development of a compendium of effective structural interventions for hiv prevention

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


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+)


2. Develop criteria for program 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







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

[email protected]

development of a compendium of effective structural interventions for hiv prevention

Health & Medicine

development procedures1

panel of scientist experts2

evaluated interventions

interventions expert

selected interventions

briefing materials5

program inclusion3

hiv risk behavior