development of a compendium of effective structural interventions for hiv prevention
TRANSCRIPT
Development of a Compendium of Effective Structural Interventions for HIV
PreventionNational HIV Prevention ConferenceAtlanta, GAAugust 15, 2011
Shayna D. Cunningham, Ph.D.Sociometrics Corporation
Taxonomy of Interventions
1. Individual-level Aim to directly change individual level HIV determinants
such as knowledge, attitudes, skills, and behaviors through direct delivery of information to individuals or groups
2. Community-level Requires the participation of peers, groups, community
members, or media campaigns in order to modify interactions between individuals at the community level
3. Structural-level Modify an aspect of the risk environment to create a
barrier that prevents disease transmission or acquisition from occurring or to remove a barrier to enable prevention to occur
John Snow’s Pump
What is the Compendium of Effective Structural Interventions? Provides HIV prevention service providers,
planners, policymakers and others with information and materials to learn about, replicate, adapt, and evaluate structural interventions that have demonstrated efficaciousness in preventing HIV transmission
Complements Sociometrics’ HIV/AIDS Prevention Program Archive
Contents Introduction to structural interventions
Synthesis of available literature for major classes of structural interventions
Detailed descriptions of selected interventions and links to intervention materials Rationale and history Implementation Evaluation methods and results Lessons learned Replications/Adaptations
Analysis of trends related to the implementation of and methods used to evaluate effectiveness
Unique Features Includes only rigorously evaluated interventions
Provides historical context for different classes of structural interventions
Includes detailed descriptions of all intervention stages
Content derived from multiple sources, including interviews with developers and/or evaluators
Facilitates comparability among structural interventions
Will be published as a book and an on-line resource
Development Procedures1. Establish panel of scientist experts
• Drs. Don Des Jarlais, Seth Kalichman, Ralph DiClemente, Gina Wingood, & Don Morisky
Development Procedures1. Establish panel of scientist experts
2. Develop criteria for inclusion
Criteria for Inclusion Quality of program implementation
Content quality; faithfulness of implementation Scientific rigor of evaluation
Appropriate design, sample size, sampling procedures; control or comparison group where feasible, otherwise, another appropriate design such as time series analysis; adequate instrumentation and data collection procedures; adequate retention across follow-up data collection; appropriate analytic procedures
Adequacy of follow-up time Minimum of 6 months after intervention initiation
Positive impact on HIV risk behavior or STI/HIV infection rates, for one or more subgroups Sexual risk behaviors; drug injection risk behaviors;
prenatal and perinatal transmission risk behaviors; ART adherence; STI/HIV infection rates; viral load (among HIV+)
Development Procedures1. Establish panel of scientist experts
2. Develop criteria for program inclusion
3. Develop list of candidate interventions
Development Procedures1. Establish panel of scientist experts
2. Develop criteria for inclusion
3. Develop list of candidate interventions
4. Develop briefing materials
Development Procedures1. Establish panel of scientist experts
2. Develop criteria for inclusion
3. Develop list of candidate interventions
4. Develop briefing materials
5. Select interventions (Expert Panel)
Development Procedures1. Establish panel of scientist experts
2. Develop criteria for inclusion
3. Develop list of candidate interventions
4. Develop briefing materials
5. Select interventions (Expert Panel)
6. Contact developer(s)
Development Procedures1. Establish panel of scientist experts
2. Develop criteria for inclusion
3. Develop list of candidate interventions
4. Develop briefing materials
5. Select interventions (Expert Panel)
6. Contact developer(s)
7. Prepare entries and materials
Development Procedures1. Establish panel of scientist experts
2. Develop criteria for inclusion
3. Develop list of candidate interventions
4. Develop briefing materials
5. Select interventions (Expert Panel)
6. Contact developer(s)
7. Prepare entries and materials
8. Review and approve entries and materials (original developer)
Selected Interventions (N=18) Policies/Laws (17%)
e.g., legislation to allow sale of needles and syringes in pharmacies, operation of needle-exchange programs and safer injecting facilities, mandating 100% condom use in commercial sex establishments, offering pre-natal HIV screening, and universal access to ART
Provision of resources (17%) e.g., distribution of clean needles and condoms, provision
of HIV/STI testing and ART
Social marketing (22%)
Combination approach (44%)
Implementation Themes Emerged from a keen awareness of the needs of the
community and were highly acceptable, engaging, and responsive to community needs
Often initiated by a high status person or body, external to the local community. Over time, the external person either became an active member of the community or surrendered control to the community
Evolved over time - the robust components were identified over time through experimentation and inspection from both external observers and participants
Program leaders continually developed strategies to address structural issues and barriers for effective implementation
Evaluation Themes Quantifying the effectiveness of structural
interventions is difficult There is no direct, one-to-one relationship between structural
interventions and HIV incidence Structural interventions are not generally amenable to
randomization Comparison groups are not always readily available Often other potentially confounding factors (e.g., other
programs) Causal pathways from intervention to outcome are usually
indirect and complex
Evaluation Methodologies
78% used a prospective serial cross-sectional design
50% included a control/comparison group 33% random assignment of groups
33% included some element of randomization as part of the participant selection process
89% collected data via surveys
28% incorporated tests for HIV/STIs
Looking Ahead Completion of all entries, introductory material,
literature syntheses/reviews
Translation of materials
Development of associated website
Further exploration of implementation and evaluation trends/themes
Acknowledgements National Institute of Allergy and Infectious
Diseases (Grant R43-AI063937-01A2)
National Center on Minority Health and Health Disparities (Grant R44 MD005177-02)
Contact Information
Shayna Cunningham, Ph.D.Sociometrics Corporation
170 State Street, Suite 260Los Altos, California 94022