Evaluation of the effect of human immunodeficiency virus-related structural interventions: the connect to protect project.

TitleEvaluation of the effect of human immunodeficiency virus-related structural interventions: the connect to protect project.
Publication TypePublication
Year of Publication2015
AuthorsEllen JM, Greenberg L, Willard N, Korelitz J, Kapogiannis BG, Monte D, Boyer CB, Harper GW, Henry-Reid LM, Friedman LB, Gonin R
JournalJAMA Pediatr
Volume169
Issue3
Pagination256-63
Date Published2015 Mar
ISSN2168-6211
KeywordsAdolescent, Child, Condoms, Cross-Sectional Studies, Female, Health Promotion, Health Surveys, HIV Infections, Humans, Male, Risk Assessment, Risk Factors, Risk Reduction Behavior, Sexual Behavior, Sexually Transmitted Diseases, Viral, United States, Young Adult
Abstract

<p><b>IMPORTANCE: </b>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.</p><p><b>OBJECTIVE: </b>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.</p><p><b>DESIGN, SETTING, AND PARTICIPANTS: </b>In this serial cross-sectional survey design, data were 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.</p><p><b>INTERVENTIONS: </b>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.</p><p><b>MAIN OUTCOMES AND MEASURES: </b>Number of sexual partners, partner characteristics, condom use, and history of sexually transmitted infections and HIV testing.</p><p><b>RESULTS: </b>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).</p><p><b>CONCLUSIONS AND RELEVANCE: </b>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.</p>

DOI10.1001/jamapediatrics.2014.3010
Alternate JournalJAMA Pediatr
PubMed ID25580593
PubMed Central IDPMC4346420
Grant ListU01 HD 040533 / HD / NICHD NIH HHS / United States
U01 HD040533 / HD / NICHD NIH HHS / United States
U01 HD 040474 / HD / NICHD NIH HHS / United States
U01 HD040474 / HD / NICHD NIH HHS / United States
U01 HD040494 / HD / NICHD NIH HHS / United States