Greet Peersman

The HIV/AIDS Prevention Research Synthesis Project: Scope, Methods, and Study Classification Results

Summary: In 1996, the Centers for Disease Control and Prevention (CDC), in collaboration with many partners, initiated the HIV/AIDS Prevention Research Synthesis (PRS) project to accumulate HIV prevention research studies and analyze their effectiveness in reducing sexual and drug‐related risk behaviors for HIV transmission. The PRS team developed standardized guidelines and procedures for the systematic reviews, conducted systematic searches for pertinent studies, characterized the selected studies, analyzed effectiveness data, and established a cumulative database. As of June 1998, the database contained more than 5000 reports: 4068 were reports that met the PRS scope criteria for inclusion and 586 of those reports contained outcome data from an intervention study. Of the 586 reports that included outcome data, 276 have been reviewed: 223 (81%) included measures of PRS‐specified behavioral or biologic HIVrelated outcomes, and 124 of the 223 (56%) used PRS‐defined rigorous study designs. The PRS database is a valuable resource for accessing and integrating the literature on HIV prevention research. CDC is committed to 1) updating the database; 2) producing systematic reviews, including meta‐analyses, related to key research questions; and 3) disseminating findings to encourage and facilitate the use of science‐based research in preventing HIV infection.

Evaluating HIV prevention effectiveness: the perfect as the enemy of the good.

There is a need to better understand the effectiveness of HIV-prevention programs. Cluster randomized designs have major limitations to evaluate such complex large-scale combination programs. To close the prevention evaluation gap, alternative evaluation designs are needed, but also better articulation of the program impact pathways and proper documentation of program implementation. Building a plausible case using mixed methods and modeling can provide a valid alternative to probability evidence. HIV prevention policies should not be limited to evidences from randomized designs only.

Identifying Structural Barriers to an Effective HIV Response: Using the National Composite Policy Index Data to Evaluate the Human Rights, Legal and Policy Environment

Attention to the negative effects of structural barriers on HIV efforts is increasing. Reviewing national legal and policy environments with attention to the international human rights commitments of states is a means of assessing and providing focus for addressing these barriers to effective HIV responses.

Are the investments in national HIV monitoring and evaluation systems paying off

Background:Concerted efforts and substantial financial resources have gone toward strengthening national monitoring and evaluation (M&E) systems for HIV programs. This article explores whether those investments have made a difference in terms of data availability, quality and use for assessing whether national programs are on track to achieve the 2015 Millenium Development Goal (MDG) of halting and reversing the HIV epidemic. Methods:Descriptive analyses, including trends, of the National Composite Policy Index data and M&E expenditures were conducted. Global Fund funding continuation assessments were reviewed for concerns related to M&E. Availability of population-based survey data was assessed. Results:There has been a marked increase in the number of countries where the prerequisites for a national HIV M&E system are in place and in human resources devoted to M&E at the national level. However, crucial gaps remain in M&E capacity, available M&E data, and data quality assurance. The extent to which data are used for program improvement is difficult to ascertain. There is a potential threat to sustaining the current momentum in M&E as governments have not committed long-term funding and current M&E-related expenditures are below the minimum needed to make M&E systems fully functional. Conclusions:There is evidence of rapid scale-up of basic HIV M&E systems, but if M&E is to fulfil its role in guiding optimal use of resources, ensuring effective HIV programs and providing evidence of progress toward the Millenium Development Goal of halting and reversing the HIV epidemic, essential data gaps will need to be filled urgently and those data will need to be used to guide decision making.

Increasing Civil Society Participation in the National HIV Response: The Role of UNGASS Reporting

Background:The 2001 Declaration of Commitment on HIV/AIDS provided impetus for strengthening collaboration between government and civil society partners in the HIV response. The biennial UNGASS reporting process is an opportunity for civil society to engage in a review of the implementation of commitments. Methods:Descriptive analyses of the National Composite Policy Index from 135 countries; a debriefing on UNGASS reporting with civil society in 40 countries; and 3 country case studies on the UNGASS process. Findings:In the latest UNGASS reporting round, engagement of civil society occurred in the vast majority of countries. The utility of UNGASS reporting seemed to be better understood by both government and civil society, compared with previous reporting rounds. Civil society participation was strongest when civil society groupings took the initiative and organized themselves. An important barrier was their lack of experience with national level processes. Civil society involvement in national HIV planning and strategic processes was perceived to be good, but better access to funding and technical support is needed. Instances remain where there are fundamental differences between government and civil society perceptions of the HIV policy and program environment. How or whether differences were resolved is not always clear, but both government and civil society seemed to appreciate the opportunity for discussion. Conclusions:Collaborative reporting by government and civil society on UNGASS indicators is a small but potentially valuable step in what should be an ongoing and fully institutionalized process of collaborative planning, implementation, monitoring, assessment and correction of HIV responses. The momentum achieved through the UNGASS process should be maintained with follow-up actions to address data gaps, formalize partnerships and enhance active and meaningful engagement.

Acquisition and review of non-U.S.-based HIV risk reduction intervention studies.

Summary: In response to the HIV/AIDS epidemic, many governments and nongovernmental organizations have supported numerous HIV prevention intervention studies in both the United States and in other countries. To understand which intervention approaches have worked outside the United States, the Centers for Disease Control and Prevention extended the scope of its HIV/AIDS Prevention Research Synthesis (PRS) project to include non‐U.S.‐based studies. We describe briefly the PRS experience with the challenges of acquiring and reviewing those studies, and some of the specialized efforts to find them. The ultimate goals of the PRS project related to international prevention research are to include all available reports of non‐U.S.‐based studies in the PRS database and to provide comprehensive reviews of those studies. The findings of the reviews would not only highlight common themes of effectiveness or research gaps in the international arena but could also be useful for improving prevention research and programs in the United States.

International collaboration in conducting systematic reviews: The Cochrane Collaborative Review Group on HIV Infection and AIDS

Summary: To make sound health care decisions, policy makers, providers and researchers need access to relevant research findings. The role of systematic reviews is increasingly acknowledged as an important contribution in evidence‐based health care decision making, and several review efforts, including that of the international Cochrane Collaboration, are under way. The Cochrane Collaborative Review Group on HIV Infection and AIDS (CRG on HIV/AIDS), conducts systematic reviews on the prevention and the treatment of HIV infection and AIDS and is guided by the Cochrane Collaborations principles, which include minimizing potential bias, ensuring quality in the review process, keeping reviews up to date, and enhancing collaboration. The CDC HIV/AIDS Prevention Research Synthesis (PRS) project is working closely with the CRG on HIV/AIDS to produce Cochrane reviews of behavioral prevention interventions and on development and maintenance of a centralized, cumulative electronic database of HIV/AIDS behavioral prevention studies. Systematic reviews can play an important role in advancing evidence‐based policy and practice in HIV/AIDS prevention and care.

Developing a Research Agenda for Impact Evaluation in Development

This article sets out what would be required to develop a research agenda for impact evaluation. It begins by explaining why it is needed and what process it would involve. It outlines four areas where research is needed – the enabling environment, practice, products and impacts. It reviews the different research methods that can be used to research impact evaluation and argues for particular attention to detailed, theory‐informed, mixed‐method comparative case studies of the actual processes and impacts of impact evaluation. It explores some examples of research questions that would be valuable to focus on and how they might be addressed. Finally, it makes some suggestions about the process that is needed to create a formal and collaborative research agenda.