AIDS and Behavior

, Volume 22, Issue 4, pp 1253–1264 | Cite as

Evaluations of Structural Interventions for HIV Prevention: A Review of Approaches and Methods

  • Brittany S. Iskarpatyoti
  • Jill Lebov
  • Lauren Hart
  • Jim Thomas
  • Mahua Mandal
Original Paper


Structural interventions alter the social, economic, legal, political, and built environments that underlie processes affecting population health. We conducted a systematic review of evaluations of structural interventions for HIV prevention in low- and middle-income countries (LMICs) to better understand methodological and other challenges and identify effective evaluation strategies. We included 27 peer-reviewed articles on interventions related to economic empowerment, education, and substance abuse in LMICs. Twenty-one evaluations included clearly articulated theories of change (TOCs); 14 of these assessed the TOC by measuring intermediary variables in the causal pathway between the intervention and HIV outcomes. Although structural interventions address complex interactions, no evaluation included methods designed to evaluate complex systems. To strengthen evaluations of structural interventions, we recommend clearly articulating a TOC and measuring intermediate variables between the predictor and outcome. We additionally recommend adapting study designs and analytic methods outside traditional epidemiology to better capture complex results, influences external to the intervention, and unintended consequences.


Structural interventions Evaluation HIV Prevention Low- and middle-income countries 



This study was funded by the United States Agency for International Development (USAID) under the terms of MEASURE Evaluation cooperative agreement AID-OAA-L-1400004.

Compliance with Ethical Standards

Conflict of interest

All authors declares that they have no conflict of interest.

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Supplementary material

10461_2017_1997_MOESM1_ESM.docx (17 kb)
Supplementary material 1 (DOCX 16 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2017

Authors and Affiliations

  • Brittany S. Iskarpatyoti
    • 1
  • Jill Lebov
    • 2
  • Lauren Hart
    • 1
  • Jim Thomas
    • 1
  • Mahua Mandal
    • 1
  1. 1.MEASURE Evaluation, Carolina Population CenterUniversity of North CarolinaChapel HillUSA
  2. 2.RTI InternationalDurhamUSA

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