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
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