TY - JOUR
T1 - Evaluation of the effect of human immunodeficiency virus-related structural interventions the connect to protect project
AU - Ellen, Jonathan M.
AU - Greenberg, Lauren
AU - Willard, Nancy
AU - Korelitz, James
AU - Kapogiannis, Bill G.
AU - Monte, Dina
AU - Boyer, Cherrie B.
AU - Harper, Gary W.
AU - Henry-Reid, Lisa M.
AU - Friedman, Lawrence B.
AU - Gonin, René
N1 - Publisher Copyright:
© 2015 American Medical Association. All rights reserved.
PY - 2015/3/1
Y1 - 2015/3/1
N2 - Importance: With the emphasis on structural-level interventions that target social determinants of human immunodeficiency virus (HIV) transmission to curb the HIV epidemic, there is a need to develop evaluation models that can detect changes in individual factors associated with HIV-related structural changes.Objective: To describe whether structural changes developed and achieved by community coalitions are associated with an effect on individual factors associated with the risk of contracting HIV.Design, Setting, And Participants: In this serial cross-sectional survey design, datawere collected from 8 cities during 4 rounds of annual surveys from March 13, 2007, through July 29, 2010. Study recruitment took place at venues where the population of focus was known to congregate, such as clubs, bars, community centers, and low-income housing. The convenience sample of at-risk youth (persons aged 12-24 years) included 5337 individuals approached about the survey and 3142 (58.9%) who were screened for eligibility. Of the 2607 eligible participants, 2559 (98.2%) ultimately agreed to participate.Interventions: Achievement of locally identified structural changes that targeted public and private entities (eg, federal agencies, homeless shelters, and school systems) with the goal of fostering changes in policy and practice to ultimately facilitate positive behavioral changes aimed at preventing HIV.Main Outcomes And Measures: Number of sexual partners, partner characteristics, condom use, and history of sexually transmitted infections and HIV testing.Results: Exposure to structural changes was not statistically significantly associated with any of the outcome measures, although some results were in the direction of a positive structural change effect (eg, a 10-unit increase in a structural change score had an odds ratio of 0.88 [95%CI, 0.76-1.03; P = .11] for having an older sexual partner and an odds ratio of 0.91 [95% CI, 0.60-1.39; P= .39] for using a condom half the time or less with a casual partner).Conclusions And Relevance This study evaluated a broad representation of at-risk individuals and assessed the effect of numerous structural changes related to various HIV risk factors. No structural changes as measured in this study were associated with a statistically significant reduction in risk behaviors. These null findings underscore the need for a long-term approach in evaluating structural interventions and the development of more nuanced methods of quantifying and comparing structural-change initiatives and determining the appropriate strategies for evaluating effect.
AB - Importance: With the emphasis on structural-level interventions that target social determinants of human immunodeficiency virus (HIV) transmission to curb the HIV epidemic, there is a need to develop evaluation models that can detect changes in individual factors associated with HIV-related structural changes.Objective: To describe whether structural changes developed and achieved by community coalitions are associated with an effect on individual factors associated with the risk of contracting HIV.Design, Setting, And Participants: In this serial cross-sectional survey design, datawere collected from 8 cities during 4 rounds of annual surveys from March 13, 2007, through July 29, 2010. Study recruitment took place at venues where the population of focus was known to congregate, such as clubs, bars, community centers, and low-income housing. The convenience sample of at-risk youth (persons aged 12-24 years) included 5337 individuals approached about the survey and 3142 (58.9%) who were screened for eligibility. Of the 2607 eligible participants, 2559 (98.2%) ultimately agreed to participate.Interventions: Achievement of locally identified structural changes that targeted public and private entities (eg, federal agencies, homeless shelters, and school systems) with the goal of fostering changes in policy and practice to ultimately facilitate positive behavioral changes aimed at preventing HIV.Main Outcomes And Measures: Number of sexual partners, partner characteristics, condom use, and history of sexually transmitted infections and HIV testing.Results: Exposure to structural changes was not statistically significantly associated with any of the outcome measures, although some results were in the direction of a positive structural change effect (eg, a 10-unit increase in a structural change score had an odds ratio of 0.88 [95%CI, 0.76-1.03; P = .11] for having an older sexual partner and an odds ratio of 0.91 [95% CI, 0.60-1.39; P= .39] for using a condom half the time or less with a casual partner).Conclusions And Relevance This study evaluated a broad representation of at-risk individuals and assessed the effect of numerous structural changes related to various HIV risk factors. No structural changes as measured in this study were associated with a statistically significant reduction in risk behaviors. These null findings underscore the need for a long-term approach in evaluating structural interventions and the development of more nuanced methods of quantifying and comparing structural-change initiatives and determining the appropriate strategies for evaluating effect.
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U2 - 10.1001/jamapediatrics.2014.3010
DO - 10.1001/jamapediatrics.2014.3010
M3 - Article
C2 - 25580593
AN - SCOPUS:84924272747
VL - 169
SP - 256
EP - 263
JO - American Journal of Diseases of Children
JF - American Journal of Diseases of Children
SN - 2168-6203
IS - 3
ER -