Evidence-Based Policy: Randomised Controlled Trials’ Knowledge Claims to AIDS Policy

  • Hakan Seckinelgin
Part of the Social Aspects of HIV book series (SHIV, volume 3)


This chapter considers the way in which the Randomised Controlled Trial (RCT) as a policy-relevant knowledge production practice has influenced Global AIDS policy thinking. It unpacks the issue by looking both at the logic of RCT design and challenges to implementing RCT-based polices outside of the trial context. It is argued that RCT method has been strongly endorsed by the Global AIDS system because of its close links to a biomedical perspective. What remains to be answered, however, is why RCTs have been so extensively used to ground Global AIDS policy decisions given widespread critical analysis of RCT method and its limits to generalisability.


Knowledge Claim Policy Advice Voluntary Medical Male Circumcision Trial Context Routine Laboratory Monitoring 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Angrist, J. D., & Pischke, J.-S. (2010). The credibility revolution in empirical economics: How better research design is taking the co out of econometrics. The Journal of Economic Perspectives, 24(2), 3–30.CrossRefGoogle Scholar
  2. Auerbach, J. D., & Hoppe, T. A. (2015). Beyond “getting drugs into bodies”: Social science perspectives on pre-exposure prophylaxis for HIV. Journal of the International AIDS Society, 18(Suppl. 3), 19983.Google Scholar
  3. Banarjee, A., & Duflo, E. (2010). Giving credit where it is due. The Journal of Economic Perspectives, 24(3), 61–79.CrossRefGoogle Scholar
  4. Barrett, C. B., & Carter, M. R. (2010). The power and pitfalls of experiments in development economics: Some non-random reflections. Applied Economic Perspectives and Policy, 32, 515–548.CrossRefGoogle Scholar
  5. BBC. (2009). Scrap tests ‘to boost HIV care’ 9 December 2009. Accessed 10 Jan 2010.
  6. Boyle, G. J., & Hill, G. (2011). Sub-Saharan African randomised clinical trials into male circumcision and HIV transmission: Methodological, ethical and legal concerns. Journal of Law and Medicine, 19(2), 316–334.Google Scholar
  7. Buchbinder, S. P., & Liu, A. Y. (2015). CROI 2015: Advances in HIV testing and prevention strategies. Topics in Antiviral Medicine, 23(1), 8–27.Google Scholar
  8. Cáceres, C. F., Koechlin, F., Goicochea, P., Sow, P., O’Reilly, K. R., Mayer, K. H., & Godfrey-Faussett, P. (2015). The promises and challenges of pre-exposure prophylaxis as part of the emerging paradigm of combination HIV prevention. Journal of the International AIDS Society, 18(Suppl. 3), 19949.Google Scholar
  9. Cartwright, N. D. (2010). Will this policy work for you? Predicting effectiveness better: How philosophy helps. Speech presented at PSA Presidential Address, Montreal, Canada, November 2010.Google Scholar
  10. Cartwright, N. (2011). The art medicine: A philosopher’s view of the long road from RCTs to effectiveness. Lancet, 377, 1400–1401.CrossRefGoogle Scholar
  11. Cartwright, N., & Hardie, J. (2012). Evidence-based policy: A critical guide to doing it better. New York: Oxford University Press.CrossRefGoogle Scholar
  12. Cohen, J., & Easterly, W. (2009). Introduction: Thinking big versus thinking small. In J. Cohen & W. Easterly (Eds.), What works in development? Thinking big and thinking small. Washington, DC: The Brookings Institution.Google Scholar
  13. Dart Trial Team. (2010). Routine versus clinically driven laboratory monitoring of HIV antiretroviral therapy in Africa (DART): A randomized non-inferiority trial. Lancet, 375, 123–131.CrossRefGoogle Scholar
  14. Deacon, A. (2010). Understanding the mechanisms of economic development. The Journal of Economic Perspectives, 24(3), 3–16.CrossRefGoogle Scholar
  15. de Camargo, K. R., Jr., de Oliveira Mendonça, A. L., Perrey, C., & Giami, A. (2013). Male circumcision and HIV: A controversy study on facts and values. Global Public Health, 8, 769–783.CrossRefGoogle Scholar
  16. Harrison, G. W. (2011). Randomisation and its discontents. Journal of African Economies, 20, 626–652.CrossRefGoogle Scholar
  17. Jain, S. L. (2010). The mortality effect: Counting the dead in the cancer trials. Public Culture, 22(1), 89–117.CrossRefGoogle Scholar
  18. Keane, M. P. (2010). A structural perspective on the experimentalist school. The Journal of Economic Perspectives, 24(2), 47–58.CrossRefGoogle Scholar
  19. Kebaabetswe, P. M., Stirratt, M. J., McLellan-Lemal, E., Henderson, F. L., Gray, S. C., Rose, C. E., Williams, T., & Paxton, L. A. (2014). Factors assocaited with adherence and concordance between measurement strategies in an HIV daily oral tenofovir/emtricitibine as pre-exposure prophylaxis (prep) clinical trial, Botswana, 2007–2010. AIDS Behaviour, 19, 758–769.CrossRefGoogle Scholar
  20. Lambert, H. (2009). Evidentiary truths? The evidence of anthropology through the anthropology of medical evidence. Anthropology Today, 25(1), 16–20.CrossRefGoogle Scholar
  21. Lock, M., & Nguyen, V.-K. (2010). An anthropology of medicine. London: Wiley-Blackwell.Google Scholar
  22. Longino, H. E. (2013). Studying human behavior: How scientists investigate aggression & sexuality. Chicago: The University of Chicago Press.CrossRefGoogle Scholar
  23. Ludwig, J., Kling, J. R., & Mullainathan, S. (2011). Mechanism experiments and policy evaluations. The Journal of Economic Perspectives, 25(3), 17–38.CrossRefGoogle Scholar
  24. MRC. (2009). ‘Thousands more could be treated for HIV in Africa if expensive routine lab tests are dropped’ Medical Research Council Press Release MRC59/09.… Accessed 15 Jan 2010.
  25. Parkhurst, J. O., Chilongozi, D., & Hutchinson, E. (2015). Doubt, defiance, and identity: Understanding resistance to male circumcision for HIV prevention in Malawi. Social Science & Medicine, 135, 15–22.CrossRefGoogle Scholar
  26. Petryna, A. (2009). When experiments travel: Clinical trials and the global search for human subjects. Princeton: Princeton University Press.CrossRefGoogle Scholar
  27. Ravallion, M. (2009). Comment. In J. Cohen & W. Easterly (Eds.), What works in development? Thinking big and thinking small. The Brookings Institution.Google Scholar
  28. Rodrik, D. (2009). The new development economics: We shall experiment, but how shall we learn? In J. Cohen & W. Easterly (Eds.), What works in development?: Thinking big and thinking small. Washington, DC: The Brookings Institution.Google Scholar
  29. Rol, M., & Cartwright, N. (2012). Warranting the use of causal claims: A non-trivial case for interdisciplinarity. Theoria, 74, 189–202.CrossRefGoogle Scholar
  30. Seckinelgin, H. (2009a). Global social policy and international organizations linking social exclusion to durable inequality. Global Social Policy, 9(2), 205–227.Google Scholar
  31. Seckinelgin, H. (2009b). Colonial silences, gender and sexuality: Unpacking international HIV and AIDS policy culture. In J. F. Klot & V.-K. Nguyen (Eds.), The fourth wave: Violence, gender, culture and HIV in the 21st century. Paris: UNESCO.Google Scholar
  32. Shaffer, P. (2011). Against excessive rhetoric in impact assessment: Overstating the case for randomised controlled experiments. Journal of Development Studies, 47, 1619–1635.CrossRefGoogle Scholar
  33. Teele, D. L. (Ed.). (2014). Field experiments and their critics: Essays on the uses and abuses of experimentation in the social sciences. New Haven: Yale University Press.Google Scholar
  34. UNAIDS. (2012). 2012 UNAIDS report on the global epidemic. Geneva: UNAIDS.,76121,en.asp. Accessed 28 Jan 2015.
  35. Wamai, R. G., Morris, B. J., Waskett, J. H., Green, E. C., Banerjee, J., Bailey, R. C., Kalusner, J. D., Sokal, D. C., & Hankins, C. A. (2012). Critism of African trials fail to withsthand scrutiny: Male circumcision does prevent HIV infection. Jounal of Law and Medicine, 20(1), 93–123.Google Scholar
  36. Wamai, R. G., Morris, B. J., Bailey, R. C., Kalusner, J. D., & Boedicker, M. N. (2015). Male circumcision for protection against HIV infection in sub-Saharn Africa: The evidence in favour justifies the implementation now in progress. Global Public Health, 10(5–6), 639–666.CrossRefGoogle Scholar
  37. WHO. (2015). The guidelines on when to start antiretroviral therapy and on pre-exposure prophylaxis. Accessed 14 Mar 2016.

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  • Hakan Seckinelgin
    • 1
  1. 1.Department of Social PolicyLondon School of Economics and PoliticalLondonUK

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