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. 2018 Apr;22(4):1253-1264.
doi: 10.1007/s10461-017-1997-x.

Evaluations of Structural Interventions for HIV Prevention: A Review of Approaches and Methods

Brittany S Iskarpatyoti  1 , Jill Lebov  2 , Lauren Hart  1 , Jim Thomas  1 , Mahua Mandal  3
Affiliations

Evaluations of Structural Interventions for HIV Prevention: A Review of Approaches and Methods

Brittany S Iskarpatyoti et al. AIDS Behav. 2018 Apr.

Abstract

Structural interventions alter the social, economic, legal, political, and built environments that underlie processes affecting population health. We conducted a systematic review of evaluations of structural interventions for HIV prevention in low- and middle-income countries (LMICs) to better understand methodological and other challenges and identify effective evaluation strategies. We included 27 peer-reviewed articles on interventions related to economic empowerment, education, and substance abuse in LMICs. Twenty-one evaluations included clearly articulated theories of change (TOCs); 14 of these assessed the TOC by measuring intermediary variables in the causal pathway between the intervention and HIV outcomes. Although structural interventions address complex interactions, no evaluation included methods designed to evaluate complex systems. To strengthen evaluations of structural interventions, we recommend clearly articulating a TOC and measuring intermediate variables between the predictor and outcome. We additionally recommend adapting study designs and analytic methods outside traditional epidemiology to better capture complex results, influences external to the intervention, and unintended consequences.

Keywords: Evaluation; HIV; Low- and middle-income countries; Prevention; Structural interventions.

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Conflict of interest statement

Conflict of Interest: Brittany Iskarpatyoti declares she has no conflict of interest. Jill Lebov declares she has no conflict of interest. Lauren Hart declares she has no conflict of interest. Jim Thomas declares he has no conflict of interest. Mahua Mandal declares she has no conflict of interest.

Figures

Figure 1.
Figure 1.
Literature review process for review of evaluations of structural interventions related to HIV prevention in low- and middle-income countries.
Figure 2.
Figure 2.
Diagram of included evaluations by type of structural intervention
Figure 3.
Figure 3.
Study design by type of evaluation
See this image and copyright information in PMC

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