***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Women who exchange sex for money or other goods , that is , female sex workers , are at increased risk of experiencing physical and sexual violence from both paying and intimate partners . Exposure to violence can be exacerbated by alcohol use and HIV/STI risk . The purpose of this study is to examine the efficacy of a HIV/STI risk reduction and enhanced HIV/STI risk reduction intervention at decreasing paying and intimate partner violence against Mongolian women who exchange sex and engage in harmful alcohol use . Women are recruited and r and omized to either ( a ) four sessions of a relationship-based HIV/STI risk reduction intervention ( n = 49 ) , ( b ) the same HIV/STI risk reduction intervention plus two additional motivational interviewing sessions ( n = 58 ) , or ( c ) a four session control condition focused on wellness promotion ( n = 59 ) . All the respondents complete assessment s at baseline ( preintervention ) as well as at immediate posttest , 3 and 6 months postintervention . A multilevel logistic model finds that women who participated in the HIV/STI risk reduction group ( OR = 0.14 , p < .00 ) , HIV/STI risk reduction and motivational interview group ( OR = 0.46 , p = .02 ) , and wellness ( OR = 0.20 , p < .00 ) group reduced their exposure to physical and sexual violence in the past 90 days . No significant differences in effects are observed between conditions . This study demonstrates the efficacy of a  relationship-based HIV/STI risk reduction intervention , a relationship-based HIV/STI risk reduction intervention combined with motivational interviewing , and a wellness promotion intervention in reducing intimate and paying partner violence against women who exchange sex in Mongolia . The findings have significant implication s for the impact of minimal intervention and the potential role of peer networks and social support in reducing women ’s experiences of violence in re source poor setting Summary Background Although structured psychological treatments are recommended as first-line interventions for depression , only a small fraction of people globally receive these treatments because of poor access in routine primary care . We assessed the effectiveness and cost-effectiveness of a brief psychological treatment ( Healthy Activity Program [ HAP ] ) for delivery by lay counsellors to patients with moderately severe to severe depression in primary health-care setting s. Methods In this r and omised controlled trial , we recruited participants aged 18–65 years scoring more than 14 on the Patient Health Question naire 9 ( PHQ-9 ) indicating moderately severe to severe depression from ten primary health centres in Goa , India . Pregnant women or patients who needed urgent medical attention or were unable to communicate clearly were not eligible . Participants were r and omly allocated ( 1:1 ) to enhanced usual care ( EUC ) alone or EUC combined with HAP in r and omly sized blocks ( block size four to six [ two to four for men ] ) , stratified by primary health centre and sex , and allocation was concealed with use of sequential numbered opaque envelopes . Physicians providing EUC were masked . Primary outcomes were depression symptom severity on the Beck Depression Inventory version II and remission from depression ( PHQ-9 score of < 10 ) at 3 months in the intention-to-treat population , assessed by masked field research ers . Secondary outcomes were disability , days unable to work , behavioural activation , suicidal thoughts or attempts , intimate partner violence , and re source use and costs of illness . We assessed serious adverse events in the per- protocol population . This trial is registered with the IS RCT N registry , number IS RCT N95149997 . Findings Between Oct 28 , 2013 , and July 29 , 2015 , we enrolled and r and omly allocated 495 participants ( 247 [ 50 % ] to the  EUC plus HAP  group [ two of whom were subsequently excluded because of protocol violations ] and 248 [ 50 % ] to the EUC alone group ) , of whom 466 ( 95 % ) completed the 3 month primary outcome assessment ( 230 [ 49 % ] in the EUC plus HAP group and 236 [ 51 % ] in the EUC alone group ) . Participants in the EUC plus HAP group had significantly lower symptom severity ( Beck Depression Inventory version II in EUC plus HAP group 19·99 [ SD 15·70 ] vs 27·52 [ 13·26 ] in EUC alone group ; adjusted mean difference −7·57 [ 95 % CI −10·27 to −4·86 ] ; p<0·0001 ) and higher remission ( 147 [ 64 % ] of 230 had a PHQ-9 score of < 10 in the HAP plus EUC group vs 91 [ 39 % ] of 236 in the EUC alone group ; adjusted prevalence ratio 1·61 [ 1·34–1·93 ] ) than did those in the EUC alone group . EUC plus HAP showed better results than did EUC alone  for the secondary outcomes of disability ( adjusted mean difference −2·73 [ –4·39 to −1·06 ] ; p=0·001 ) , days out of work ( −2·29 [ –3·84 to −0·73 ] ; p=0·004 ) , intimate partner physical violence in women ( 0·53 [ 0·29–0·96 ] ; p=0·04 ) , behavioural activation ( 2·17 [ 1·34–3·00 ] ; p<0·0001 ) , and suicidal thoughts or attempts ( 0·61 [ 0·45–0·83 ] ; p=0·001 ) . The incremental cost per quality -adjusted life-year gained was $ 9333 ( 95 % CI 3862–28 169 ; 2015 international dollars ) , with an 87 % chance of being cost-effective in the study setting . Serious adverse events were infrequent and similar between groups ( nine [ 4 % ] in the EUC plus HAP group vs ten [ 4 % ] in the EUC alone group ; p=1·00 ) . Interpretation HAP delivered by lay counsellors plus EUC was better than EUC alone was for patients with moderately severe to severe depression in routine primary care in Goa , India . HAP was readily accepted by this previously untreated population and was cost-effective in this setting . HAP could be a key strategy to reduce the treatment gap for depressive disorders , the leading mental health disorder worldwide . Funding Wellcome Trust Background The Healthy Activity Programme ( HAP ) , a brief behavioural intervention delivered by lay counsellors , enhanced remission over 3 months among primary care attendees with depression in peri-urban and rural setting s in India . We evaluated the sustainability of the effects after treatment termination , the cost-effectiveness of HAP over 12 months , and the effects of the hypothesized mediator of activation on clinical outcomes . Methods and findings Primary care attendees aged 18–65 years screened with moderately severe to severe depression on the Patient Health Question naire 9 ( PHQ-9 ) were r and omised to either  HAP plus enhanced usual care ( EUC ) ( n = 247 ) or EUC alone ( n = 248 ) , of whom 95 % completed assessment s at 3 months , and 91 % at 12 months . Primary outcomes were severity on the Beck Depression Inventory – II ( BDI-II ) and remission on the PHQ-9 .  HAP participants maintained the gains they showed at the end of treatment through the 12-month follow-up ( difference in mean BDI-II score between 3 and 12 months = −0.34 ; 95 % CI −2.37 , 1.69 ; p = 0.74 ) , with lower symptom severity scores than participants who received EUC alone ( adjusted mean difference in BDI-II score = −4.45 ; 95 % CI −7.26 , −1.63 ; p = 0.002 ) and higher rates of remission ( adjusted prevalence ratio [ aPR ] = 1.36 ; 95 % CI 1.15 , 1.61 ; p < 0.009 ) . They also fared better on most secondary outcomes , including recovery ( aPR = 1.98 ; 95 % CI 1.29 , 3.03 ; p = 0.002 ) , any response over time ( aPR = 1.45 ; 95 % CI 1.27 , 1.66 ; p < 0.001 ) , higher likelihood of reporting a minimal clinical ly important difference ( aPR = 1.42 ; 95 % CI 1.17 , 1.71 ; p < 0.001 ) , and lower likelihood of reporting suicidal behaviour ( aPR = 0.71 ; 95 % CI 0.51 , 1.01 ; p = 0.06 ) . HAP plus EUC also had a marginal effect on WHO Disability Assessment Schedule score at 12 months ( aPR = −1.58 ; 95 % CI −3.33 , 0.17 ; p = 0.08 ) ; other outcomes ( days unable to work , intimate partner violence toward females ) did not statistically significantly differ between the two arms . Economic analyses indicated that HAP plus EUC was dominant over EUC alone , with lower costs and better outcomes ; uncertainty analysis showed that from this health system perspective there was a 95 % chance of HAP being cost-effective , given a willingness to pay threshold of Intl$16,060—equivalent to GDP per capita in Goa — per quality -adjusted life year gained . Patient-reported behavioural activation level at 3 months mediated the effect of the HAP intervention on the 12-month depression score ( β = −2.62 ; 95 % CI −3.28 , −1.97 ; p < 0.001 ) . Serious adverse events were infrequent , and prevalence was similar by arm . We were unable to assess possible episodes of remission and relapse that may have occurred between our outcome assessment time points of 3 and 12 months after r and omisation . We did not account for or evaluate the effect of mediators other than behavioural activation . Conclusions HAP ’s superiority over EUC at the end of treatment was largely stable over time and was mediated by patient activation . HAP provides better outcomes at lower costs from a perspective covering publicly funded healthcare services and productivity impacts on patients and their families . Trial registration IS RCT N registry IS RCT Background Violence against women and girls ( VAWG ) is an urgent global health problem . Root causes for VAWG include the individual- and family-level factors of alcohol abuse , mental health problems , violence exposure , and related adverse experiences . Few studies in low- and middle-income countries ( LMIC ) have assessed the effectiveness of psychological interventions for reducing VAWG . This r and omized controlled trial , part of the What Works to Prevent Violence Against Women and Girls consortium , examines the effectiveness of a common elements treatment approach ( CETA ) for reducing VAWG and comorbid alcohol abuse among families in Zambia . Methods / design Study participants are families consisting of three persons : an adult woman , her male husb and or partner , and one of her children aged 8–17 ( if available ) . Eligibility criteria include experience of moderate-to-severe intimate partner violence by the woman and hazardous alcohol use by her male partner . Family units are r and omized to receive CETA or treatment as usual . The primary outcome is VAWG as measured by the Severity of Violence Against Women Scale , assessed along with secondary outcomes at 24 months post-baseline . Interim assessment s are also conducted at 4–5 months ( following CETA completion ) and 12 months post-baseline . Conclusions This ongoing trial is one of the first in sub-Saharan Africa to evaluate the use of an evidence -based common elements approach for reducing VAWG by targeting a range of individual- and family-level factors , including alcohol abuse . Results of this trial will inform policy on what interventions work to prevent VAWG in LMIC with local perspectives on scale up and wider implementation Background Counselling for Alcohol Problems ( CAP ) , a brief intervention delivered by lay counsellors , enhanced remission and abstinence over 3 months among male primary care attendees with harmful drinking in a setting in India . We evaluated the sustainability of the effects after treatment termination , the cost-effectiveness of CAP over 12 months , and the effects of the hypothesized mediator ‘ readiness to change ’ on clinical outcomes . Methods and findings Male primary care attendees aged 18–65 years screening with harmful drinking on the Alcohol Use Disorders Identification Test ( AUDIT ) were r and omised to either CAP plus enhanced usual care ( EUC ) ( n = 188 ) or EUC alone ( n = 189 ) , of whom 89 % completed assessment s at 3 months , and 84 % at 12 months . Primary outcomes were remission and mean st and ard ethanol consumed in the past 14 days , and the proposed mediating variable was readiness to change at 3 months . CAP participants maintained the gains they showed at the end of treatment through the 12-month follow-up , with the proportion with remission ( AUDIT score < 8 : 54.3 % versus 31.9 % ; adjusted prevalence ratio [ aPR ] 1.71 [ 95 % CI 1.32 , 2.22 ] ; p < 0.001 ) and abstinence in the past 14 days ( 45.1 % versus 26.4 % ; adjusted odds ratio 1.92 [ 95 % CI 1.19 , 3.10 ] ; p = 0.008 ) being significantly higher in the CAP plus EUC arm than in the EUC alone arm 
    Output:
    
The dedicated mental health treatments targeting depression or alcohol misuse consistently reduced levels of these outcomes .
In contrast to the dedicated mental health interventions , the integrated interventions did not consistently reduce mental ill health or alcohol misuse compared to control conditions .
Conclusions Too few studies have been conducted to judge whether mental health treatments may provide a beneficial strategy to prevent or reduce IPV in LMIC .