Evaluating Structural Interventions – Guidance for HIV prevention programs
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Author(s): Hart L, Iskarpatyoti BS, Mandal M, Thomas JC
Structural interventions aim to improve health outcomes by altering the social, economic, and legal-political environment in which health processes and outcomes are embedded (Blankenship, et al., 2006; Parkhurst, 2013). By targeting structural factors such as poverty and education, structural interventions aim to influence the underlying context of HIV risk (Blankenship, et al., 2006). Investment in structural interventions and their evaluations has lagged behind that in behavioral and biomedical interventions for HIV prevention. Additionally, methodological challenges in evaluating structural interventions have contributed to the relative dearth of evidence about their effectiveness (Gupta, et al., 2008; Heise & Watts, 2013). In addition to showing that a structural intervention works in a particular context, it is important to provide evidence for why, under what circumstances, for whom, and at what cost the intervention is effective (Heise & Watts, 2013).
The process of evaluating structural interventions is much the same as that of evaluating other interventions. However, in this guidance we highlight strategies and considerations that are uniquely important in the former.
Although numerous challenges exist in evaluating structural interventions, current evidence indicates their promise for HIV prevention. By planning for evaluations early, working with stakeholders, determining a theory of change, carefully selecting research questions, and selecting the most appropriate research design, those in the HIV-prevention field can continue to determine which interventions are most effective.
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