title: 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.
abstract: 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.
  
  
  BACKGROUND
  ClinicalTrials.gov #NCT00790959.
authors.forename: Tanya
authors.initials: T
authors.lastname: Abramsky
authors.forename: Karen
authors.initials: K
authors.lastname: Devries
authors.forename: Ligia
authors.initials: L
authors.lastname: Kiss
authors.forename: Janet
authors.initials: J
authors.lastname: Nakuti
authors.forename: Nambusi
authors.initials: N
authors.lastname: Kyegombe
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Starmann
authors.forename: Bonnie
authors.initials: B
authors.lastname: Cundill
authors.forename: Leilani
authors.initials: L
authors.lastname: Francisco
authors.forename: Dan
authors.initials: D
authors.lastname: Kaye
authors.forename: Tina
authors.initials: T
authors.lastname: Musuya
authors.forename: Lori
authors.initials: L
authors.lastname: Michau
authors.forename: Charlotte
authors.initials: C
authors.lastname: Watts
mesh_terms: D000293:Adolescent; D000328:Adult; D016000:Cluster Analysis; D003153:Community Health Services; D019058:Community Networks / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013179:Spouse Abuse / Q000517:prevention & control*; D016896:Treatment Outcome; D014454:Uganda / Q000453:epidemiology