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The Updated CDC’s Compendium of Evidence- based Behavioral Interventions for Reducing     HIV Risk Behaviors and Promoting...
The National HIV/AIDS Strategy (NHAS)Three main goals:  1. Reducing the number of people who become     infected with HIV ...
HIV/AIDS Prevention Research     Synthesis (PRS) Project at CDC• Prevention Research Synthesis (PRS) Project  – Quantitati...
Purpose of Today’s Talk   PRS efficacy review process   PRS efficacy criteria   Findings of recent PRS efficacy reviews...
PRS Project Website      http://www.cdc.gov/hiv/topics/research/prs/index.htm   PRS project   Efficacy review    methods...
Efficacy Review Methods          Systematic search of literature†† DeLuca, J. B., Mullins, M. M., Lyles, C. M., Crepaz, N....
Efficacy Review Methods          Systematic search of literature†          Screen literature to identify eligible         ...
Efficacy Review Methods              Systematic search of literature†              Screen literature to identify eligible ...
Efficacy Review Methods          Systematic search of literature†          Screen literature to identify eligible         ...
Eligible for Efficacy Review•   HIV/STD behavioral prevention focus•   U.S. (or U.S. territories) study•   Outcome evaluat...
Eligible for Efficacy Review       Relevant behavioral or biologic outcome data   Risk Reduction Outcomes          Medicat...
Efficacy Review Methods            Systematic search of literature†            Screen literature to identify eligible     ...
Efficacy Criteria Development   •        Review of scientific literature†   •        Internal PRB consultation   •        ...
Efficacy Criteria†   •       Quality of research study design   •       Quality of study implementation   •       Quality ...
Efficacy Reviews for the       Updated CompendiumUpdated in 2010:          Risk Reduction Chapter     Individual-, Group-,...
Results of Risk Reduction (RR) and   Medication Adherence (MA) Efficacy Reviews                               RR          ...
Compendium of Evidence-Based HIV Behavioral    Interventions: Risk Reduction Chapter• 4 new RR EBIs• Total of 74 RR EBIs i...
Risk Reduction Chapter – 4 New EBIs        Intervention       Best/   ILI/   Target Population              Male/Female   ...
Gaps in the Scientific Literature for         Risk Reduction EBIs• No NEW Risk Reduction EBIs for  – Men who have sex with...
New Medication Adherence     Efficacy Review   Individual- & Group-Level     Interventions (ILI/GLI)   January 1996 – Dece...
Results of New Medication Adherence       ILI/GLI Efficacy Review                                 MA                      ...
Compendium of Evidence-Based HIV Behavioral Interventions:            New Medication Adherence Chapter• 8 new MA EBIs• Com...
NEW Medication Adherence Chapter             8 EBIs• 0 Best-evidence• 8 Good-evidence• 5 Individual-level• 3 Group-level• ...
NEW Medication Adherence Chapter        Intervention Name                                 ILI      GLI       CLI          ...
NEW Medication Adherence Chapter        Intervention Name      Target Risk      Race/Ethnicity of               Author, Ye...
NEW Medication Adherence Chapter       Intervention Name      Healthcare               Author, Year                       ...
NEW Medication Adherence Chapter       Intervention Name      Healthcare Provider               Author, Year              ...
Description of MA Non-EBIs• Intervention studies not meeting MA criteria  – No positive significant intervention effect on...
Next Steps for Medication Adherence• Work with federal partners (NIH, HRSA),  DHAP (Capacity Building Branch), and  stakeh...
Summary: Compendium of Evidence-Based         HIV Behavioral Interventions• Two chapters:   Risk Reduction and            ...
Next Steps for the Compendium• Post new EBIs on the web as identified• Consider new EBIs for future research translation  ...
Thank You!                                Khiya Marshall                              kmarshall@cdc.govFor more informatio...
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The Updated CDC’s Compendium of Evidence-based Behavioral Interventions for Reducing HIV Risk Behaviors and Promoting HIV Medication Adherence

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The Updated CDC’s Compendium of Evidence-based Behavioral Interventions for Reducing HIV Risk Behaviors and Promoting HIV Medication Adherence

  1. 1. The Updated CDC’s Compendium of Evidence- based Behavioral Interventions for Reducing HIV Risk Behaviors and Promoting HIV Medication Adherence Khiya Marshall, Mahnaz Charania, Linda Kay, Nicole Crepaz, Cynthia Lyles, Darigg Brown, Renyea Colvin, Darrel Higa, Sima Rama, Malu Tungol, Waverly Vosburgh Prevention Research Branch DHAP, NCHHSTP, CDC 2011 National HIV Prevention Conference, Atlanta, GA, August 16, 2011 National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Division of HIV/AIDS Prevention
  2. 2. The National HIV/AIDS Strategy (NHAS)Three main goals: 1. Reducing the number of people who become infected with HIV 2. Increasing access to care and optimizing health outcomes for people living with HIV 3. Reducing HIV-related health disparities
  3. 3. HIV/AIDS Prevention Research Synthesis (PRS) Project at CDC• Prevention Research Synthesis (PRS) Project – Quantitative (meta-analyses) & qualitative reviews – Efficacy Review• Evidence-Based Interventions (EBIs) – Interventions rigorously evaluated – Demonstrated strong and sufficient evidence of efficacy – Identified through on-going efficacy reviews
  4. 4. Purpose of Today’s Talk PRS efficacy review process PRS efficacy criteria Findings of recent PRS efficacy reviews  Updated Compendium – Risk Reduction Chapter – NEW Medication Adherence Chapter Discuss research gaps and next steps
  5. 5. PRS Project Website http://www.cdc.gov/hiv/topics/research/prs/index.htm PRS project Efficacy review methods Best- & Good- evidence criteria Compendium of evidence-based interventions (EBIs)
  6. 6. Efficacy Review Methods Systematic search of literature†† DeLuca, J. B., Mullins, M. M., Lyles, C. M., Crepaz, N., Kay, K., Thadiparthi, S. (2008). Developing a comprehensive search strategy for evidence based systematic reviews. Evidence Based Library and Information Practice, 3, 3-32.
  7. 7. Efficacy Review Methods Systematic search of literature† Screen literature to identify eligible interventions, their evaluation reports, and linked citations† DeLuca, J. B., Mullins, M. M., Lyles, C. M., Crepaz, N., Kay, K., Thadiparthi, S. (2008). Developing a comprehensive search strategy for evidence based systematic reviews. Evidence Based Library and Information Practice, 3, 3-32.
  8. 8. Efficacy Review Methods Systematic search of literature† Screen literature to identify eligible interventions, their evaluation reports, and any linked citations Evaluate evidence for each intervention using explicit a-priori efficacy criteria† DeLuca, J. B., Mullins, M. M., Lyles, C. M., Crepaz, N., Kay, K., Thadiparthi, S. (2008). Developing a comprehensive search strategy for evidence based systematic reviews. Evidence Based Library and Information Practice, 3, 3-32.
  9. 9. Efficacy Review Methods Systematic search of literature† Screen literature to identify eligible interventions, their evaluation reports, and any linked citations Evaluate evidence for each intervention using explicit a-priori efficacy criteria† DeLuca, J. B., Mullins, M. M., Lyles, C. M., Crepaz, N., Kay, K., Thadiparthi, S. (2008). Developing a comprehensive search strategy for evidence based systematic reviews. Evidence Based Library and Information Practice, 3, 3-32.
  10. 10. Eligible for Efficacy Review• HIV/STD behavioral prevention focus• U.S. (or U.S. territories) study• Outcome evaluation report• Peer-reviewed journal publication / in press• Relevant behavioral or biologic outcome data• Individual-, group-, community-level intervention Excluded Interventions• Only HIV C&T or partner notification• Only drug abuse tx or needle-exchange• School-based curriculum• Structural & policy interventions• Only treatment regimen changes
  11. 11. Eligible for Efficacy Review Relevant behavioral or biologic outcome data Risk Reduction Outcomes Medication Adherence OutcomesBehaviors – Sex & Drug Injection Behaviors - Adherence Abstinence MEMs caps/electronic data Mutual monogamy monitoring (EDM) Number of sex partners Pill count (announced/unannounced) Negotiation of safer sex Pharmacy refill Condom use Self-report adherence Refusal to have unsafe sex Frequency of injection drug use Biologic Outcome Needle sharing Viral loadBiologic Outcomes HIV, Hepatitis, or other STDs (prevalence or incidence)
  12. 12. Efficacy Review Methods Systematic search of literature† Screen literature to identify eligible interventions, their evaluation reports, and any linked citations Evaluate evidence for each intervention using explicit a-priori efficacy criteria† DeLuca, J. B., Mullins, M. M., Lyles, C. M., Crepaz, N., Kay, K., Thadiparthi, S. (2008). Developing a comprehensive search strategy for evidence based systematic reviews. Evidence Based Library and Information Practice, 3, 3-32.
  13. 13. Efficacy Criteria Development • Review of scientific literature† • Internal PRB consultation • External consultation • Criteria testing • Finalize Best & Good criteria† Flores and Crepaz for the HIV PRS Team. Quality of study methods in individual- and group-level HIV intervention research: Critical reporting elements. AIDS Educ Prev. 2004;16:341-352.
  14. 14. Efficacy Criteria† • Quality of research study design • Quality of study implementation • Quality of analysis • Strength of findings† Lyles, Crepaz, Herbst, Kay, for the HIV/AIDS PRS Team. Evidence-based HIV behavioral prevention from the perspective of CDC’s HIV/AIDS Prevention Research Synthesis Team. AIDS Educ Prev. 2006;18(suppl A):21-31.
  15. 15. Efficacy Reviews for the Updated CompendiumUpdated in 2010: Risk Reduction Chapter Individual-, Group-, & Community-Level Interventions (ILI/GLI/CLI) (July 2009 – December 2009)New in 2010: Medication Adherence Chapter Individual- & Group-Level Interventions (ILI/GLI) (January 1996 – December 2009)
  16. 16. Results of Risk Reduction (RR) and Medication Adherence (MA) Efficacy Reviews RR MA Jul ’09 – Dec ‘09 Jan ‘96 – Dec ‘09 Intervention citationswith Beh/Bio outcomes 69 202 Unique Studies Eligible for Review 20 50New Evidence-based 4 Interventions (EBIs) 8
  17. 17. Compendium of Evidence-Based HIV Behavioral Interventions: Risk Reduction Chapter• 4 new RR EBIs• Total of 74 RR EBIs in the Compendium• Complete List of Best & Good RR EBIs• Stratified list by characteristic• Fact sheet on each EBI http://www.cdc.gov/hiv/topics/research/prs/index.htm
  18. 18. Risk Reduction Chapter – 4 New EBIs Intervention Best/ ILI/ Target Population Male/Female Name Good GLI/ Race/Ethnicity Author, Year CLIHoMBReS Best CLI Recently immigrated, 100% M(Hombres Manteniendo heterosexual Latino menBienestar y Relaciones in rural areas 100% HispanicSaludables)Rhodes, 2009Centering Pregnancy Plus Best GLI Young pregnant women in 100% F(CPP) prenatal careKershaw, 2009 94% Minority 6% WhiteHealthy Love Good GLI Black women 100% FDiallo, 2010(in press in 2009) 97% AA 3% Caribbean, Central, or South AmericanSafe on the Outs Good GLI Adolescents in detention 83% MBryan, 2009 facilities 17% F 63% Minority 37% White
  19. 19. Gaps in the Scientific Literature for Risk Reduction EBIs• No NEW Risk Reduction EBIs for – Men who have sex with men (MSM) – Injection drug users (IDUs) – Persons living with HIV (PLWH)
  20. 20. New Medication Adherence Efficacy Review Individual- & Group-Level Interventions (ILI/GLI) January 1996 – December 2009
  21. 21. Results of New Medication Adherence ILI/GLI Efficacy Review MA Jan ‘96 – Dec ‘09 Intervention citations 202 with Beh/Bio outcomes Eligible Unique 50 Studies in Review New Evidence-based 8 Interventions (EBIs)
  22. 22. Compendium of Evidence-Based HIV Behavioral Interventions: New Medication Adherence Chapter• 8 new MA EBIs• Complete List of Best & Good MA EBIs• Stratified list by characteristic• Fact sheet on each EBI http://www.cdc.gov/hiv/topics/research/prs/index.htm
  23. 23. NEW Medication Adherence Chapter 8 EBIs• 0 Best-evidence• 8 Good-evidence• 5 Individual-level• 3 Group-level• 0 Community-level
  24. 24. NEW Medication Adherence Chapter Intervention Name ILI GLI CLI Author, YearPartnership for HealthMilam, 2005ATHENAWilliams, 2006Pager MessagingSimoni, 2009DAART in a Methadone ClinicLucas, 2006DAART for Drug UsersAltice, 2007SMART CouplesRemien, 2005Project HEARTKoenig, 2008Peer SupportSimoni, 2009
  25. 25. NEW Medication Adherence Chapter Intervention Name Target Risk Race/Ethnicity of Author, Year Group Study SamplePartnership for Health 60% MinorityMilam, 2005ATHENA 58% MinorityWilliams, 2006Pager Messaging 53% MinoritySimoni, 2009DAART in a Methadone Clinic IDUs in tx 79% African AmericanLucas, 2006DAART for Drug Users Drug Users 78% MinorityAltice, 2007SMART Couples Sero-discordant 62% African AmericanRemien, 2005 Couples 24% HispanicProject HEART 83% African AmericanKoenig, 2008Peer Support 53% MinoritySimoni, 2009
  26. 26. NEW Medication Adherence Chapter Intervention Name Healthcare Author, Year Tx Exp Tx naïve SettingPartnership for HealthMilam, 2005ATHENAWilliams, 2006Pager MessagingSimoni, 2009DAART in a Methadone ClinicLucas, 2006DAART for Drug UsersAltice, 2007SMART CouplesRemien, 2005Project HEARTKoenig, 2008Peer SupportSimoni, 2009
  27. 27. NEW Medication Adherence Chapter Intervention Name Healthcare Provider Author, Year Peer Other (e.g., PCP, nurse)Partnership for HealthMilam, 2005ATHENAWilliams, 2006Pager MessagingSimoni, 2009DAART in a Methadone ClinicLucas, 2006DAART for Drug UsersAltice, 2007SMART CouplesRemien, 2005Project HEARTKoenig, 2008Peer SupportSimoni, 2009
  28. 28. Description of MA Non-EBIs• Intervention studies not meeting MA criteria – No positive significant intervention effect on relevant behavioral/biologic outcome – Pilot studies with small sample sizes (<40 per arm) – Low retention rates at follow-up (<60% per arm)
  29. 29. Next Steps for Medication Adherence• Work with federal partners (NIH, HRSA), DHAP (Capacity Building Branch), and stakeholders to determine future translation activities  What kinds of products need to be developed?  Who needs adherence intervention products?  How do we disseminate products?  What kind of training & TA are needed?
  30. 30. Summary: Compendium of Evidence-Based HIV Behavioral Interventions• Two chapters: Risk Reduction and New Medication Adherence Total of 82 RR & MA EBIs• 74 Risk Reduction• 8 Medication Adherence• 48 Group-level• 28 Individual-level• 6 Community-level
  31. 31. Next Steps for the Compendium• Post new EBIs on the web as identified• Consider new EBIs for future research translation activities• Continue to update the Compendium with proven interventions• Begin a new Chapter: Linking & retention in care
  32. 32. Thank You! Khiya Marshall kmarshall@cdc.govFor more information please contact Centers for Disease Control and Prevention1600 Clifton Road NE, Atlanta, GA 30333Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: cdcinfo@cdc.gov Web: http://www.cdc.govThe findings and conclusions in this report are those of the authors and do not necessarily represent the official position ofthe Centers for Disease Control and Prevention. National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Division of HIV/AIDS Prevention

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