Routine Screening For Intimate Partner Violence Research Articles

Views from midwives and perinatal nurses on barriers and facilitators in responding to perinatal intimate partner violence in Japan: baseline interview before intervention

BackgroundMidwives and perinatal nurses play a crucial role in responding to intimate partner violence (IPV) against pregnant women; however, these roles are often not performed adequately. This study aimed to identify provider-related, healthcare system, and social barriers and facilitators to IPV response from the perspective of midwives and perinatal nurses.MethodsThis qualitative descriptive study used semi-structured interviews with five midwives and a nurse from perinatal care facilities in Tokyo, Japan. A framework approach was employed to analyze the interview transcripts.ResultsBarriers included inadequate knowledge about IPV and reluctance to provide support by healthcare providers. Barriers in the healthcare system included the absence of structural infrastructure for IPV response. This involved the lack of screening tool adoption, the partner’s presence during interviews, and time constraints. Additionally, there was insufficient systematic and collaborative coordination within and outside the team. Another barrier was the lack of in-service training to develop IPV-related knowledge and skills. Finally, there was uncertainty about how the support at healthcare facilities impacts women’s lives. Further barriers in the social system included the absence of additional reimbursement for IPV response. There was also a lack of a comprehensive approach to IPV that provides for the rehabilitation of perpetrators and care for the children of victims and a culture that discourages separation from the perpetrator. Conversely, facilitators included healthcare providers recognizing the perinatal period as an opportunity to address IPV. They also acknowledged IPV as a prevalent issue, practiced conscious self-care, and systematically collaborated within the healthcare team.ConclusionThis study emphasized the need for routine IPV screening in perinatal care and the importance of team-based educational interventions for healthcare providers to facilitate implementation.

Rising to the challenge: The motivation to champion routine intimate partner violence screening in rural emergency departments.

To understand the motivations of champions who worked to bring about system and practice change that supported routine screening for intimate partner violence (IPV) in two rural emergency departments (EDs). Practice changes are required to achieve routine and effective identification and response to IPV. Nurses play a significant role in affecting such practice change. This paper identifies the motivations of champions in the ED setting who successfully brought about such change. The EDs of two Level 5 tertiary hospitals within a rural Local Health District (LHD) of New South Wales, Australia. Twenty-three individuals who identified as champions and worked to introduce routine IPV screening in two rural hospital EDs. Qualitative longitudinal semi-structured interviews employing a process of constant comparison and an interpretive framework to analyse data thematically. Interviews were carried out between June and August 2017 and again between July and August 2019. Over the period of the study, routine screening was established, and screening rates steadily increased from a low baseline to a significantly higher rate. Three aspects of champion motivation emerged from the analysis: formation of an identity as a champion, making a difference to a significant social justice issue and providing quality and community-relevant care. This study is the first study to report on champions and their motivation as they supported IPV practice change in the ED. The findings highlight the capacity for innovation in rural health services, with important implications for other settings looking to translate similar programs. Understanding motivating factors may assist in improved utilisation and support for champions. This is vital if champions are to bring about required practice change within their service and ensure the needs of individuals experiencing IPV are effectively met.

An Overview of Health Care Support of Intimate Partner Violence Survivors

Intimate Partner Violence (IPV) has severe physical and psychological effects on survivors. Despite growing awareness, accessing comprehensive health care remains a challenge for many survivors. This review aims to assess the impact of IPV on the survivors, health care needs, and interventions for IPV survivors, evaluate their effectiveness, and identify areas for improvement. This paper reviewed literature and guidelines from reputable journals with a focus on studies about health care support, including interventions and outcomes for IPV survivors. The paper found there is a need for routine IPV screening in health settings, effective multidisciplinary care, and better training for healthcare providers. Barriers such as stigma, resource limitations, and inadequate referral systems were common. Survivors also face difficulties accessing the healthcare system due to fear and confidentiality issues. Quality and effective support requires universal screening, trauma-informed care, and accessible services. While some practices are beneficial, there is a need for standard and improved provider training. Policymakers should focus on overcoming systemic barriers and enhancing support services. The support system for IPV survivors is improving but still faces significant challenges. Addressing these issues through better policies, resources, and training is crucial for providing effective care and reducing the long-term impact of IPV. Keywords: Intimate Partner Violence, Health Care Support, Survivor support, Multidisciplinary Approaches, Trauma-Informed Care

Intimate Partner Violence Screening in a Pregnant Military Population: Implementation of the E-HITS Protocol [ID 2683442

INTRODUCTION: The military population has higher rates of intimate partner violence (IPV) compared to the civilian population. This is further exacerbated in obstetrics patients, with an estimated rate of 4–29% of pregnant women affected. The American College of Obstetricians and Gynecologists and 2018 Department of Defense Clinical Practice Guidelines for Management of Pregnancy recommend routine screening for IPV at obstetric visits, although a preferred screening modality has not been identified. METHODS: The prevalence of IPV in pregnancy before and after implementation of the validated Extended-Hurt, Insult, Threaten, Scream (E-HITS) questionnaire at a single military treatment facility was compared. Retrospective chart review was conducted between January and December 2019 of patients who had been screened using a single question (“Do you feel safe at home?”). E-HITS was implemented in the obstetrics clinic in February 2022, and data were collected prospectively for 12 months. The difference between the two IPV screening modalities was analyzed using Fisher’s exact test. RESULTS: A total of 1,627 IPV screenings were reviewed. Of the 783 IPV screenings using the single question, there were 2 positive screens (0.26%). Using greater than 7 as the positive screening cutoff, there were 24 positives (2.84%) out of the 844 E-HITS screenings. Using greater than 6 as the cutoff for E-HITS, there were 54 positive screens (6.4%). There was a statistically significant difference in the detection rate between the two modalities at both cutoff levels (P<.0001). CONCLUSION: E-HITS is a more sensitive screening tool for IPV in this population, more closely mirroring previously published rates.

Empowering Survivors of Intimate Partner Violence: The Role of Advanced Practice Nurses

Intimate partner violence (IPV) is a serious public health problem that affects millions of people worldwide. IPV is associated with significant short-term and long-term health consequences for individuals and families and has high social and economic costs. Advanced practice registered nurses can use the empowerment process model as a framework for caring for IPV survivors. Incorporating routine IPV screening into daily clinical practice should be a priority. Advanced practice registered nurses can lead an approach to facilitate practice change, enhance multidisciplinary collaboration, and provide support for the implementation of IPV screening and care for survivors.

Facilitators and barriers to routine intimate partner violence screening in antenatal care settings in Uganda

BackgroundUganda clinical guidelines recommend routine screening of pregnant women for intimate partner violence (IPV) during antenatal care (ANC). Healthcare providers play a critical role in identifying IPV during pregnancy in ANC clinics. This study explored facilitators and barriers for IPV screening during pregnancy (perinatal IPV screening) by ANC-based healthcare workers in Uganda.MethodsWe conducted qualitative in-depth interviews among twenty-eight purposively selected healthcare providers in one rural and an urban-based ANC health center in Eastern and Central Uganda respectively. Barriers and facilitators to IPV screening during ANC were identified iteratively using inductive-deductive thematic analysis.ResultsParticipants had provided ANC services for a median (IQR) duration of 4.0 (0.1–19) years. Out of 28 healthcare providers, 11 routinely screened women attending ANC clinics for IPV and 10 had received IPV-related training. Barriers to routine IPV screening included limited staffing and space resources, lack of comprehensive gender-based violence (GBV) training and provider unawareness of the extent of IPV during pregnancy. Facilitators were availability of GBV protocols and providers who were aware of IPV (or GBV) tools tended to use them to routinely screen for IPV. Healthcare workers reported the need to establish patient trust and a safe ANC clinic environment for disclosure to occur. ANC clinicians suggested creation of opportunities for triage-level screening and modification of patients’ ANC cards used to document women’s medical history. Some providers expressed concerns of safety or retaliatory abuse if perpetrating partners were to see reported abuse.ConclusionsOur findings can inform efforts to strengthen GBV interventions focused on increasing routine perinatal IPV screening by ANC-based clinicians. Implementation of initiatives to increase routine perinatal IPV screening should focus on task sharing, increasing comprehensive IPV training opportunities, including raising awareness of IPV severity, trauma-informed care and building trusting patient-physician relationships.

'If the Partner Finds Out, then there's Trouble': Provider Perspectives on Safety Planning and Partner Interference When Offering HIV Pre-exposure Prophylaxis (PrEP) to Women Experiencing Intimate Partner Violence (IPV).

Pre-exposure prophylaxis is an effective women-controlled HIV prevention strategy but women experiencing intimate partner violencefear partners' interference and subsequent violence could limit its utility. This study explores provider perceptions of safety planning strategies to prevent escalating violence, mitigate partner interference, and promote daily oral PrEP adherence. We conducted interviews (N = 36) with healthcare providers (n = 18) and IPV service providers (n = 18) in Baltimore and New Haven. Using the Contextualized Assessment for Strategic Safety Planning model we organized data into two categories: the appraisal process and strategic safety planning. Themes revealed during the appraisal process, providers conduct routine IPV screening, facilitate HIV risk perception, and offer PrEP. Strategic safety planning utilizes concealment tactics, informal sources of support, role playing and cover stories. Future interventions to enhance PrEP services among women exposed to IPV should implement safety planning strategies, integrate PrEP care with IPV services, and employ novel PrEP modalities to maximize effectiveness.

How accurate and effective are screening tools and subsequent interventions for intimate partner violence in non-high-risk settings (IPV)? A rapid review

Purpose The purpose of this paper is to estimate the accuracy and effectiveness of screening tools and subsequent interventions in the detection and treatment of intimate partner violence (IPV) in non-high-risk settings (defined here as those in which routine IPV screening does not take place in the UK, such as in general practice). Design/methodology/approach Rapid review as defined by Grant and Booth – it is used under time or financial constraint to assess what is known using systematic review methods. Medline, PsycINFO, Embase and Cochrane Library databases to May 2019 were searched for “intimate partner violence” and synonyms plus terms related to screening and interventions. A Medline update was performed in August 2020. Data were extracted with the help of a predesigned tool and were synthesised to answer the two study aims. Data were mixed quantitative and qualitative. Findings The search yielded 10 relevant papers on screening (6 on accuracy and 4 on effectiveness) and 13 on intervention. These showed evidence of the effectiveness of simple screening tools and of subsequent interventions. However, the evidence was insufficient to support a change in UK guidelines which currently do not recommend their use outside of current high-risk environments. Originality/value Clinicians outside of high-risk areas should consider the use of some IPV screening tools and interventions but only within research protocols to gather further evidence.

Asking the Right Questions: Screening Men for Partner Violence.

With lifetime intimate partner violence (IPV) victimization rates for self-identified men between 14% and 20%, and an expanding understanding of gender as a nonbinary construct, practitioners in some clinical environments have expressed interest in screening all patients for IPV. Yet, few IPV screening instruments have been validated for use in nonfemale populations. This research tests the appropriateness and acceptability of a screening instrument developed for use with women.A literature review was completed to determine the current state of research into IPV screening practices tailored to men. Next, cognitive interviews were conducted to test a 9-question IPV screening instrument with men considered at average and elevated risk for experiencing partner violence. Participants were read the questions aloud and asked about item comprehension and question appropriateness and acceptability.The literature review uncovered no published reports describing routine clinic based IPV screening of men, and only two screening instruments had been validated with men. Twenty men participated in cognitive interviews from a variety of settings in a large urban center. All participants accurately described the intended meaning of each question and verified the appropriateness of asking the questions.This work addresses the gap in research on routine IPV screening with men, building on efforts to screen individuals and support improved health and response to violence to those across the gender spectrum.

15215 Female sex worker experiences with intimate partner violence screening by health care providers

ABSTRACT IMPACT: This work will inform the need for more trauma-informed approaches to violence screenings among marginalized populations by health care providers. OBJECTIVES/GOALS: Female sex workers (FSW) experience high rates of intimate partner violence (IPV) which may have negative reproductive health consequences. Routine IPV screening by healthcare providers (HCP) is recommended. This study examines how FSW experience IPV assessments by HCP. METHODS/STUDY POPULATION: This qualitative descriptive study is nested within EMERALD, a longitudinal cohort study of street-based FSW. EMERALD assesses a structural community-level intervention on HIV and STI risks among FSW. Participants were recruited for EMERALD using time-location sampling to identify a sampling frame of venues and times where sex work is likely to occur. Inclusion criteria for this qualitative study include: participating in EMERALD, age 18-49, and willingness to participate in one phone interview. Twenty-two semi-structured individual qualitative interviews were conducted. Two coders, using thematic analysis, applied deductive codes and inductive coding to identify themes. RESULTS/ANTICIPATED RESULTS: Three themes emerged from participant interviews regarding IPV screening. Inconsistent screening practices: Despite frequent reproductive health visits among participants, many women did not recall IPV screening by a HCP. Stigma as a barrier to disclosure: Women described feeling judged by HCP regarding their frequency of visits for reproductive concerns, sex work, and substance use and did not trust disclosing violence to HCP. Transactional health encounters: During visits, HCP were focused on addressing women’s immediate concerns; if the HCP did ask about IPV women felt the questions were asked part of a required protocol and not driven by a concern to deeply understand their lives. DISCUSSION/SIGNIFICANCE OF FINDINGS: FSW described inconsistent IPV screening practices by HPC. Participants expressed feeling stigmatized by HCP and that encounters with HCP did not foster trust for women to disclose IPV experiences. There is a need for HPC training in universal IPV screening focused on relationship and trust building to facilitate disclosure.

Intimate Partner Violence (IPV) Screening and Referral Outcomes among Transgender Patients in a Primary Care Setting.

Transgender patients are at elevated risk of intimate partner violence (IPV), but national guidelines do not recommend routine screening for this population. This paper explores the feasibility and effectiveness of routine IPV screening of transgender patients in a primary care setting by describing an existing screening program and identifying factors associated with referral and engagement in IPV-related care for transgender patients. An IPV "referral cascade" was created for 1,947 transgender primary care patients at an urban community health center who were screened for IPV between January 1, 2014 to May 31, 2016: (a) Of those screening positive, how many were referred? (b) Of those referred, how many engaged in IPV-specific care within 3 months? Logistic regression identified demographic correlates of referral and engagement. Of the 1,947 transgender patients screened for IPV, 227 screened positive. 110/227 (48.5%) were referred to either internal or external IPV-related services. Of those referred to on-site services, 65/103 (63.1%) had an IPV-related appointment within 3 months of a positive screen. IPV referral was associated with being assigned male at birth (AMAB) versus assigned female at birth (AFAB) (AOR = 2.69, 95% CI 1.52, 4.75) and with nonbinary, rather than binary, gender identity (AOR = 2.07, 95%CI 1.09, 3.73). Engagement in IPV-related services was not associated with any measured demographic characteristics. Similar to published rates for cisgender women, half of transgender patients with positive IPV screens received referrals and two-thirds of those referred engaged in IPV-specific care. These findings support routine IPV screening and referral for transgender patients in primary care settings. Provider training should focus on how to ensure referrals are made for all transgender patients who screen positive for IPV, regardless of gender identity, to ensure the benefits of screening accrue equally for all patients.

Trying Times and Trying Out Solutions: Intimate Partner Violence Screening and Support for Women Veterans During COVID-19.

Initial reports indicate widespread increases in intimate partner violence (IPV) rates during the coronavirus disease 2019 (COVID-19) pandemic. Women veterans are at particular risk for experiencing IPV, and the COVID-19 pandemic and resulting stay-at-home orders may be exacerbating this risk. IPV screening and intervention are an integral part of the care provided to women veterans in the Veteran’s Health Administration (VHA). Current changes in healthcare delivery during COVID-19 may present challenges to the VHA’s standard methods of initiating IPV screening and intervention with women veterans. We discuss the potential challenges VHA healthcare providers may be encountering when conducting routine IPV screening during the COVID-19 pandemic and when providing resources and support to women veterans experiencing IPV. We describe solutions to these challenges, including existing efforts led by the VHA IPV Assistance Program (IPVAP) as well as additional potential solutions. New ideas and partnerships will be critical for helping the VHA continue to assist women veterans experiencing IPV as the COVID-19 pandemic evolves. Though our focus is on women veterans and the VHA, the challenges and solutions we discuss are likely applicable to other populations experiencing IPV and other health care systems screening for IPV.

Middle-aged Women’s Experiences of Intimate Partner Violence Screening and Disclosure: “It’s a private matter. It’s an embarrassing situation”

National guidelines indicate that healthcare providers should routinely screen women of reproductive age for experience of intimate partner violence. We know little about intimate partner violence (IPV) screening and disclosure experience among women older than reproductive age. To examine the perspectives of middle-aged women who had experienced past-year IPV regarding IPV screening and disclosure in the healthcare setting. Individual semi-structured qualitative interviews were conducted in-person as part of a larger study examining IPV screening and response services through the Veterans Health Administration. Twenty-seven women aged 45-64 (mean age 53) who experienced past-year IPV and received care at one of two Veterans Affairs Medical Centers. Interviews were digitally recorded and transcribed. Data were sorted and analyzed using templated notes and line-by-line coding, based on codes developed by the study team through an initial review of the data. Themes were derived from further analysis of the data coded for "screening" and "disclosure" for respondents aged 45 and older. Barriers to disclosure of IPV to a healthcare provider included as follows: (a) feelings of shame, stigma, and/or embarrassment about experiencing IPV; (b) screening context not feeling comfortable or supportive, including lack of comfort with or trust in the provider and/or a perception that screening was conducted in a way that felt impersonal and uncaring; and (c) concerns about privacy and safety related to disclosure. Provider demonstrations of care, empathy, and support facilitated disclosure and feelings of empowerment following disclosure. Middle-aged women may benefit from routine IPV screening and response in the healthcare setting. Such interventions should be sensitive to concerns regarding stigma and privacy that may be prevalent among this population.

Association of Health Conditions and Health Service Utilization With Intimate Partner Violence Identified via Routine Screening Among Middle-Aged and Older Women

The US Preventive Services Task Force recently determined that there is insufficient evidence to recommend routine screening for intimate partner violence (IPV) in women who are middle-aged and older. Certain Veterans Health Administration (VHA) clinics have been routinely screening women of all ages for IPV since 2014. To examine the proportion of women older than childbearing age (ie, ≥45 years) who have positive results when routinely screened for past-year IPV at VHA clinics and to evaluate the associations of a positive screening result with health conditions and health service utilization. This cohort study included 4481 women aged 45 years and older who were screened for past-year IPV in 13 VHA outpatient clinics in 11 states between April 2014 and April 2016. Data analysis was conducted from March 2019 to August 2019. Positive screening result for past-year IPV. Mental and physical health conditions (identified using International Classification of Diseases, Ninth Edition [ICD-9] and ICD-10 codes from VHA medical record data) and VHA health services utilization (identified using inpatient and outpatient VHA encounter data) in the 20 months after screening. In this study, 2937 of 4481 women (65.5%) were middle-aged (ie, aged 45 to 59 years), and 1544 (34.5%) were older (ie, aged ≥60 years), with 1955 (43.6%) black participants. A total of 255 middle-aged women (8.7%; mean [SD] age, 51 [4] years) and 79 older women (5.1%; mean [SD] age, 64 [5] years) screened positive for past-year IPV. In adjusted logistic regression models among middle-aged women, screening positive for IPV was associated with subsequent diagnoses of anxiety (adjusted odds ratio [aOR], 2.00; 95% CI, 1.50-2.70; P < .001), depression (aOR, 2.30; 95% CI, 1.80-3.00; P < .001), posttraumatic stress disorder (aOR, 2.30; 95% CI, 1.80-3.00; P < .001), suicidal ideation and/or behavior (aOR, 3.80; 95% CI, 2.10-6.90; P < .001), and substance use disorder (aOR, 2.50; 95% CI, 1.80-3.50; P < .001). Similar but attenuated associations were seen for older women (eg, substance use disorder: aOR, 2.20; 95% CI, 1.10-4.40; P = .04). In adjusted negative binomial regression models among middle-aged women, screening positive for IPV was associated with a higher rate of subsequent psychosocial (eg, mental health) visits (adjusted rate ratio [aRR], 2.40; 95% CI, 2.00-2.90; P < .001), primary care visits (aRR, 1.20; 95% CI, 1.10-1.30; P < .001), and emergency department visits (aRR, 1.50; 95% CI 1.20-1.80; P < .001). Older women screening positive for IPV had a higher rate of psychosocial visits (aRR, 1.90; 95% CI, 1.30-2.70; P < .001) but not of other visit types. To our knowledge, this study was the largest to evaluate routine screening for IPV among women aged 45 years and older, and it found that IPV remained prevalent and was associated with morbidity for these women. Screening for IPV in women older than 44 years may improve detection and provision of evidence-based services to this growing population.

Identifying Opportunities to Improve Intimate Partner Violence Screening in a Primary Care System.

Intimate partner violence (IPV) is a silent epidemic affecting one in three women. The US Preventive Services Task Force recommends routine IPV screening for women of childbearing age, but actual rates of screening in primary care settings are low. Our objectives were to determine how often IPV screening was being done in our system and whether screening initiated by medical assistants or physicians resulted in more screens. We conducted a retrospective chart review to investigate IPV screening practices in five primary care clinics within a university-based network in Northern California. We reviewed 100 charts from each clinic for a total of 500 charts. Each chart was reviewed to determine if an IPV screen was documented, and if so, whether it was done by the medical assistant or the physician. The overall frequency of IPV screening was 22% (111/500). We found a wide variation in screening practices among the clinics. Screening initiated by medical assistants resulted in significantly more documented screens than screening delivered by physicians (74% vs 9%, P&lt;0.001). IPV screening is an important, but underdelivered service. Using medical assistants to deliver IPV screening may be more effective than relying on physicians alone.

Associations of Emotional, Physical, or Sexual Intimate Partner Violence and Depression Symptoms Among South African Women in a Prospective Cohort Study.

Violence against women remains a significant public health problem globally. The majority of longitudinal studies documenting the negative impact of intimate partner violence (IPV) on the mental health of women come from high-income countries. The aim of this study was to investigate the longitudinal association between emotional, physical, or sexual IPV and depression symptoms among South African women in a prospective cohort study. Participants were 981 South African women enrolled in the Drakenstein Child Health Study-a cohort study investigating the early life determinants of child health. Interview data from four time-points (antenatal care visit, 6 months, 12 months, and 18 months postpartum) were included. The primary independent variable was self-reported emotional, physical, and sexual IPV in the past 12 months. Depressive symptoms were assessed at each time-point with the Edinburgh Postnatal Depression Scale (EPDS); a cutoff score of ⩾13 was used to define significant depression symptoms. We used pooled-multivariable logistic regression models to determine associations between the three different forms of IPV and significant depression symptoms while adjusting for time-fixed and time-updated covariates. The mean age of the sample at antenatal care visit was 27 years (standard deviation = 6.0). In the adjusted model including all forms of IPV and adjusting for sociodemographic and clinical characteristics, substance use, and childhood trauma, emotional (adjusted odds ratio [aOR] =1.55, 95% confidence interval (CI): [1.02, 2.34]; p = .039)] and sexual (aOR = 2.02, 95% CI: [1.10, 3.72]; p < .001) IPV were significantly associated with significant depression symptoms. The relationship between physical IPV and significant depression symptoms was not statistically significant (aOR = 0.68, 95% CI: [0.44, 1.05]; p = .485). Our study confirms findings from high-income countries of the association between IPV and depressive symptoms among women in South Africa. Routine screening for IPV, including emotional IPV and intervention programs for IPV among women, is needed in South Africa.

Exploring Reproductive Coercion in Relationship Contexts Among Young Adult, Primarily African American Women at Three Women's Health Clinics.

Understanding reproductive coercion experiences in marginalized populations is important to assist in tailoring care and services. Reproductive coercion is consistently associated with intimate partner violence (IPV), engaging in sexual risk-taking, and is more commonly reported among non-White women. We conducted a secondary analysis of data from a mixed methods study to examine reproductive coercion in relationship contexts among a sample (N = 130) of young adult, primarily African American women recruited from three women's health clinics; 12 also participated in an in-depth interview. Thirty-six women (27.7%) reported reproductive coercion in the past year. Past-year reproductive coercion was associated with relationship trust, (t(128) = -3.01, p = .003), and past-year IPV (Fisher's exact test, p = .005). In the best-fit model, odds of past-year reproductive coercion increased by 4% with each one-point increase in relationship trust score (indicating reproductive coercion increased with lower trust; adjusted odds ratio [AOR] = 1.04; 95% confidence interval [CI] = [1.00, 1.08]), and by more than 4 times with past experience of IPV (AOR = 4.74; 95% CI = [1.07, 20.86]). Qualitative analysis revealed women's awareness of reproductive coercion whether or not they personally experienced it. Those who experienced reproductive coercion identified it as a form of abuse and additionally described experiences of pressure to conceive from the partner's family. Our results support routine screening for IPV and reproductive coercion. Furthermore, the intersection of partner reproductive coercion with family pressure related to reproductive decision making should be explored to better inform clinical interventions.

Decreasing Intimate Partner Violence during Pregnancy through Routine Screening

Intimate partner violence (IPV) during pregnancy is a significant yet preventable public health problem that affects millions of women globally per year (ACOG). Women are especially vulnerable to IPV when pregnant and coincidentally are seen often by practitioners for antenatal visits. Practitioners are in an adventitious position in screening these women for IPV as they are to be able to build rapport with these patients. The aim of this integrative review is to determine if practitioners routinely screen for IPV during pregnancy does it lower the incidence. Research studies were obtained from electronic databases, Cochrane Library, MEDLINE, CINAHL (Cumulative Index of Nursing and Allied Health Literature), and the U.S. National Library of Medicine/PubMed. Studies searched were from 2008 to 2016 and included quantitative and qualitative, national and international, and all were published in English. Twelve studies were used that met the inclusion criteria. The studies showed evidence that routine screening for IPV during prenatal visits increased the identification of IPV, versus not screening. There is evidence that interventions provided to women who screened positive decreased the degree of IPV experienced. There is also evidence that practitioners need more education on IPV screening to feel comfortable routinely screening their patients. There was a limited amount of studies on IVP screening during pregnancy. Therefore, more research is needed to establish a clear consensus.

Dating Violence Against HIV-Infected Youth in South Africa: Associations With Sexual Risk Behavior, Medication Adherence, and Mental Health.

As perinatal HIV-infected youth become sexually active, the potential for onward transmission becomes an increasing concern. In other populations, intimate partner violence (IPV) is a risk factor for HIV acquisition. We build on this critical work by studying the role of IPV in facilitating onward transmission among HIV-infected youth-an important step toward effective intervention. Soweto, South Africa. Self-report surveys were completed by 129 perinatal HIV-infected female youth (aged 13-24 years). We calculated the IPV prevalence and used logistic models to capture the association between IPV and health outcomes known to facilitate onward HIV transmission (eg, risky sex, poor medication adherence, depression, and substance abuse). A fifth of perinatal HIV-infected participants reported physical and/or sexual IPV in the past year; one-third reported lifetime IPV. Childhood adversity was common and positively associated with IPV. Past-year physical and/or sexual IPV was positively correlated with high-risk sex [odds ratio (OR) = 8.96; 95% confidence interval (CI): 2.78 to 28.90], pregnancy (OR = 6.56; 95% CI: 1.91 to 22.54), poor medication adherence to antiretroviral therapy (OR = 5.37; 95% CI: 1.37 to 21.08), depression (OR = 4.25; 95% CI: 1.64 to 11.00), and substance abuse (OR = 4.11; 95% CI: 1.42 to 11.86). Neither past-year nor lifetime IPV was associated with viral load or HIV status disclosure to a partner. We find that IPV may increase risk for onward HIV transmission in perinatal HIV-infected youth by both increasing engagement in risky sexual behaviors and lowering medication adherence. HIV clinics should consider integrating primary IPV prevention interventions, instituting routine IPV screening, and collocating services for victims of violence.

Prevalence and Predictors of Intimate Partner Violence in a Military Urogynecology Clinic

Intimate partner violence (IPV) is common, with prevalence in women of 15 to 71% over the lifespan, 4 to 54% currently. Violence is associated with poor health, and may be more common in military populations. A history of abuse is also common in patients with pain, urinary/bowel symptoms, and dyspareunia. Our purpose was to determine the prevalence and predictors of abuse in a military urogynecology clinic. Patients presenting to a military urogynecology clinic were screened for IPV with the 4-item Hurt-Insult-Threaten-Scream (HITS) screen. Patients' abuse history, reason for visit, and risk factors for IPV were assessed. χ2 and Fisher's exact tests were used for categorical variables. Out of 142 surveys, only 4 (2.8%) indicated a positive HITS screen (score of 10 or greater on a scale of 4-20), and 39 (27.5%) responded positively to at least one item. These individuals were significantly more likely to have a history of physical abuse or abuse in their families, with at least one positive response in 45.4% of patients with a history of family abuse compared to 20.8% of patients without this history (p = 0.007). The lifetime prevalence of physical abuse by an intimate partner was reported by 10 women (7%). A total of 29 women (20%) reported a history of forced sex and 33 (23%) reported a history of abuse in their family. Participants with a family history of abuse were more likely to have a positive HITS score, relative risk (RR) 2.19 (95% confidence interval [CI] 1.29-3.71), p = 0.004, as were those with history of physical abuse RR 2.44 (95% CI 1.35-4.39), p = 0.003 and a history of forced sexual contact, RR 1.73 (95% CI 1.00-3.00), p = 0.049. Race, education, marital status, and employment showed no association with a positive HITS response. The self-reported rate of IPV in a sample of women presenting to a urogynecology clinic in a military setting was 2.8%, below the rate reported in the civilian literature of 4 to 54%. We found that lifetime prevalence of IPV (7%) was also lower than the civilian rate of 15 to 71%. Routine screening for IPV is recommended by the American College of Obstetricians and Gynecologists, U.S. Preventative Services Task Force, and the Joint Commission. Even though IPV rates in the military are below civilian rates, IPV affects 3 to 7% of our population and remains a significant and preventable problem affecting women. IPV in military urogynecology patients was lower than the civilian setting; however, women with a history of abuse may be at increased risk of experiencing current IPV, and continued screening is important.