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Evaluations of Structural Interventions for HIV Prevention


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Presented at the 2016 AEA conference.

Published in: Health & Medicine
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Evaluations of Structural Interventions for HIV Prevention

  1. 1. Evaluations of Structural Interventions for HIV Prevention Mahua Mandal, MPH, PhD Brittany S. Iskarpatyoti, MPH Jill Lebov, PhD, MSPH Jim Thomas, MPH, PhD MEASURE Evaluation University of North Carolina-Chapel Hill October 27, 2016 American Evaluation Association Annual Conference
  2. 2. Health processes and outcomes are embedded in and influenced by structural factors: the social, economic, legal-political, and built environment Background What are structural factors?
  3. 3. Background
  4. 4. Structural interventions intervene on distal factors Background What are structural interventions?
  5. 5. • Contextual factors • Generalizability • Complexity • Non-linear relationships • Random assignment • Time horizon Background Challenges in evaluations of structural interventions
  6. 6. Systematic review of outcome and impact evaluations of structural interventions of HIV prevention, focused on • Economic strengthening • Formal and informal education • Substance abuse Introduction to study Aim of study
  7. 7. Methods
  8. 8. Examined characteristics, methods, and rigor of evaluations in peer-reviewed literature Methods
  9. 9. • Theory of change • Mixed methods (included in paper or referenced) • Random assignment • Length of study period • Use of cohort • Comparison/control group • Equivalence at baseline • Pre/post data • Follow-up rate • Statistical significance testing • Report of intervention details Methods Checklist – rigor of evaluations Weak: 0-4 Moderate: 5-9 Strong: 10-14
  10. 10. Results Total # evaluations = 27
  11. 11. Results Study Design 0 2 4 6 8 10 12 RCT Quasi-Experimental Non-Experimental NumberofPapers Study Design by Level of Evaluation Outcome Outcome + Impact
  12. 12. • 21 papers included a TOC (>75 percent) • 27 included basic sampling information • Length of intervention: 10 months – 10 yrs (median=12 months) • 7 did not measure intermediate variables • 26 papers included study limitations • 14 discussed replicability and generalizability Results Components of evaluations
  13. 13. • HIV/AIDS and sexual knowledge (n=11), attitudes (9) and behaviors (24) • Couples communication and condom negotiation (8) • Gender-based violence (6) • Gender attitudes and norms (6) • HIV biomarkers (7) • STI biomarkers (2) Results Outcome measures reported
  14. 14. Results Rigor of evaluations Number of Evaluations by Quality Rating Strong Moderate Weak 9 14 4
  15. 15. • Generally, evaluations of good quality • Most used only traditional epidemiological methods • Only 5 evaluations either included or referenced qualitative methods • FGDs, IDI, and KIIs Discussion
  16. 16. Discussion Future of evaluations
  17. 17. • Longitudinal qualitative methods • Most significant change • Multi-level analysis • Social network analysis • Systems dynamics (agent-based modeling, discrete event modeling) Discussion Future of evaluations: “novel” methods
  18. 18. Discussion What novel or lesser known methods have you used? How have you simultaneously maintained flexibility and rigor? What methodological, logistical and ethical challenges have you faced? How did you address these challenges?
  19. 19. This presentation was produced with the support of the United States Agency for International Development (USAID) under the terms of MEASURE Evaluation cooperative agreement AID- OAA-L-14-00004. MEASURE Evaluation is implemented by the Carolina Population Center, University of North Carolina at Chapel Hill in partnership with ICF International; John Snow, Inc.; Management Sciences for Health; Palladium; and Tulane University. Views expressed are not necessarily those of USAID or the United States government.