The issue

In spite of a growing understanding of the dynamics of GBV and HIV, less is known about how to prevent GBV both among those living with and without HIV, particularly in low resource settings. For the most part, intervention strategies that have been tested have focused either on health care for survivors of GBV and secondary GBV prevention or on efforts to curb violence at the community level. Recent reviews of program research and evidence have highlighted the need for multi-component programs that address multiple risk factors and work across multiple settings with an aim of achieving broad impact across communities.

 

Our approach

The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) funded the implementation of a comprehensive GBV program delivered through the HIV prevention, care, and treatment platform in Mbeya Region in Tanzania and commissioned an independent evaluation of the program’s impacts. The Tathmini GBV Study was a matched-pair, cluster randomized controlled trial to assess the impact of comprehensive programs and services to prevent and treat GBV in Mbeya Region. In 2013, a baseline household survey of 1,299 women 15 to 49 years of age was conducted in twelve clusters. A follow-up survey of 1,250 women was conducted 24 months later.

 

The impact

Results from these activities will inform GBV policy and practice, and identify future research agendas and collaborations.

 

The Tathmini GBV stud was the first of its kind to assess the impact of a package of programs and services delivered at the health facility and community levels that aimed to improve care for GBV survivors and prevent GBV. While there was no significant impact on intimate partner violence, the intervention appears to have impacted acceptance of intimate partner violence and gender norms. Nearly three times as many GBV client visits were recorded at the intervention health facilities compared to controls over a 16-month period. HIV testing and counseling were more likely to be provided to GBV clients at the intervention facilities. Improved screening of clients appears to have contributed to increased health care coverage of GBV survivors visiting the intervention facilities. Nearly three times as many GBV client visits were recorded at the intervention health facilities compared to controls over a 16-month period. HIV testing and counseling were more likely to be provided to GBV clients at the intervention facilities. Improved screening of clients appears to have contributed to increased health care coverage of GBV survivors visiting the intervention facilities. While efforts were made to prevent program contamination, receipt of GBV programs and services in control clusters may have influenced study outcomes. Furthermore, exposure to GBV community interventions in the intervention clusters was not directly measured and may not have been sufficient to detect a benefit on intimate partner violence. Results on intermediate outcomes, however, are encouraging. Findings also confirm the feasibility of delivering multi-component GBV interventions through the HIV prevention, care, and treatment program platform.