Samvedana Plus — Karnataka's Multilevel Programme for Female Sex Workers' Intimate Partnerships (Cautionary Null-Result Trial)

Samvedana Plus is a multilevel intervention working with female sex workers, their intimate partners and their communities in northern Karnataka, India, to reduce intimate partner violence (IPV) and increase condom use in intimate partnerships.
It was tested in a cluster-randomised trial (NCT02807259) in 47 villages, 24 receiving the programme and 23 wait-list controls, with 620 women at baseline and 547 at endline. At endline there was no significant difference in physical or sexual IPV (8.1% vs 9.0%), severe physical or sexual IPV (6.9% vs 8.7%) or consistent condom use with intimate partners (62.5% vs 57.3%). Baseline groups differed on age and on IPV (31.4% vs 45.0%).
Secondary outcomes were favourable: lower acceptance of IPV (AOR 0.62, 95% CI 0.40–0.94), greater awareness of self-protection strategies (AOR 1.73, 1.04–2.89) and greater solidarity among sex workers on IPV (AOR 1.69, 1.02–2.82). Reported IPV rose from 25.9% at baseline to 63.5% at midline in intervention villages (41.8% to 44.3% in controls) before both arms fell to about 7% at endline; the authors conclude inconsistent IPV reporting limited the trial's ability to assess effectiveness. The case is included as a candid reminder that well-designed community interventions can fail to show impact, and that measurement of violence is itself fragile.

Read the full analysis: https://researchonline.lshtm.ac.uk/4655168