This IRSDA application embodies the Fogarty mission of facilitating global health research through building collaboration between international health research institutes and training new global health scientists. The award will enable Dr. Ameeta Kalokhe, a 2012-2013 Fogarty Global Health Fellow at the National AIDS Research Institute (NARI, Pune, India) and infectious diseases physician at Emory University, to establish herself as an independently-funded, global health researcher with capacity to develop and implement effective, culturally-tailored interventions to curb intimate partner violence (IPV) in India. The career development plan will provide Dr. Kalokhe with 1) enhanced knowledge of IPV theories and their application in designing prevention interventions in the Indian context, methods for developing and assessing behavioral interventions, and qualitative study design and analysis, 2) a strong grasp of the ethical considerations in conducting international IPV research, and 3) improved oral and written research presentation skills to disseminate results to multi-disciplinary, international audiences. Dr. Kalokhe has assembled a diverse mentorship team that collectively has extensive knowledge and experience in conducting IPV research (in low- and middle-income countries including India), utilizing behavioral theory to develop behavioral health interventions, and in-depth Indian cultural understanding. This includes primary Emory and India mentors, Rob Stephenson, PhD and Seema Sahay, PhD, and co-mentors Carlos del Rio, MD, Kristin Dunkle, PhD, and Anuradha Paranjape, MD. IPV is prevalent among women in India and associated with poor mental and physical health. This study will be conducted in Pune, India through NARI and aims to 1) explore differences by wealth in IPV prevalence, acceptance, and resource utilization, and sexual health knowledge among recently-married women, and 2) to develop and 3) pilot a culturally-tailored primary IPV prevention intervention in low-wealth husband-wife dyads to preliminarily evaluate feasibility, acceptability, safety, and efficacy. Phase I (quantitative) involves cross-sectional survey administration to 200 randomly-sampled, recently-married women stratified by wealth to assess 12-month frequency of IPV (using our recently-developed Indian Family Violence and Control Scale), sexual health knowledge, IPV acceptance, and use and barriers to use of IPV support services. Phase II (qualitative) uses key informant interviews and focus groups to develop the intervention by examining community perspectives on vital intervention components, acceptability and feasibility, and barriers to participation. Phase III pilots the intervention in 4 sessions over a month to 20 husband-wife dyads and assesses 1) acceptability and feasibility post-intervention using semi-structured interviews with participants and intervention staff and 2) safety and efficacy at 3 months using semi-structured interviews and surveys quantifying the change in the dyad's attitudes toward IPV acceptability and gender equality and knowledge of sexual health and IPV resources from pre-intervention levels.
Forty percent of married women in India are estimated to experience intimate partner violence (IPV) during their lifetime. In addition to directly inflictin mental and physical injury, IPV has been associated with HIV, sexually-transmitted infections, chronic non-infectious disease like asthma and chronic fatigue, and poor mental, maternal, and child health. The proposed research will provide critical insight into whether and how IPV experiences and prevention strategies may differ by economic status and develops and pilots a primary IPV prevention intervention for low-wealth husband-wife dyads in India.