Development of a Compendium of Effective Structural Interventions for HIV Prevention
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This document discusses the development of a compendium of effective structural HIV prevention interventions. It describes the process of establishing expert criteria for inclusion, selecting 18 interventions, and preparing detailed entries on the rationale, implementation, evaluation and lessons of each. The interventions addressed policies/laws, resource provision, and social marketing. Key themes were emerging from community needs, evolving implementation, and the difficulty of evaluating complex structural interventions. The compendium aims to facilitate replication and adaptation of evidence-based structural approaches.
Development of a Compendium of Effective Structural Interventions for HIV Prevention
- 1. Development of a Compendium of Effective Structural Interventions for HIV Prevention National HIV Prevention Conference Atlanta, GA August 15, 2011 Shayna D. Cunningham, Ph.D. Sociometrics Corporation
- 2. 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
- 5. 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
- 6. 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
- 7. 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
- 8. Development Procedures 1. Establish panel of scientist experts • Drs. Don Des Jarlais, Seth Kalichman, Ralph DiClemente, Gina Wingood, & Don Morisky
- 9. Development Procedures 1. Establish panel of scientist experts 2. Develop criteria for inclusion
- 10. 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+)
- 11. Development Procedures 1. Establish panel of scientist experts 2. Develop criteria for program inclusion 3. Develop list of candidate interventions
- 12. Development Procedures 1. Establish panel of scientist experts 2. Develop criteria for inclusion 3. Develop list of candidate interventions 4. Develop briefing materials
- 13. Development Procedures 1. 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)
- 14. Development Procedures 1. 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)
- 15. Development Procedures 1. 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
- 16. Development Procedures 1. 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)
- 17. 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%)
- 22. 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
- 23. 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
- 24. 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
- 25. 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
- 26. Acknowledgements National Institute of Allergy and Infectious Diseases (Grant R43-AI063937-01A2) National Center on Minority Health and Health Disparities (Grant R44 MD005177-02)
- 27. Contact Information Shayna Cunningham, Ph.D. Sociometrics Corporation 170 State Street, Suite 260 Los Altos, California 94022 650-383-6259 scunning@socio.com