Cluster randomized trial of comprehensive gender-based violence programming delivered through the HIV/AIDS program platform in Mbeya Region, Tanzania: Tathmini GBV study.

The Tathmini GBV study was a cluster randomized trial to assess the impact of a comprehensive health facility- and community-based program delivered through the HIV/AIDS program platform on reduction in gender-based violence and improved care for survivors. Twelve health facilities and surrounding communities in the Mbeya Region of Tanzania were randomly assigned to intervention or control arms. Population-level effects were measured through two cross-sectional household surveys of women ages 15-49, at baseline (n = 1,299) and at 28 months following program scale-out (n = 1,250). Delivery of gender-based violence services was assessed through routine recording in health facility registers. Generalized linear mixed effects models and analysis of variance were used to test intervention effects on population and facility outcomes, respectively. At baseline, 52 percent of women reported experience of recent intimate partner violence. The odds of reporting experience of this violence decreased by 29 percent from baseline to follow-up in the absence of the intervention (time effect OR = 0.71, 95% CI: 0.57-0.89). While the intervention contributed an additional 15 percent reduction, the effect was not statistically significant. The program, however, was found to contribute to positive, community-wide changes including less tolerance for certain forms of violence, more gender equitable norms, better knowledge about gender-based violence, and increased community actions to address violence. The program also led to increased utilization of gender-based violence services at health facilities. Nearly three times as many client visits for gender-based violence were recorded at intervention (N = 1,427) compared to control (N = 489) facilities over a 16-month period. These visits were more likely to include provision of an HIV test (55.3% vs. 19.6%, p = .002). The study demonstrated the feasibility and impact of integrating gender-based violence and HIV programming to combat both of these major public health problems. Further opportunities to scale out GBV prevention and response strategies within HIV/AIDS service delivery platforms should be pursued. Trial Registration: Pan African Clinical Trials Registry No. PACTR201802003124149.

Physical violence by a partner during pregnancy in Tanzania: prevalence and risk factors.

Violence by an intimate partner, including violence during pregnancy, is an important human rights and public health issue. This paper presents the findings from large household surveys conducted in Mbeya and Dar es Salaam, Tanzania, in 2001-2002, as part of the WHO Multi-Country Study on Women's Health and Domestic Violence against Women. Seven (n=88) and twelve per cent (n=147) of ever-partnered, ever-pregnant women in Dar es Salaam (n=1,298) and Mbeya (n=1,205), respectively, reported being physically assaulted during pregnancy by their partner. Of those experiencing partner violence during pregnancy, 38% (n=33) and 23% (n=34) reported blows to the abdomen. More than a third of women experiencing the violence in each setting reported that it started during pregnancy. In both settings, the violence was significantly associated with adverse maternal health behaviours and outcomes, including drinking during pregnancy, having had a child that died and the partner preventing or discouraging attendance for antenatal care. Factors significantly associated with higher likelihood of partner violence during pregnancy included being currently unmarried, having had children from different fathers, partner's unfaithfulness and his refusal to use contraception. While interventions on partner violence during pregnancy have been tested in antenatal services in some developed countries, effective solutions for how to intervene in low-resource settings like Tanzania are still needed.