HIV Risk Reduction (RR) Efficacy Review: Efficacy Criteria

The Prevention Research Synthesis (PRS) Project risk reduction efficacy criteria are used to determine if an HIV behavioral intervention is evidence-based, that is, if there is sufficient evidence that the intervention reduced HIV-related risk behaviors. Based on the overall quality of the study, evidence-based risk reduction behavioral interventions are classified as either best-evidence or good-evidence. Additional details about the RR Chapter or the PRS Project can be obtained by contacting PRS.

Best-evidence Risk Reduction Interventions

Best-evidence interventions are HIV behavioral interventions that have been rigorously evaluated and have been shown to have significant and positive evidence of efficacy (i.e., eliminate or reduce sex- or drug-risk behaviors, reduce the rate of new HIV/STD infections, or increase HIV-protective behaviors). These interventions are considered to be scientifically rigorous and provide the strongest evidence of efficacy. These interventions meet the PRS efficacy criteria for best evidence ILIs/GLIs/CPLs or efficacy criteria for best evidence CLIs.

Good-evidence Risk Reduction Interventions

Good-evidence interventions are HIV behavioral interventions that have been sufficiently evaluated and have been shown to have significant and positive evidence of efficacy (i.e., eliminate or reduce sex- or drug-risk behaviors, reduce the rate of new HIV/STD infections, or increase HIV-protective behaviors). While the evaluations of these interventions do not meet the same level of rigor as best-evidence interventions, they are considered to be scientifically sound, provide sufficient evidence of efficacy, and address the HIV prevention needs of many communities by targeting high-risk populations. These interventions meet the PRS efficacy criteria for good evidence ILIs/GLIs/CPLs or efficacy criteria for good evidence CLIs.

History of Efficacy Review Criteria

Because most community-level interventions (CLIs) have study and design characteristics that do not lend themselves to evaluation with the efficacy criteria for ILIs/GLIs/CPLs, PRS developed efficacy criteria specific for identifying evidence-based CLIs in 2008. These revised criteria were developed as the result of multiple consultations with methodologists and HIV prevention researchers. The CLI efficacy criteria, like the ILI/GLI/CPL criteria, focus on quality of study design, quality of study implementation and analysis, and strength of evidence of efficacy. The CLI EBIs are also classified as either best- or good-evidence.

A CLI study is considered to be eligible for the efficacy review if it meets the definition of “community” and “community-level intervention study” listed below:

Community – A group of individuals that exists prior to the intervention whose members share one or more common characteristics and a common geographic area, and relate with one another in a way that may influence their HIV risk.

• Common characteristic – a shared trait or feature or quality, which may include, but is not limited to, race/ethnicity, culture, religion, social economic status, education level, behavior, identity, customary beliefs or practices, social norms, and other underlying motivators.
• Geographic area – a physical region, area, or medium (e.g., internet) where people live, congregate, or frequent.

Community-level intervention (CLI) study – An evaluation study of an intervention intended to reduce the HIV risk of an entire community. A CLI study does the following:

• Directly or indirectly influences the knowledge, attitudes, social norms, or behaviors of individuals in the targeted community.
• Provides the intervention where individuals of the targeted community are likely to be; and
• Delivers the intervention broadly (not only to those assessed) and broadly assesses community members (not only those who received the intervention).

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