TY - JOUR
T1 - The Highest Attainable Standard of Evidence (HASTE) for HIV/AIDS Interventions
T2 - Toward a Public Health Approach to Defining Evidence
AU - Baral, Stefan D.
AU - Wirtz, Andrea
AU - Sifakis, Frangiscos
AU - Johns, Benjamin
AU - Walker, Damian
AU - Beyrer, Chris
PY - 2012
Y1 - 2012
N2 - Objectives. Evidence-driven decisions have become a standard for health interventions, policy, and programs. While randomized controlled trials (RCTs) are encouraged for public health interventions, there are limitations with RCTs as the gold standard of evidence for HIV interventions. We developed a novel system of evaluating evidence for assessing HIV preventive interventions termed the Highest Attainable Standard of Evidence (HASTE). Methods. The HASTE system focuses on triangulation of three distinct categories of evidence: efficacy data, implementation data, and plausibility. We conducted systematic reviews, including experimental and observational data, to assess all available interventions for men who have sex with men (MSM). We collected implementation and programmatic data using a global electronic consultation, Internet searches, and in-person consultations. We assessed plausibility with expert analyses of both biological and public health evidence. Results. HASTE includes four grades of evidence: Strong (Grade 1), Conditional (Grade 2), Insufficient (Grade 3), and Inappropriate (Grade 4). We used the HASTE system to evaluate the evidence for HIV interventions for MSM in low- and middle-income countries. Several differences emerged in the strength of recommendation with the use of the HASTE system, including strong recommendations for voluntary counseling and testing and for structural interventions. Conclusions. The HASTE system addresses a need for an evidence evaluation tool that is specific for HIV interventions and facilitates an evaluation of biomedical, behavioral, and structural approaches using the highest standard of attainable evidence. HASTE represents a tool that balances scientific integrity and practicality in assessing the quality of evidence of preventive interventions targeting the most-at-risk populations for HIV.
AB - Objectives. Evidence-driven decisions have become a standard for health interventions, policy, and programs. While randomized controlled trials (RCTs) are encouraged for public health interventions, there are limitations with RCTs as the gold standard of evidence for HIV interventions. We developed a novel system of evaluating evidence for assessing HIV preventive interventions termed the Highest Attainable Standard of Evidence (HASTE). Methods. The HASTE system focuses on triangulation of three distinct categories of evidence: efficacy data, implementation data, and plausibility. We conducted systematic reviews, including experimental and observational data, to assess all available interventions for men who have sex with men (MSM). We collected implementation and programmatic data using a global electronic consultation, Internet searches, and in-person consultations. We assessed plausibility with expert analyses of both biological and public health evidence. Results. HASTE includes four grades of evidence: Strong (Grade 1), Conditional (Grade 2), Insufficient (Grade 3), and Inappropriate (Grade 4). We used the HASTE system to evaluate the evidence for HIV interventions for MSM in low- and middle-income countries. Several differences emerged in the strength of recommendation with the use of the HASTE system, including strong recommendations for voluntary counseling and testing and for structural interventions. Conclusions. The HASTE system addresses a need for an evidence evaluation tool that is specific for HIV interventions and facilitates an evaluation of biomedical, behavioral, and structural approaches using the highest standard of attainable evidence. HASTE represents a tool that balances scientific integrity and practicality in assessing the quality of evidence of preventive interventions targeting the most-at-risk populations for HIV.
UR - http://www.scopus.com/inward/record.url?scp=84868026548&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84868026548&partnerID=8YFLogxK
U2 - 10.1177/003335491212700607
DO - 10.1177/003335491212700607
M3 - Review article
C2 - 23115382
AN - SCOPUS:84868026548
SN - 0033-3549
VL - 127
SP - 572
EP - 584
JO - Public health reports
JF - Public health reports
IS - 6
ER -