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Structural Interventions in HIV Prevention: A Taxonomy and Descriptive Systematic Review

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Abstract

One of the four national HIV prevention goals is to incorporate combinations of effective, evidence-based approaches to prevent HIV infection. In fields of public health, techniques that alter environment and affect choice options are effective. Structural approaches may be effective in preventing HIV infection. Existing frameworks for structural interventions were lacking in breadth and/or depth. We conducted a systematic review and searched CDC’s HIV/AIDS Prevention Research Synthesis Project’s database for relevant interventions during 1988–2013. We used an iterative process to develop the taxonomy. We identified 213 structural interventions: Access (65%), Policy/Procedure (32%), Mass Media (29%), Physical Structure (27%), Capacity Building (24%), Community Mobilization (9%), and Social Determinants of Health (8%). Forty percent targeted high-risk populations (e.g., people who inject drugs [12%]). This paper describes a comprehensive, well-defined taxonomy of structural interventions with 7 categories and 20 subcategories. The taxonomy accommodated all interventions identified.

Resumen

Uno de los cuatro objetivos nacionales de prevención del VIH es usar combinaciones de enfoques los cuales son eficaces y basadas en evidencia para prevenir la infección por el VIH. En los campos de la salud pública, técnicas que alteran el medio ambiente y afectan opciones son eficaces. Enfoques estructurales pueden ser eficaces en la prevención de la infección por VIH. Los marcos existentes para las intervenciones estructurales carecían en amplitude, en profundidad, o en ambos. Se realizó una revisión sistemática y búsquedas en la base de datos del proyecto Síntesis de los VIH/SIDA Prevención Investigaciónes de los Centros para el Control y la Prevención de Enfermedades para intervenciones pertinentes publicado durante 1988-2013. Utilizamos un proceso iterativo para desarrollar la taxonomía. Se identificaron 213 intervenciones estructurales: Acceso (65%), Política o procedimiento (32%), Medios de comunicación (29%), Estructura física (27%), Capacitación (24%), Movilización de la comunidad (9%) y Determinantes sociales de la salud (8%). Cuarenta por ciento había concentrado en poblaciones de alto riesgo (por ejemplo, personas que se inyectan drogas [12%]). Este artículo describe una taxonomía completa y bien definida de intervenciones estructurales con 7 categorías y 20 subcategorías. La taxonomía acomodado todas las intervenciones identificadas.

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Acknowledgements

We thank Lyle McCormick for data analysis; Mary Mullins and Julia DeLuca for conducting the original search in the PRS database and assisting with writing the search strategy section; and Tom Painter, Linda Kay, Juarlyn Gaiter who were involved in early process of defining structural interventions and operationalizing taxonomy. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the U.S. Centers for Disease Control and Prevention.

Funding

This study was supported by the Prevention Research Branch, Division of HIV/AIDS Prevention at the U.S. Centers for Disease Control and Prevention and was not funded by any other organization.

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  1. Division of HIV/AIDS Prevention, Prevention Research Branch, The U.S. Centers for Disease Control and Prevention, 1600 Clifton Rd, Mailstop E-37, Atlanta, GA, 30333, USA

    Theresa Ann Sipe, Terrika L. Barham, Wayne D. Johnson, Heather A. Joseph, Maria Luisa Tungol-Ashmon & Ann O’Leary

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  1. Theresa Ann Sipe
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Correspondence to Theresa Ann Sipe.

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Appendix

Appendix

See Table 6.

Table 6 Structural interventions for HIV prevention, 1989–2013 (k = 213)
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Sipe, T.A., Barham, T.L., Johnson, W.D. et al. Structural Interventions in HIV Prevention: A Taxonomy and Descriptive Systematic Review. AIDS Behav 21, 3366–3430 (2017). https://doi.org/10.1007/s10461-017-1965-5

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