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. 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. 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. 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. 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. 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. 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. 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. 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. 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. Eligible for Efficacy Review
Relevant behavioral or biologic outcome data
Risk Reduction Outcomes Medication Adherence Outcomes
Behaviors – 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 load
Biologic Outcomes
HIV, Hepatitis, or other STDs
(prevalence or incidence)

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. 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. 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. Efficacy Reviews for the
Updated Compendium
Updated 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. Results of Risk Reduction (RR) and
Medication Adherence (MA) Efficacy Reviews
RR MA
Jul ’09 – Dec ‘09 Jan ‘96 – Dec ‘09
Intervention citations
with Beh/Bio outcomes 69 202
Unique Studies
Eligible for Review 20 50
New Evidence-based 4
Interventions (EBIs)
8

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. Risk Reduction Chapter – 4 New EBIs
Intervention Best/ ILI/ Target Population Male/Female
Name Good GLI/ Race/Ethnicity
Author, Year CLI
HoMBReS Best CLI Recently immigrated, 100% M
(Hombres Manteniendo heterosexual Latino men
Bienestar y Relaciones in rural areas 100% Hispanic
Saludables)
Rhodes, 2009
Centering Pregnancy Plus Best GLI Young pregnant women in 100% F
(CPP) prenatal care
Kershaw, 2009 94% Minority
6% White
Healthy Love Good GLI Black women 100% F
Diallo, 2010
(in press in 2009) 97% AA
3% Caribbean,
Central, or South
American
Safe on the Outs Good GLI Adolescents in detention 83% M
Bryan, 2009 facilities 17% F
63% Minority
37% White

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. New Medication Adherence
Efficacy Review
Individual- & Group-Level
Interventions (ILI/GLI)
January 1996 – December 2009

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. 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. NEW Medication Adherence Chapter
8 EBIs
• 0 Best-evidence
• 8 Good-evidence
• 5 Individual-level
• 3 Group-level
• 0 Community-level

24. NEW Medication Adherence Chapter
Intervention Name
ILI GLI CLI
Author, Year
Partnership for Health
Milam, 2005
ATHENA
Williams, 2006
Pager Messaging
Simoni, 2009
DAART in a Methadone Clinic
Lucas, 2006
DAART for Drug Users
Altice, 2007
SMART Couples
Remien, 2005
Project HEART
Koenig, 2008
Peer Support
Simoni, 2009

25. NEW Medication Adherence Chapter
Intervention Name Target Risk Race/Ethnicity of
Author, Year Group Study Sample
Partnership for Health 60% Minority
Milam, 2005
ATHENA 58% Minority
Williams, 2006
Pager Messaging 53% Minority
Simoni, 2009
DAART in a Methadone Clinic IDUs in tx 79% African American
Lucas, 2006
DAART for Drug Users Drug Users 78% Minority
Altice, 2007
SMART Couples Sero-discordant 62% African American
Remien, 2005 Couples 24% Hispanic
Project HEART 83% African American
Koenig, 2008
Peer Support 53% Minority
Simoni, 2009

26. NEW Medication Adherence Chapter
Intervention Name Healthcare
Author, Year
Tx Exp Tx naïve
Setting
Partnership for Health
Milam, 2005
ATHENA
Williams, 2006
Pager Messaging
Simoni, 2009
DAART in a Methadone Clinic
Lucas, 2006
DAART for Drug Users
Altice, 2007
SMART Couples
Remien, 2005
Project HEART
Koenig, 2008
Peer Support
Simoni, 2009

27. NEW Medication Adherence Chapter
Intervention Name Healthcare Provider
Author, Year
Peer Other
(e.g., PCP, nurse)
Partnership for Health
Milam, 2005
ATHENA
Williams, 2006
Pager Messaging
Simoni, 2009
DAART in a Methadone Clinic
Lucas, 2006
DAART for Drug Users
Altice, 2007
SMART Couples
Remien, 2005
Project HEART
Koenig, 2008
Peer Support
Simoni, 2009

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. 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. 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. 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. Thank You!
Khiya Marshall
kmarshall@cdc.gov
For more information please contact Centers for Disease Control and Prevention
1600 Clifton Road NE, Atlanta, GA 30333
Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348
E-mail: cdcinfo@cdc.gov Web: http://www.cdc.gov
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of
the Centers for Disease Control and Prevention.
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Division of HIV/AIDS Prevention