Development and integration of IPV-4, a patient-reported screening instrument of intimate partner violence for primary and HIV care

Intimate partner violence (IPV) is a significant and under-reported health problem. Legacy measures of IPV lack brevity and/or are relevant only to specific populations, which limit their usefulness for routine clinical care. We developed a brief patient-reported screening instrument of past-year intimate partner violence (IPV). We developed an item pool from validated IPV screening instruments, dimensionalized and winnowed its content to select candidate items. We conducted interviews with English and Spanish-speaking persons in HIV care in six U.S. primary care clinics to assess their comprehensibility, which informed the development of the four-item instrument (IPV-4). After integration into care we performed chart review for indication of IPV in the past 5 years to assess impact. We identified 68 items from 12 instruments and winnowed content within dimensions of physical, sexual, and psychological violence. We then presented 11 candidate items to PWH in interviews (n=45, 49% Spanish-language; mean age 45 years; 62% cisgender male, 33% cisgender female, 5% transgender female; 71% nonwhite). The resulting instrument was well-understood in English and Spanish and relevant across gender and sexual orientation. PWH (n=6415) completed the IPV-4 in clinical care settings; 9% reported any type of IPV and 5% reported physical and/or sexual violence. In chart notes of a single-site subset of PWH (n=1756), of those indicating physical and/or sexual violence on the IPV-4 with medical records available from the past five years (n=63), only 19% of PWH had prior notes indicating IPV in that time period. The IPV-4 is a brief, gender/sexual orientation-neutral, clinically relevant screening instrumentthat identifies and dimensionalizes past-year IPV present in 9% of PWH in routine care.