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Should structural interventions be evaluated using RCTs? The case of HIV prevention
Christopher Bonell1, James Hargreaves, Vicki Strange
1Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, UK. chris.bonell@lshtm.ac.uk
Social Science & Medicine (1982)
|May 16, 2006
Summary
Randomized controlled trials (RCTs) can evaluate structural interventions for HIV prevention. However, ethical, feasibility, and utility concerns may necessitate alternative study designs in specific situations.
Area of Science:
- Public Health
- Epidemiology
- Social Sciences
Background:
- Structural interventions targeting macro-social determinants are proposed as adjuncts to biomedical and behavioral strategies for disease prevention, including HIV.
- Randomized controlled trials (RCTs) are the gold standard for evaluating interventions but their application to structural interventions is debated.
Purpose of the Study:
- To assess the appropriateness of using randomized controlled trials (RCTs) to evaluate structural interventions for HIV prevention.
- To identify ethical, feasibility, and utility considerations that may preclude RCT use in this context.
Main Methods:
- The paper reviews the suitability of RCTs for evaluating structural interventions.
- It discusses specific circumstances where RCTs might be unacceptable, unfeasible, or not useful.
Main Results:
- There are no inherent characteristics of structural interventions that prohibit the use of RCTs.
- However, RCTs may be unsuitable when interventions offer significant non-HIV benefits, face resistance to randomization, involve excessively large units, or have lengthy trial periods.
Conclusions:
- RCTs are a viable option for evaluating structural HIV prevention interventions.
- Alternative evaluation designs should be considered when RCTs present insurmountable ethical, feasibility, or utility challenges.
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