Persistence of inefficient HIV prevention interventions: a mixed-method analysis of the reasons why

Growing evidence suggests that public health organizations continue to provide inefficient interventions even when better intervention options may be available. Factors informing an organization's decision to continue providing inefficient interventions are unclear. We present an analysis of HIV service organizations to understand factors influencing organizations to continue or end interventions. Between 2017 and 2019, HIV service organizations were recruited from the Center for Disease Control and Prevention's (CDC) website gettested.org, in the 20 metropolitan areas with the highest HIV incidence. Organizations were eligible to participate if they had provided at least one of 37 HIV prevention interventions identified as inefficient by the CDC. 877 organizations were recruited, with a response rate of 66%, (n = 578). Thirty-eight percent (n = 213) of organizations met the eligibility criteria, and 188 organizations completed the survey asking about reasons for continuing or ending interventions. Funding status (41%, n = 79) and client demand for interventions (60%, n = 116) were reported as the primary driving factors why organizations continued ineffective interventions. Scientific evidence was a rarely reported reason for ending an inefficient intervention (12%, n = 23). Qualitative responses indicated interventions were continued if clients demanded interventions they found useful or if staff perceived interventions as improving client behavior and health outcomes. Conversely, interventions were ended if client demand or retention was low, not relevant to the target population or funding ended. The decision to continue or end inefficient interventions is influenced by a number of factors-most often by funding and client interest but not scientific evidence.