Intimate Partner Violence and Electronic Health Interventions: Systematic Review and Meta-Analysis of Randomized Trials.

BACKGROUND: Intimate partner violence (IPV) is a major public health concern. eHealth interventions may reduce exposure to violence and health-related consequences as the technology provides a safe and flexible space for the target population. However, the evidence is unclear. OBJECTIVE: The goal of the review is to examine the effect of eHealth interventions compared with standard care on reducing IPV, depression, and posttraumatic stress disorder (PTSD) among women exposed to IPV. METHODS: We searched EMBASE, MEDLINE, Cochrane Central Register of Controlled Trials, PsycInfo, Scopus, Global Health Library, ClinicalTrials.gov, and International Clinical Trials Registry Platform for published and unpublished trials from inception until April 2019. Trials with an eHealth intervention targeting women exposed to violence were included. We assessed risk of bias using the Cochrane Risk of Bias Tool. Trials that reported effect estimates on overall IPV; physical, sexual, and psychological violence; depression; or posttraumatic stress disorder were included in meta-analyses. RESULTS: A total of 14 trials were included in the review; 8 published trials, 3 unpublished trials and 3 ongoing trials. Of the 8 published trials, 2 were judged as overall low risk of bias trials. The trials reported 23 types of outcomes, and 7 of the trials had outcomes that were eligible for meta-analyses. Our pooled analyses found no effect of eHealth interventions on any of our prespecified outcomes: overall IPV (SMD -0.01; 95% CI -0.11 to 0.08; I2=0%; 5 trials, 1668 women); physical violence (SMD 0.01; 95% CI -0.22 to 0.24; I2=58%; 4 trials, 1128 women); psychological violence (SMD 0.07; 95% CI -0.12 to 0.25; I2=40%; 4 trials, 1129 women); sexual violence (MD 0.36; 95% CI -0.18 to 0.91; I2=0%; 2 trials, 1029 women); depression (SMD -0.13; 95% CI -0.37 to 0.11; I2=78%; 5 trials, 1600 women); and PTSD (MD -0.11; 95% CI -1.04 to 0.82; I2=0%; 5 trials, 1267 women). CONCLUSIONS: There is no evidence from randomized trials of a beneficial effect of eHealth interventions on IPV. More high-quality trials are needed, and we recommend harmonizing outcome reporting in IPV trials by establishing core outcome sets. TRIAL REGISTRATION: PROSPERO International Prospective Register of Systematic Reviews CRD42019130124; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=130124.

Intimate partner violence and breastfeeding: a systematic review.

OBJECTIVE: The association between intimate partner violence (IPV) and breastfeeding is unclear. We conducted a systematic review to summarise the evidence of breastfeeding outcomes following exposure to IPV. DESIGN: Systematic review. METHODS: We searched for published studies without study design or language restrictions (up to July 2019) in the following databases: PubMed, Embase, SCOPUS and The Global Health Library. Studies assessing various breastfeeding outcomes (initiation, duration and exclusive breastfeeding) in women exposed to IPV in any form (physical, psychological or sexual) and at any stage (1 year pre-pregnancy, during or post-pregnancy) were included. Two authors independently selected the studies and conducted the quality appraisal by use of the Newcastle-Ottawa Scale. Results were summarised taking precision and quality into account. RESULTS: A total of 16 studies (participants n=414 393) were included and they adjusted for a total of 48 different confounders. The majority of studies were cross-sectional (n=11) and most studies were judged to be fair/low quality. Four out of seven studies found that IPV exposure shortened breastfeeding duration (adjusted ORs/aORs=0.22 (95% CI: 0.05-0.85), 1.18 (95% CI: 1.01-1.37), 5.92 (95% CI: 1.72-27.98), 1.28 (95% CI: 1.18-1.39)). Further, 5/10 studies found that IPV led to early termination of exclusive breastfeeding (aORs=1.53 (95% CI: 1.01-23.1), 0.83 (95% CI: 0.71-0.96), 1.35 (95% CI: 1.07-1.71), 0.17 (95% CI: 0.07-0.4), 1839 (95% CI: 1.61-2911)) and 2/6 studies found that IPV significantly reduced breastfeeding initiation (aORs=2.00 (95% CI: 1.2-3.3), 0.81 (95% CI: 0.7-0.93)). CONCLUSION: IPV exposure appears to associate negatively with some breastfeeding outcomes. Individual patient data meta-analysis is required to quantify the magnitude of the association for specific IPV-outcome combinations. More high-quality studies and definition of core confounders are warranted. PROSPERO REGISTRATION NUMBER: CRD42019129353.

"The best thing is that you are doing it for yourself" - perspectives on acceptability and feasibility of HPV self-sampling among cervical cancer screening clients in Tanzania: a qualitative pilot study.

BACKGROUND: Cervical cancer is the most common type of cancer in sub-Saharan Africa, and it is also the cancer disease that most women die from. The high mortality rate is partly due to low attendance rates to screening services and low sensitivity of visual inspection with acetic acid, which is the standard screening method used in screening programs in sub-Saharan Africa. In order to overcome of the burden of disease new screening strategies and methods are warranted. This study aims to explore the acceptability and feasibility of HPV self-sampling compared to provider-based sampling among cervical cancer screening clients living in Dar es Salaam. METHODS: Women attending cervical cancer screening at Ocean Road Cancer Institute in Dar es Salaam, Tanzania between February - April 2017 were invited into the study. The participants had (1) a provider-collected sample, and (2) a self-sample for HPV on top of the regular cervical cancer screening. 50% of the participants conducted the self-sample after receiving a written instruction guide of how to collect the sample (written). The other 50% received both the written and an oral introduction to self-sampling (written+). All participants could ask for nurse assistance during self-sample collection if needed. Individual semi-structured interviews were conducted with the participants post sample collection. Data collection stopped when saturation was reached. Data were analysed using a thematic content analysis. RESULTS: Twenty-one women participated in the study. Regardless of how women were introduced to the self-sample (written or written+), there was a high demand for nurse presence as they felt uncertain of their personal capabilities to collect the self-sample correctly. However, as long as nurse assistance was an option most women perceived self-sampling as easy and comfortable though few experienced bleeding and pain. The majority of women preferred self-sampling over provider-sampling primarily due to the method being more private than the provider-sampling. CONCLUSIONS: HPV self-sampling was well-perceived and accepted, however, for the method to be feasible a nurse needed to be present. HPV Self-sampling may be an alternative method to increase uptake of cervical cancer screening. Larger quantitative studies are recommended to support the study findings.