METHODS

We searched the Cochrane Common Mental Disorders Controlled Trials Register (CCMDCTR), CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, and three other databases, to the end of October 2019. We also searched international trials registries to identify unpublished or ongoing trials and handsearched selected journals, reference lists of included trials and grey literature.

SELECTION CRITERIA

We included randomised controlled trials (RCTs), quasi-RCTs, cluster-RCTs and cross-over trials of psychological therapies with women aged 16 years and older who self-reported recent or lifetime experience of IPV. We included trials if women also experienced co-existing mental health diagnoses or substance abuse issues, or both. Psychological therapies included a wide range of interventions that targeted cognition, motivation and behaviour compared with usual care, no treatment, delayed or minimal interventions. We classified psychological therapies according to Cochrane Common Mental Disorders's psychological therapies list.

DATA COLLECTION AND ANALYSIS

Two review authors extracted data and undertook 'Risk of Bias' assessment. Treatment effects were compared between experimental and comparator interventions at short-term (up to six months post-baseline), medium-term (six to under 12 months, primary outcome time point), and long-term follow-up (12 months and above). We used standardised mean difference (SMD) for continuous and odds ratio (OR) for dichotomous outcomes, and used random-effects meta-analysis, due to high heterogeneity across trials.

MAIN RESULTS

We included 33 psychological trials involving 5517 women randomly assigned to experimental (2798 women, 51%) and comparator interventions (2719 women, 49%). Psychological therapies included 11 integrative therapies, nine humanistic therapies, six cognitive behavioural therapy, four third-wave cognitive behavioural therapies and three other psychologically-orientated interventions. There were no trials classified as psychodynamic therapies. Most trials were from high-income countries (19 in USA, three in Iran, two each in Australia and Greece, and one trial each in China, India, Kenya, Nigeria, Pakistan, Spain and UK), among women recruited from healthcare, community, shelter or refuge settings, or a combination of any or all of these. Psychological therapies were mostly delivered face-to-face (28 trials), but varied by length of treatment (two to 50 sessions) and staff delivering therapies (social workers, nurses, psychologists, community health workers, family doctors, researchers). The average sample size was 82 women (14 to 479), aged 37 years on average, and 66% were unemployed. Half of the women were married or living with a partner and just over half of the participants had experienced IPV in the last 12 months (17 trials), 6% in the past two years (two trials) and 42% during their lifetime (14 trials). Whilst 20 trials (61%) described reliable low-risk random-sampling strategies, only 12 trials (36%) described reliable procedures to conceal the allocation of participant status. While 19 trials measured women's depression, only four trials measured depression as a continuous outcome at medium-term follow-up. These showed a probable beneficial effect of psychological therapies in reducing depression (SMD -0.24, 95% CI -0.47 to -0.01; four trials, 600 women; moderate-certainty evidence). However, for self-efficacy, there may be no evidence of a difference between groups (SMD -0.12, 95% CI -0.33 to 0.09; one trial with medium-term follow-up data, 346 women; low-certainty evidence). Further, there may be no difference between the number of women who dropped out from the experimental or comparator intervention groups, an indicator of no harm (OR 1.04, 95% CI 0.75 to 1.44; five trials with medium-term follow-up data, 840 women; low-certainty evidence). Although no trials reported adverse events from psychological therapies or participation in the trial, only one trial measured harm outcomes using a validated scale. For secondary outcomes, trials measured anxiety only at short-term follow-up, showing that psychological therapies may reduce anxiety symptoms (SMD -0.96, 95% CI -1.29 to -0.63; four trials, 158 women; low-certainty evidence). However, within medium-term follow-up, low-certainty evidence revealed that there may be no evidence between groups for the outcomes safety planning (SMD 0.04, 95% CI -0.18 to 0.25; one trial, 337 women), post-traumatic stress disorder (SMD -0.24, 95% CI -0.54 to 0.06; four trials, 484 women) or re-exposure to any form of IPV (SMD 0.03, 95% CI -0.14 to 0.2; two trials, 547 women).

AUTHORS' CONCLUSIONS

There is evidence that for women who experience IPV, psychological therapies probably reduce depression and may reduce anxiety. However, we are uncertain whether psychological therapies improve other outcomes (self-efficacy, post-traumatic stress disorder, re-exposure to IPV, safety planning) and there are limited data on harm. Thus, while psychological therapies probably improve emotional health, it is unclear if women's ongoing needs for safety, support and holistic healing from complex trauma are addressed by this approach. There is a need for more interventions focused on trauma approaches and more rigorous trials (with consistent outcomes at similar follow-up time points), as we were unable to synthesise much of the research.

A Systematic Review of Intimate Partner Violence Interventions: State of the Field and Implications for Practitioners

Intimate partner violence (IPV) victimization is a global public health issue and has serious consequences of women's health. While scholars and researchers have made some progress in addressing IPV and its impact across different levels of care, there is a paucity of intervention research in this area. For example, we know little about which intervention models work best for particular groups of IPV survivors. Previous reviews have concluded there is insufficient evidence to recommend specific treatment options for victims, but they have also been limited in scope of target populations or have employed narrow eligibility criteria. This systematic review examined the efficacy and effectiveness of interventions for victims of IPV related to physical and mental health and revictimization. Three large databases were searched and articles were selected using specified criteria. Fifty-seven articles met inclusion criteria. Results indicate that both empowerment-based advocacy and cognitively focused clinical interventions demonstrate positive outcomes on the vast sequelae of violence in the context of an intimate relationship. The heterogeneity of intervention approaches and frameworks makes comparisons across studies challenging, but this review demonstrates that interventions focused on problem-solving/solution seeking, enhanced choice making and the alteration in distorted self-thinking and perception are promising in facilitating and maintaining positive physical and mental health changes for women who experience violence.

Association between intimate partner violence and HIV status among Haitian Women

The prevalence of intimate partner violence (IPV) among women living in Haiti increased from 25% in 2006-29% in 2012, with escalating reports of crisis in the last several years. We examined the association between IPV and HIV status among these women in Haiti. Participants were drawn from a larger sample of women (n = 513) with a history of IPV. Women living with HIV (n = 55) were matched to uninfected women (n = 110) to form a control group. Attitudes towards gender roles, mental and physical well-being, and partner violence were assessed and compared. Logistic regressions were utilised to calculate multivariable-adjusted odds ratios. Women living with HIV were more likely to report more severe forms of psychological violence (p < 0.01), and severe physical violence (p < 0.0001). Women who experienced severe forms of IPV were 3.5 times more likely to have an HIV positive status compared to those who did not experience severe IPV (p < 0.0001). There were significant associations between severe forms of IPV, and HIV status among Haitian women. IPV severity should be integrated into eligibility screening for biomedical strategies of prevention such as pre-exposure prophylaxis (PrEP) among Haitian women.

Power to participants: a call for person-centred HIV prevention services and research

INTRODUCTION

While biomedical HIV prevention offers promise for preventing new HIV infections, access to and uptake of these technologies remain unacceptably low in some settings. New models for delivery of HIV prevention are clearly needed. This commentary highlights the potential of person-centred programming and research for increasing the cultural relevance, applicability and use of efficacious HIV prevention strategies. It calls for a shift in perspective within HIV prevention programmes and research, whereby people are recognized for their agency rather than assumed to be passive beneficiaries or research participants.

DISCUSSION

Person-centred HIV prevention reorientates power dynamics so that individuals (rather than interventions) are at the centre of the response. Respecting personal choice and agency - and understanding how these are shaped by the context in which people exercise these choices - are critical dimensions of the person-centred approach. Community-based participatory research should be employed to inform and evaluate person-centred HIV prevention. We argue that community-based participatory research is an orientation rather than a method, meaning that it can be integrated within a range of research methods including randomized controlled trials. But embracing community-based participatory approaches in HIV prevention research requires a systemic shift in how this type of research is reported in high impact journals and in how research impact is conceived. Community-based organizations have a critical role to play in both person-centred HIV prevention and research.

CONCLUSIONS

HIV prevention is situated at the intersection of unprecedented opportunity and crisis. Person-centred approaches to HIV prevention and research shift power dynamics, and have the potential to ensure a more sustainable response with each individual actively participating in their own care and meaningfully contributing to the production of knowledge on HIV prevention. This approach taps into the resourcefulness, resilience and knowledge of the person and their communities, to strengthen research and programmes, making them more relevant, appropriate and effective.

The effectiveness of a group-based computerized HIV/STI prevention intervention for black women who use drugs in the criminal justice system: study protocol for E-WORTH (Empowering African-American Women on the Road to Health), a Hybrid Type 1 randomized controlled trial

BACKGROUND

This paper describes the study protocol of a hybrid type I randomized controlled trial that evaluates the effectiveness and cost-effectiveness of implementing Empowering African-American Women on the Road to Health (E-WORTH), an Afrocentric, group-based, computerized human immunodeficiency virus (HIV)/sexually transmitted infection (STI) prevention intervention for controlled substance-using black women in community corrections settings in New York City.

METHODS/DESIGN

We provide an overview of E-WORTH's hybrid type I design, which is guided by the Consolidated Framework for Implementation Research (CFIR). E-WORTH combines HIV/STI and intimate partner violence (IPV) prevention components and tests the comparative effectiveness of E-WORTH and streamlined HIV testing versus streamlined HIV testing alone in decreasing biologically confirmed HIV and STI incidence, sexual risk, and IPV, as well as in improving access to HIV and STI prevention services and care.

DISCUSSION

This paper provides an overview of E-WORTH's intervention protocol and serves as a framework for using hybrid type I designs, guided by the CFIR conceptual framework, to evaluate HIV/STI and IPV prevention interventions in community corrections settings. We discuss how E-WORTH's hybrid type I design advances implementation science through its effectiveness and cost-effectiveness aims as well as through a mixed-methods study that evaluates multilevel theory-driven factors (structural, organizational, staffing, and client) guided by the CFIR that influences the implementation of E-WORTH in a criminal justice setting. This study also addresses the novel challenges and opportunities of implementing an intervention that targets specific racial subgroup(s) in a community corrections setting that services all populations, implementing a group-based intervention with technological components in such settings, and employing community-based participatory research strategies to guide recruitment and retention efforts.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT02391233 . Registered on 17 March 2015.

Reproductive Health Concerns among Substance-Using Women in Community Corrections in New York City: Understanding the Role of Environmental Influences

Women living in urban settings who are engaged in the criminal justice system are disproportionately affected by HIV and also contend with poor sexual and reproductive health (SRH). While studies have examined environmental influences of HIV, few have examined how these influences relate to poor SRH among this population. We used baseline data from an HIV-risk reduction study among substance-using women with a pregnancy history in community corrections in New York City (N = 299). We examined risk environment factors typically associated with HIV, and SRH outcomes of abortion, and miscarriage. We used logistic regression models to examine associations between risk environment factors with SRH outcomes. Most women identified as black and ranged in age from 18 to 62. Approximately half had miscarriages and/or abortions in their lifetime. Few women used birth control despite not wanting children in the future. While most women faced high rates of environmental influences of HIV risk, only intimate partner violence (IPV) was associated with SRH outcomes. Women experiencing IPV were significantly more likely to report both miscarriage and abortion. Community corrections present a unique opportunity for intervention around HIV risk reduction and SRH outcomes, given that effective programming for each often requires multiple and formal contacts with health providers.

Leveraging the U.S. Criminal Justice System to Access Women for HIV Interventions

The criminal justice (CJ) system can be leveraged to access women for HIV prevention and treatment programs. Research is lacking on effective implementation strategies tailored to the specific needs of CJ-involved women. We conducted a scoping review of published studies in English from the United States that described HIV interventions, involved women or girls, and used the CJ system as an access point for sampling or intervention delivery. We identified 350 studies and synthesized data from 42 unique interventions, based in closed (n = 26), community (n = 7), or multiple/other CJ settings (n = 9). A minority of reviewed programs incorporated women-specific content or conducted gender-stratified analyses. CJ systems are comprised of diverse access points, each with unique strengths and challenges for implementing HIV treatment and prevention programs for women. Further study is warranted to develop women-specific and trauma-informed content and evaluate program effectiveness.

The Effectiveness of HIV Prevention Interventions in Socioeconomically Disadvantaged Ethnic Minority Women: A Systematic Review and Meta-Analysis

BACKGROUND

Surveys in the United States and Europe have shown a plateau of new HIV cases, with certain regions and populations disproportionately affected by the disease. Ethnic minority women and socioeconomically disadvantaged groups are disproportionately affected by HIV. Previous reviews have focused on prevention interventions targeting ethnic minority men who have sex with men, have not accounted for socioeconomic status, or have included only interventions carried out in clinical settings.

OBJECTIVES

To review and assess the effectiveness of HIV prevention interventions targeting socioeconomically disadvantaged ethnic minority women in member states of the Organisation for Economic Co-operation and Development (OECD).

SEARCH METHODS

On March 31, 2014, we executed a search using a strategy designed for the MEDLINE (Ovid), CINAHL, Embase, Scopus, and Web of Knowledge databases. Additional searches were conducted through the Cochrane Library, CRD Databases, metaRegister of Controlled Trials, EURONHEED, CEA Registry, and the European Action Program for Health Inequities as well as in gray literature sources. No language or date restrictions were applied.

SELECTION CRITERIA

We selected studies assessing the effectiveness of interventions to prevent HIV among ethnic minority women of low socioeconomic status in which at least 80% of participants were reported to belong to an ethnic minority group and to have a low income or be unemployed. We included only studies that were conducted in OECD member states and were randomized controlled trials or quasi-experimental investigations with a comparison group.

DATA COLLECTION AND ANALYSIS

A data extraction form was developed for the review and used to collect relevant information from each study. We summarized results both qualitatively and quantitatively. The main outcomes were categorized into 3 groups: improved knowledge regarding transmission of HIV, behavior changes related to HIV transmission, and reductions in the incidence of sexually transmitted infections (STIs). We then performed meta-analyses to assess the effectiveness of the prevention interventions in terms of the 3 outcome categories.

MAIN RESULTS

A total of 43 interventions were included, and 31 were judged to be effective, 7 were partially effective, and 5 were ineffective. The most frequently recurring characteristics of these interventions were cultural adaptation, a cognitive-behavioral approach, the use of small groups and trained facilitators, and a program duration of between 1 and 6 weeks. Our meta-analyses showed that the interventions improved knowledge of HIV transmission (odds ratio [OR] = 0.59; 95% confidence interval [CI] = 0.43, 0.75), increased the frequency of condom use (OR = 1.60; 95% CI = 1.16, 2.19), and significantly reduced the risk of STI transmission by 41% (relative risk = 0.59; 95% CI = 0.46, 0.75).

CONCLUSIONS

Our study demonstrates the feasibility and effectiveness of HIV prevention interventions targeting socioeconomically deprived ethnic minority women. Public Health Implications. This is one of the first studies to include a meta-analysis assessing reductions in STI incidence among at-risk women who have participated in HIV prevention programs. The fact that our meta-analyses showed a statistically significant reduction in STI transmission provides important evidence supporting the overall effectiveness of directing prevention programming toward this vulnerable population. For policymakers, this review demonstrates the feasibility of working with multiple intervention components while at the same time facilitating more effective interventions that take into account the principal outcome measures of knowledge, behavior change, and STI transmission rates. The review also underscores the need for additional research outside the United States on the effectiveness of prevention interventions in this vulnerable group.

Conducting Clinically Based Intimate Partner Violence Research: Safety Protocol Recommendations

BACKGROUND

Maintaining safety is of utmost importance during research involving participants who have experienced intimate partner violence (IPV). Limited guidance on safety protocols to protect participants is available, particularly information related to technology-based approaches to informed consent, data collection, and contacting participants during the course of a study.

PURPOSE

The purpose of the article is to provide details on the safety protocol developed and utilized with women receiving care at an urban HIV clinic and who were taking part in an observational study of IPV, mental health symptoms, and substance abuse and their relationship to HIV treatment adherence. The protocol presents the technological strategies to promote safety and allow autonomy in participant decision-making throughout the research process, including Voice over Internet Protocol telephone numbers, and tablet-based eligibility screening and data collection. Protocols for management of participants at risk for suicide and/or intimate partner homicide that included automated high-risk messaging to participants and research staff and facilitated disclosure of risk to clinical staff based on participant preferences are discussed.

DISCUSSION

Use of technology and partnership with clinic staff helped to provide an environment where research regarding IPV could be conducted without undue burden or risk to participants. Utilizing tablet-based survey administration provided multiple practical and safety benefits for participants. Most women who screened into high-risk categories for suicide or intimate partner homicide did not choose to have their results shared with their healthcare providers, indicating the importance of allowing participants control over information sharing whenever possible.

Feasibility and preliminary effects of a screening, brief intervention and referral to treatment model to address gender-based violence among women who use drugs in Kyrgyzstan: Project WINGS (Women Initiating New Goals of Safety)

INTRODUCTION AND AIMS

Intimate partner violence (IPV) and other forms of gender-based violence (GBV) are serious public health threats among women who use drugs or engage in binge drinking in Kyrgyzstan. This study aimed to evaluate the feasibility and preliminary effects of a two-session IPV and GBV screening, brief intervention and referral to treatment model (WINGS) with HIV counselling and testing for women who use drugs or engage in binge drinking in Kyrgyzstan, using a pre/post-design.

DESIGN AND METHODS

We screened 109 women from harm reduction non-government organisations in Kyrgyzstan, of whom 78 were eligible, 73 participated in the intervention study, and 66 completed a 3-month post-intervention follow-up. To assess the effects of the intervention, we used random-effect Poisson and Logistic regression analyses for continuous and dichotomous outcomes respectively.

RESULTS

At baseline, 73% reported any physical or sexual IPV victimisation, and 60% reported any physical or sexual GBV victimisation in the past year. At the 3-month follow-up, participants reported experiencing 59% fewer physical IPV incidents in the prior 90 days than at baseline (P < 0.001) and 27% fewer physical GBV incidents than at baseline (P < 0.01). From baseline to the 3-month follow-up, participants also reported a 65% reduction in the odds of using any illicit drugs (P < 0.05) and were more likely to report receiving GBV-related services (P < 0.001).

DISCUSSION AND CONCLUSION

The high rates of participation, attendance and retention and significant reductions in IPV and GBV victimisation and drug use from baseline to the 3-month follow-up suggest the feasibility and promising effects of this brief intervention. [Gilbert L, Jiwatram-Negron T, Nikitin D, Rychkova O, McCrimmon T, Ermolaeva I, Sharonova N, Mukambetov A, Hunt T. Feasibility and preliminary effects of a screening, brief intervention and referral to treatment model to address gender-based violence among women who use drugs in Kyrgyzstan: Project WINGS (Women Initiating New Goals of Safety). Drug Alcohol Rev 2017;36:125-133].

Risk Profiles of Women Experiencing Initial and Repeat Incarcerations: Implications for Prevention Programs

Incarcerated women experience myriad individual, interpersonal, and structural factors leading to arrest and rearrest. This study examined risk profiles of women experiencing initial and repeat incarcerations. The sample included 521 women recruited from two prisons in North Carolina and enrolled in a HIV/STD risk-reduction intervention trial. Variables included socio-demographics, structural/economic factors, sexual and substance use behaviors, STDs, victimization history, and depressive symptoms. Bivariate and multivariable analyses identified risk differences. Compared to women incarcerated for the first time, women with repeat incarcerations reported significantly greater economic instability, substance use and sexual risk behaviors, laboratory-confirmed STDs, and victimization during childhood and adulthood. Multivariable logistic regression found women with repeat incarcerations experienced greater unstable housing, injection drug use, crack cocaine use, concurrent sex partners, and childhood sexual victimization. Findings can inform the development of prevention programs by addressing economic instability, sexual risk, and substance use among women prisoners.